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Evidence Update Issue 12, 2018| November 15, 2018 |
PUBLICATIONS FROM THE SIREN TEAM AND MEMBERS
Incidence and predictors of HIV, chlamydia and gonorrhoea among men who have sex with men attending a peer-based clinic. This study assessed the incidence of HIV, chlamydia and gonorrhoea among men attending the M Clinic in Perth. The HIV incidence was higher than found in similar studies in other Australian sexual health clinics, but the incidence of chlamydia and gonorrhoea was similar. The high HIV incidence among clients of the M Clinic points to the importance of making PrEP available to clients of the M Clinic and similar services.
Australian Drug Trends 2018: Key Findings from the National Illicit Drug Reporting System (IDRS) Interviews. IDRS is an ongoing illicit drug monitoring system which has been conducted in all states and territories of Australia since 2000. This report presents key findings and trends from interviews conducted annually from 2000-2018 with a cross-sectional sentinel group of people who regularly inject drugs from across Australia.
Taking stock: A decade of drug policy - A civil society shadow report. Produced by the International Drug Policy Consortium, this report evaluates the impacts of drug policies implemented across the world and contributes to high-level discussions on the next decade in global drug policy.
Hepatitis C – Peer insights on barriers and motivators to Direct-Acting Antiviral (DAA) treatment uptake. This broadsheet is the first of a series that will be produced over the duration of the project. It provides background to the study and presents an overview of the attitudes, beliefs and experiences of people who inject drugs (PWID) related to the access and scale-up of direct acting antiviral (DAA) treatment among this community.
Highlights from the Australasian HIV&AIDS Conference 2018. Held in Sydney in September this conference is the premier HIV Conference in Australia and the Asia and Pacific region. Audio recordings and speaker PDF presentations are now available on the conference website.
The HIV Research for Prevention Conference. Held in Spain in October, this global scientific conference focused on the latest biomedical HIV prevention research. Highlights from the conference can be viewed here.
Journals this edition include: Australian and New Zealand Journal of Public Health; AIDS and Behavior; Culture, Health & Sexuality; International Journal on Drug Policy; Journal of Medical Internet Research Public Health and Surveillance; The Lancet HIV, Journal of Viral Hepatitis; Sexual Health; and Sexually Transmitted Infections.
Only a select number of articles relevant to sexual health, STIs, and BBVs in the Australian context have been summarised.
Australian and New Zealand Journal of Public Health (volume 42, issue 5)
Culturally and linguistic diversity of people living with chronic hepatitis B in 2011-2016: changing migration, shifting epidemiology. This study estimated the cultural and linguistic diversity in Australians currently living with chronic hepatitis B (HBV), the majority of whom were born overseas, and to identify trends in this diversity over time. Results found that the epidemiology of chronic HBV in Australia has shifted over time due to changing migration patterns, with increases in many countries in the Asia‐Pacific, African and Middle Eastern regions.
AIDS and Behavior (online & volume 22, issue 11&12)
Comfort Relying on HIV Pre-exposure Prophylaxis and Treatment as Prevention for Condomless Sex: Results of an Online Survey of Australian Gay and Bisexual Men. HIV-negative and untested gay and bisexual men (GBM) from Victoria were surveyed about their comfort having condomless sex with casual male partners in scenarios in which PrEP or treatment as prevention were used. Results found that being on PrEP, having recent condomless sex with casual partners or a HIV-positive regular partner were independently associated with comfort having condomless sex.
Why I Quit Pre-Exposure Prophylaxis (PrEP)? A Mixed-Method Study Exploring Reasons for PrEP Discontinuation and Potential Re-initiation Among Gay and Bisexual Men. This study explored the reasons why GBM discontinue PrEP use. The results found that the most common reasons for discontinuation were lower perceived HIV risk and cost/insurance. Reasons for potential re-initiation included higher-risk sexual activities and changes to structural related barriers. More research is needed to inform interventions on how GBM can continue taking PrEP during changes to employment that effect insurance coverage and cost.
How Do Gay Serodiscordant Couples in Sydney, Australia Negotiate Undetectable Viral Load for HIV Prevention? Many gay Australian serodiscordant couples are currently relying on an HIV-positive partner’s undetectable viral load (UVL) to practice condomless sex. In learning to rely on ‘UVL for prevention’ (UfP), couples were initially apprehensive as they navigated unfamiliar territory, but their concerns faded over time. Confidence in UfP was facilitated by repeated condomless sex without transmission, consistent test results, and being in a couple framed by trust, commitment, and familiarity. Gay male serodiscordant couples should be encouraged to negotiate clear, spoken ‘viral load agreements’ if they choose to rely on UfP.
