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Evidence Update Issue 11, 2018| October 4, 2018 |
These emails provide bite-size summaries of the latest evidence from sexual health and blood-borne virus journal articles, podcasts and reports with relevance to the Australian setting. We hope that these emails will save you time and help keep you on top of the latest evidence. SiREN regularly Tweets new research articles and reports, so follow us on Twitter.
If you or your organisation publish a report or journal article, let us know and we will share it as part of these emails. And don’t forget, if you are unable to access any journal articles or reports you can email us at firstname.lastname@example.org and we will send you a copy.
PUBLICATIONS FROM THE SiREN TEAM AND MEMBERS
Prevention of HIV and other sexually transmissible infections in expatriates and traveler networks: Qualitative study of peer interaction in an online forum. This study explored the use of an online forum by Australian expatriates and travelers living or working in Thailand. It found that participation in the online forum formed, influenced, and reinforced knowledge, attitudes, interaction, and identity. Such forums can be used by policy makers and health-promoting organizations to provide support and information to hard-to-reach mobile populations who may be at risk of HIV or other sexually transmissible infections (STIs).
HIV in Australia: Annual surveillance short report 2018. The Kirby Institute. This short report is a review of available surveillance data pertaining to the occurrence of HIV in Australia. Australia has recorded its lowest level of HIV diagnoses in seven years. This decrease is attributed to declines in new HIV diagnoses reporting male‑to‑male sex as likely exposure. In contrast, increases were seen in diagnoses reporting heterosexual sex as likely exposure. The full report will be available in November.
Annual report of trends in behaviour 2018. Centre for Social Research in Health. This annual report presents data from a selection of the behavioural and social research conducted by the Centre for Social Research in Health. The report focuses on studies assessing trends over time or addressing emerging issues relating to HIV and STIs within the Australian context.
Australian recommendations for the management of hepatitis C virus infection: A consensus statement. Hepatitis C Virus Infection Consensus Statement Working Group. These guidelines have been developed to ensure the best hepatitis C (HCV) treatment options are recommended for people in Australia. New editions of this statement are released as new medicines for curing hepatitis C become available.
SpeakEasy. In this podcast, Carla Treloar and Annie Madden chat with Dr Nico Clark, the medical director for the recently opened medically supervised injecting facility in North Richmond. They discuss the progress of the service since opening and its impact on local people who inject drugs.
Journals this edition include: The Lancet (Gastroenterology & Hepatology); The Lancet (HIV); Australian and New Zealand Journal of Public Health; AIDS and Behavior; Harm Reduction; Sex Education; Sexually Transmitted Infections; and Journal of Viral Hepatitis.
Only a select number of articles relevant to sexual health, STIs, and BBVs in the Australian context have been summarised.
The Lancet, Gastroenterology & Hepatology (online)
Direct-acting antiviral treatment for hepatitis C among people who use or inject drugs: A systematic review and meta-analysis. This systematic review assessed direct-acting antiviral (DAA) treatment outcomes among people with recent drug use and those receiving opioid substitution therapy. It found that response to DAA therapy was favourable among people with recent drug use (including those who inject) and those receiving opioid substitution therapy, supporting broadening access in these populations.
The Lancet, HIV (vol 5, issue 9)
Decline in new HIV diagnoses among MSM in Melbourne. This study reports on the number of new HIV diagnoses among Australian-born men who have sex with men (MSM) attending the Melbourne Sexual Health Centre between 2009 and 2017. It found that in 2017, the number of new HIV diagnoses among Australian-born MSM attending the clinic was the lowest for the past decade. They found a 43% decline in new diagnoses, despite a 203% increase in testing. This reduction is likely due to the launch of a population level PrEP study in 2016.
HIV incidence in Indigenous and non-Indigenous populations in Australia: A population-level observational study. To assist in evaluating the target of eliminating HIV by 2020, the authors analysed HIV notification data for Indigenous and non-Indigenous Australians. Four percent of Australians living with HIV are Indigenous. Differences in HIV exposure, prevalence, and stage of diagnosis exist between Indigenous and non-Indigenous Australians. To prevent widening the gap in HIV diagnosis rates between non-Indigenous and Indigenous Australians, greater efforts should be made to include Indigenous people in prevention strategies.
Australian and New Zealand Journal of Public Health (online)
Responding to a national policy need: Development of a stigma indicator for blood-borne viruses and sexually transmissible infections. There are five strategies that set out Australia's national response to HIV, viral hepatitis and STIs. A clear objective exists within each of these to “eliminate the negative impact of stigma, discrimination, and legal and human rights issues on people's health.” However, until recently, there has been no indicator to measure stigma and monitor progress. This commentary outlines an approach taken to develop a stigma indicator and lessons learned from its implementation in surveys of priority population groups.