Promoting ‘equitable access’ to PrEP in Australia: Taking account of stakeholder perspectives. This study explored how people working in policy, advocacy, research and/or clinical settings dealt with the rollout of PrEP access programs. They explored: who is a suitable candidate for PrEP; why are disparities in PrEP access important; and how can disparities be addressed? They found stakeholders were challenged with promoting ‘equitable access’ to PrEP in an resource rationed health system, and discuss how the principles believed to underpin the Australian response to HIV were both reaffirmed and challenged through this period of change.
High Adherence to HIV Pre-exposure Prophylaxis and No HIV Seroconversions Despite High Levels of Risk Behaviour and STIs: The Australian Demonstration Study PrELUDE. This study evaluated daily PrEP in high-risk individuals in Australia and reported on trends over 18 months in medication adherence, side-effects, HIV/STI incidence and behaviour. They found that in this high-risk cohort of mainly GBM, increases in risk behaviours and high STI incidence were not accompanied by HIV infections due to high adherence to daily PrEP.
Culture, Health & Sexuality (volume 20, issue 8)
Negotiating gay men’s relationships: how are monogamy and non-monogamy experienced and practised over time? This paper used in-depth interviews with Australian gay men to explore how monogamy and non-monogamy are experienced over time, expectations of what constitutes the norms regarding gay men’s relationships and how couples experience and practices change. These findings shed light on how gay men approach change to the status of ‘fidelity’ within their relationships, and the tensions and opportunities that change can produce for couples.
International Journal on Drug Policy (online and volume 60)
Should sterile needle and syringe wastage be included within individual-level needle and syringe coverage measures? In this viewpoint piece the author argued that population-level measurement of needle and syringe coverage amongst PWID, defined by the World Health Organization as the total number of syringes distributed, divided by an estimate of the PWID population, has many limitations that may lead to bias. The author concluded that additional work is needed to identify other relevant behaviours of PWID and assess their influence on the measurement of individual-level syringe coverage.
Acceptability and preferences of point-of-care finger-stick whole-blood and venepuncture hepatitis C virus testing among people who inject drugs in Australia. This article assessed the acceptability of finger-stick and venepuncture hepatitis C (HCV) RNA testing among PWID. The results found that finger-stick whole-blood collection is acceptable to PWID, with males and Aboriginal and/or Torres Strait Islander people with recent injecting drug use less likely to prefer finger-stick testing. Further research is needed to evaluate interventions integrating simplified point-of-care HCV testing to engage people in care in a single-visit, thereby facilitating HCV treatment scale-up.
Journal of Medical Internet Research Public Health and Surveillance (volume 4, issue 4)
Quality of HIV Websites With Information About Pre-Exposure Prophylaxis or Treatment as Prevention for Men Who Have Sex With Men: Systematic Evaluation. Electronic health interventions are promising tools for disseminating information about PrEP and treatment as prevention (TasP) strategies and addressing key barriers to uptake among target populations. This study aimed to systematically review and evaluate existing HIV websites that include information about PrEP or TasP for MSM. The article concluded that existing HIV prevention websites with information about PrEP or TasP for MSM fail to provide adequate content as well as present that content to users in an interactive and audience-conscious way.
The Lancet HIV (volume 5, issue 11)
Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. This study examined whether rapid, targeted, and high-coverage roll-out of PrEP in an MSM epidemic would reduce HIV incidence in the cohort prescribed PrEP and state-wide in New South Wales (NSW). It found that PrEP implementation was associated with a rapid decline in HIV diagnoses in NSW. As part of a combination prevention approach, rapid, targeted, high-coverage PrEP implementation is effective to reduce new HIV infections at the population level.
Journal of Viral Hepatitis (volume 25, issue 11)
Real‐world outcomes of unrestricted direct‐acting antiviral treatment for hepatitis C in Australia: The South Australian statewide experience. This study sought to determine the outcomes and experience of unrestricted access to DAA therapy for chronic HCV in the first year in South Australia. The study's findings support the high responses observed in clinical trials; however, a significant gap exists in sustained virological response in their real‐world cohort due to people lost to follow-up. A declining treatment initiation rate and shift to community‐based treatment highlight the need to explore additional strategies to identify, treat and follow‐up remaining patients in order to achieve elimination targets.