AIDS and Behavior (volume 22, issue 10)
The effect of a text messaging based HIV prevention program on sexual minority male youths: A national evaluation of information, motivation and behavioral skills in a randomized controlled trial of Guy2Guy. This study explored a HIV prevention program delivered via text messaging, in young gay, bisexual, and/or queer cisgender males. Results found that the intervention did not have an effect on HIV information, behavioral skills for condom use or abstinence. There was an increase in motivation to engage in HIV preventative behaviour in young people with no prior sexual experience, which highlights the need to tailor HIV prevention according to past sexual experience. The behavioural skills measured may not have reflected those most emphasized in the content, which may explain the lack of intervention impact.
The impact of cell phone support on psychosocial outcomes for youth living with HIV non-adherent to antiretroviral therapy. This study evaluated the impact of cell phone support (CPS) on a range of psychosocial outcomes to help explain its positive impact on adherence to antiretroviral therapy (ART) among adolescents and young adults living with HIV. Participants receiving CPS reported significant decreases in perceived stress, depression, and illicit substance use, and increases in self-efficacy during at least one study assessment period, in comparison to participants receiving usual care.
Preferences for sexual health smartphone App features among gay and bisexual men. This study sought to examine gay, bisexual, and other men who have sex with men's (GBMSM) willingness to use sexual health and behaviour tracking features if integrated within geosocial networking (GSN) Apps. Most reported interest in one or more sexual health App features, including features to find LGBT-friendly providers, receive lab results, and schedule appointment reminders. Fewer were interested in tracking and receiving feedback on their sexual behaviour and substance use. Integrating sexual health and behaviour tracking features for GBMSM who use Apps could be promising in engaging them in HIV prevention interventions.
Harm Reduction (online)
Acceptability of prison-based take-home naloxone programmes among a cohort of incarcerated men with a history of regular injecting drug use. This study examined the acceptability of take-home naloxone (THN) in male prisoners with history of regular injecting drug use (IDU) in Victoria. The findings suggest that they are overwhelmingly willing to participate in THN training prior to release. Factors associated with willingness to participate in prison THN programmes are presented in the article and offer insights to help support the implementation and uptake of THN programmes to reduce opioid-overdose deaths in the post-release period.
Beyond cure: Patient reported outcomes of hepatitis C treatment among people who inject drugs in Australia. This study explored what people who inject drugs consider to be important in relation to outcomes of HCV treatment, and whether there are outcomes ‘beyond cure’ that might be important to understand as part of improving engagement in treatment. The findings show that people who inject drugs are seeking outcomes ‘beyond cure’ including improved physical and mental health, positive changes in identity and social relationships, and managing future health and risk.
Sex Education (volume 18, issue 6)
Untangling the conflation of ‘young adults’ and ‘young people’ in STI and sexual health policy and sex education. Using Australia’s National Strategies for BBVs and STIs from 2005 to 2017 as a case study the authors discuss the implications of ‘young adults’ being included in the broader category of ‘young people’ within these strategies. They conclude that sexual health policies should reflect the complexity and opportunities of young adulthood in order to offer an enabling policy environment for innovative and nuanced health promotion strategies, including adult appropriate health education.
Learning about sex and relationships among migrant and refugee young people in Sydney, Australia: ‘I never got the talk about the birds and the bees’. This study was undertaken to explore the complexities and opportunities for engaging young people from migrant and refugee backgrounds with sexual and reproductive health information and care in Sydney. Interviews were undertaken with migrant and refugee young people and expert informants. Nearly all young people reported that they were unable to discuss sexuality or sexual health with their parents, and most identified secondary school as the place where they first learnt about these issues. Schools and other education settings are well placed to deliver relationships and sexuality education for migrant and refugee young people.
Sexuality and relationship education training to primary and secondary school teachers: An evaluation of provision in Western Australia. This paper describes the evaluation of sexuality and relationships education (SRE) training for teachers in WA. The formative evaluation found that although most respondents were relatively confident and skilled in facilitating SRE, there was a need for ongoing professional development. Workshop evaluation data found significant improvements in attitudes towards SRE, comfort in teaching SRE, and facilitating discussions and activities. The evaluation identified the need for an integrated and coordinated whole school approach and efforts to engage teachers with lower levels of confidence in teaching SRE.