New viral biomarkers for Hepatitis B: Are we able to change practice? The management of chronic HBV infection is challenged by its varying natural course and its stealthy nature. Hepatic inflammation and quantification of HBV DNA have guided treatment decisions in the last decade, and these guided interventions have been shown to reduce liver‐related complications and death. Data on the quantification of additional HBV markers such as HBV surface antigen (HBsAg), HBV core‐related antigen (HBcrAg) and HBV RNA have accumulated in recent years. This study reviews the current evidence of how to use these markers and discuss issues that require additional research.
Sexual Health (online early)
Early initiation of antiretroviral therapy (ART): from point-of-care test to ART at a peer-led community-based testing site in Sydney. The effect of performing baseline HIV investigations (BLHIVI) at the time of a reactive HIV point-of-care test in the pathway to antiretroviral therapy (ART) in a community setting has not been described. This study found that in a community setting, the inclusion of BLHIVI has the potential to reduce the time to early ART initiation.
A systematic evaluation of mobile apps to improve the uptake of and adherence to HIV pre-exposure prophylaxis. PrEP use among all at-risk groups is low, mobile apps have been shown to increase the use of PrEP; however, it is unknown whether currently available apps have been designed with features to facilitate PrEP uptake and adherence. From a systematic search, less than 2% of the identified apps were relevant to improving PrEP uptake and adherence. Overall, currently available mobile apps for PrEP demonstrate promise as potential avenues for increasing PrEP uptake and adherence among persons at-risk for HIV infection.
Nurse-led pre-exposure prophylaxis: a non-traditional model to provide HIV prevention in a resource-constrained, pragmatic clinical trial. There is little evidence and no standardised model for nurse-led HIV PrEP. In 2016, public sexual health clinics in NSW participating a a PrEP trial were authorised to adopt a nurse-led model of PrEP provision in order to facilitate the rapid expansion of PrEP access. The model has been implemented successfully in public clinics in 10 of 14 local health districts, with widespread support and no serious safety events reported. With the increasing importance of PrEP as an HIV prevention tool, non-traditional models of care are needed.
Cross-sectional survey of Chinese-speaking and Thai-speaking female sex workers in Sydney, Australia: factors associated with consistent condom use. In this study, we describe the demographics and safe sexual practices in the Chinese- and Thai-speaking female sex workers attending the Sydney Sexual Health Centre (SSHC). Consistent condom use for vaginal sex at work among Chinese- and Thai-speaking female sex workers has decreased slightly from that reported in a similar survey conducted by the SSHC in 2003. Ongoing health promotion efforts should focus on providing culturally appropriate education around STIs and safe sex practices not only to workers, but also to parlour owners, managers and consumers.
Sexually Transmitted Infections (volume 94, issue 6&7)
Original article: 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 in MSM attending Western Sydney Sexual Health Centre (WSSHC). The results demonstrated a high prevalence of M. genitalium and very high levels of macrolide resistance among MSM attending WSSHC. Our findings support the routine use of an assay to detect macrolide resistance mutations in M. genitalium infections. This will 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.
Short report: Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men. The aim of this report was to raise the issue of the definition and classification of partner terminology in MSM research, particularly in regards to ‘fuck buddies’. There was a consensus among men that partners they engaged with for ‘sex only’ were classified as casual partners and partners with whom there was an emotional attachment or formalisation of the relationship were classified as ‘regular partners’. Further research is needed to ascertain the ways in which men conceptualise sexual relationships and define or classify partner types, particularly ‘fuck buddy’ relationships. A third category for sexual relationships should be considered to encapsulate fuck buddy relationships.
ART Antiretroviral Therapy
BLHIVI Baseline HIV investigations
DAA Direct-Acting Antiviral
GBM Gay and Bisexual-Identifying Men
HBcrAG Hepatitis B core-related antigen
HBsAG Hepatitis B surface antigen
HBV Hepatitis B Virus
HBV RNA Hepatitis B Virus Ribonucleic Acid
HCV Hepatitis C Virus
HIV Human Immunodeficiency Virus
HIVR4P HIV Research for Prevention Conference
IDRS Illicit Drug Reporting System
MSM Men who have Sex with Men
NSW New South Wales
OST Opioid Substitution Therapy
PrEP Pre Exposure Prophylaxis
PWID People Who Inject Drugs
SSHC Sydney Sexual Health Centre
SRE Sexuality and Relationships Education
STI Sexually Transmitted Infection
SVR12 Sustained Virological Response
TasP Treatment as Prevention
UfP UVL for Protection
UVL Undetectable Viral Load
VLAs Viral Load Agreements
WSSHC Western Sydney Sexual Health Centre