Sexually Transmitted Infections (volume 94, issue 6)
Use of geosocial networking applications to reach men who have sex with men: Progress and opportunities for improvement. This editorial discusses the increase in the use of GSN Apps in MSM including those for finding nearby sexual or romantic partners. GSN App users versus non-App users tend to be younger, more likely to engage in risky sexual behaviours and have a higher prevalence of prior STIs, but lower prevalence of HIV. The authors highlight considerations for the use of GSN Apps as platforms to promote increased sexual health awareness and testing for HIV and STIs.
Mycoplasma genitalium: High prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in Western Sydney. This study aimed to estimate the prevalence of Mycoplasma genitalium infection and mutations linked to macrolide resistance in a group of MSM attending a clinic in Sydney. A high prevalence of M. genitalium and levels of macrolide resistance were found. These findings support the routine use of an assay to ensure, in regions or populations with high rates of macrolide resistance among M. genitalium strains, that first-line treatment with azithromycin will only be used if a macrolide-sensitive strain is identified.
Does HIV pre-exposure prophylaxis use lead to a higher incidence of sexually transmitted infections? A case-crossover study of men who have sex with men in Los Angeles, California. This study compared the STI incidence before and after PrEP initiation within a cohort of MSM in California. It found significant increases in rectal chlamydia and syphilis diagnoses when comparing the periods directly before and after PrEP initiation. However, only 28% of individuals had an increase in STIs between periods. Although risk compensation appears to be present for a segment of PrEP users, the majority of individuals either maintain or decrease their sexual risk following PrEP initiation.
Journal of Viral Hepatitis (volume 25, issue 9 & 10)
Feasibility of reaching World Health Organization targets for hepatitis C and the cost‐effectiveness of alternative strategies. This study analysed the impact of initiatives that aim to increase the proportion of people living with HCV on treatment and reduce the incidence of new HCV infection among people who inject drugs. It found combining an increase in the current clean needles and syringe programme with opioid substitution therapy (OST) was the most cost‐effective option and would reduce the incidence of hepatitis C by 80% compared with the current incidence by 2030. Reaching the WHO target of a 90% reduction in hepatitis C incidence by 2030 may be difficult without combining different initiatives.
Aiming for elimination: Outcomes of a consultation pathway supporting regional general practitioners to prescribe direct‐acting antiviral therapy for hepatitis C. This study describes the establishment and outcomes of a remote consultation pathway supporting GPs to treat HCV in Australia. It found that collaborative development and implementation of the remote consultation pathway led to increased HCV treatment initiation by GPs. Follow‐up post‐treatment could be improved; however, no treatment failure was documented. To eliminate HCV as a public health threat, it is vital that specialists support GPs to prescribe DAA.
Shortened therapy of eight weeks with paritaprevir/ritonavir/ombitasvir and dasabuvir is highly effective in people with recent HCV genotype 1 infection. This study assessed the efficacy of shortened duration paritaprevir/ritonavir/ombitasvir and dasabuvir with or without ribavirin from 12 weeks to 8 weeks among people with recent HCV infection in Australia, England and New Zealand. It found the shortened duration was highly effective among HIV‐positive and HIV‐negative individuals with recent HCV infection. These data support the use of this shortened duration direct‐acting antiviral regimen in this population.
Effectiveness and cost‐effectiveness of interventions targeting harm reduction and chronic hepatitis C cascade of care in people who inject drugs: The case of France. This study assessed the effectiveness/cost‐effectiveness of improvements in harm reduction and chronic HCV care cascade in people who inject drugs (PWID) in France. This study illustrated the high effectiveness, and cost‐effectiveness, of a faster diagnosis/linkage to care together with treatment from a F0 (normal liver) with DAAs. This “test and treat” strategy should play a central role both in improving the life expectancies of HCV‐infected patients, and in reducing HCV transmission.
AIDS Acquired Immune Deficiency Syndrome
ART Antiretroviral Therapy
CPS Cell Phone Support
DAA Direct Acting Antiviral
GSN Geosocial Networking
GBMSM Gay, Bisexual and other Men who have Sex with Men
HCV Hepatitis C
HIV Human Immunodeficiency Virus
IDU Injecting Drug Use
LGBTI Lesbian, Gay, Bisexual, Transgender, and Intersex
MSM Men who have Sex with Men
NT Neisseria Gonorrhoeae
OST Opioid Substitution Therapy
PATH Prison and Transition Health
PWID People Who Inject Drugs
SRE Sexuality and Relationships Education
STI Sexually Transmitted Infection
THN Take-home Naloxone