Evidence Update Issue 2, 2017

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Summary

HPV, school vaccination programs

HPV vaccine coverage is increasing in Australia. J. M. L. Brotherton.

What they did: Compared 2007-2015 Australian vaccine delivery rates recorded by the National HPV Vaccination Program Register.

What they found: Improvements in vaccine coverage were observed for 14 and 15 year old girls and boys, a trend that is likely to continue.

Policy and practice implications: Systemic assessment and action regarding barriers to HPV vaccination in schools is increasing uptake.

HBV, vaccination, pregnancy, Indigenous   

Trends in the prevalence of hepatitis B infection among women giving birth in New South Wales. L. Deng.

What they did: Linked perinatal data and hepatitis B (HBV) notifications to evaluate the effect of targeted and catch-up hepatitis B vaccination programs in NSW for women giving birth for the first time during 2001-2012.

What they found: Overall HBV prevalence was low. HBV prevalence in Indigenous women had declined, although not to levels of non-Indigenous Australian born women.

Policy and practice implications: Programs to evaluate and reduce HBV prevalence in Australia must continue.

Blood transfusion, HEV

First confirmed case of transfusion-transmitted hepatitis E in Australia. V. C. Hoad.

What they did: Case study of a 6-year old boy who received multiple blood transfusions when undergoing split liver transplant was later found to have hepatitis E (HEV).

What they found:  After ruling out other risk factors a blood service investigation and molecular characterisation of HEV samples supported transmission by transfusion.

Policy and practice implications: Although HEV has a low prevalence in Australia, it is an emerging disease of developed nations, and can cause significant morbidity in immunocompromised patients.

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PrEP, HIV, stigma

Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men. L. A. Eaton.

What they did: Assessed the relationships between potential barriers to PrEP (i.e., PrEP stigma and conspiracy beliefs) and interest in PrEP in a US city.

What they found: Believing that PrEP is for people who are promiscuous (stigma belief) was strongly associated with lack of interest in using PrEP, and individuals who endorsed this belief were more likely to report sexual risk taking behaviour.

Policy and practice implications: Addressing sociocultural barriers to PrEP access is urgently needed and failure to do so will weaken the potential benefits of biomedical prevention.

PrEP, HIV, primary care

PrEP Awareness, Familiarity, Comfort, and Prescribing Experience among US Primary Care Providers and HIV Specialists. A. E. Petroll.

What they did: Undertook a survey across 10 US cities of primary care providers and HIV providers awareness, knowledge, and experience with prescribing PrEP; and, comfort with and barriers to PrEP-related activities.

What they found: Primary care providers and HIV providers differ in needs that will facilitate their PrEP prescribing.

Policy and practice implications: Efforts to increase PrEP uptake will require interventions to increase the knowledge, comfort, and skills of providers to prescribe PrEP.

Young people, MSM, HIV, prevention

Reactions to Testing HIV Negative: Measurement and Associations with Sexual Risk Behaviour Among Young MSM Who Recently Tested HIV Negative. B. A Feinstein.

What they did: The study aimed to assess the behavioural reactions of young MSM who have recently tested HIV-negative in the US.

What they found: Four factors eventuated from a HIV-negative test result: reinforced safety (belief that the result reinforced past decisions to have safer sex), luck (the belief that testing negative represented ‘dodging a bullet’), invulnerability (testing negative produced feelings of immunity), and reinforced risk (belief that the result reinforced past decisions to engage in risk behaviours).

 Policy and practice implications: Testing facilities should be aware of these potential outcomes to a HIV-negative test result and counsel individuals accordingly.

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Sex workers

A content analysis of health & safety communications among internet-based sex work advertisements: important information for public health. J. Kille.

What they did: Aimed to increase our understanding of the health and safety information within internet advertisements among women, men, and transgender sex workers and describe how this information may be utilised to inform eHealth service development for this population.

What they found: Common components were demographic characteristics, sexual services, health and safety and security. Less common components regarded STIs or restriction of drugs or alcohol.

Policy and practice implications: This information affords health care providers and policy makers insights to how they might assist with promoting the health of Internet-based sex workers and their clients.

Stigma, HIV, prevention, treatment

Measuring Sexual Behaviour Stigma to Inform Effective HIV Prevention and Treatment Programs for Key Populations. S. Stahlman.

What they did: The levels of coverage of HIV services have consistently been shown to be limited by stigma. This study proposes an agenda for the goals and approaches of a sexual behaviour stigma surveillance effort for key populations.

What they found: Consistent and validated stigma metrics for key populations are needed to monitor trends and guide immediate action.

Policy and practice implications: Evidence-based stigma interventions may ultimately be the key to overcoming the barriers to coverage and retention in life-saving antiretroviral-based HIV prevention and treatment programs for key populations.

Young people, treatment

Timely Digital Patient-Clinician Communication in Specialist Clinical Services for Young People: A Mixed-Methods Study (The LYNC Study). F. Griffiths.

What they did: Sought to understand how the use of digital communication between young people with long-term conditions and their National Health Service specialist clinicians changes engagement of young people with their health care; and to identify costs and necessary safeguards.

What they found: Digital communication enables timely access for young people to the right clinician at the time when it can make a difference to how they manage their health condition.

Policy and practice implications: Benefit is most likely, and harms are mitigated, when digital communication is used with patients who already have a relationship of trust with the clinical team.

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Chemsex, MSM

Motivations & values associated with combining sex & illicit drugs (‘chemsex’) among gay men in South London: findings from a qualitative study. P. Weatherburn.

What they did: With a view to inform supportive therapeutic and clinical interventions, the authors sought to examine the motivations for engaging in chemsex among gay men living in South London.

What they found: Sexualised drug use provides both motivation and capability to engage in the kinds of sex that some gay men value: sex that explores and celebrates adventurism.

Policy and practice implications: Those services providing (talking) interventions to men engaging in chemsex should consider these benefits of sexualised drug use alongside the harms arising.

Chlamydia, testing

Chlamyweb study I: rationale, design & acceptability of an internet-based Chlamydia testing intervention. N. Lydie

What they did: Describe the Chlamyweb Study which involves Chlamydia home-based self-sampling testing via the internet.

What they found: Forty six percent agreed to receive a self-sampling kit and 61% returned it, with more women doing so than men.

Policy and practice implications: The offer of easy-to-use and self-sampling kits free of charge appeared to be a logistically feasible strategy for testing in France and reached a large and diverse population including individuals who have limited access to the traditional healthcare system.

Gonorrhoea

Identifying factors that lead to the persistence of imported gonorrhoea strains: a modelling study. B. B. Hui.

What they did: Developed an individual based model to simulate the transmission of N. gonorrhoea in urban Australian MSM.

What they found: Importation of N. gonorrhoea strains from overseas are a possible source of antimicrobial resistance in Australia, although unlikely to become endemic unless it is resistant to treatment, can form mixed infections with the local NG strain or if there are frequent importation events.

Policy and practice implications: Continued monitoring of antibiotic resistance of N. gonorrhoea is required.

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HBV, high-risk populations, vaccination

Uptake & trends in ordering of funded hepatitis B immunisation for priority populations in Victoria, Australia 2013-2014. J. H. MacLachlan.

What they did: Analysed GP admin data to determine the uptake of hepatitis B (HBV) vaccine ordering for at-risk groups over time, to assess any trends and identify any gaps in prevention of hepatitis B for those at risk.

What they found: HBV vaccine orders increased between 2013-2104. They were largely distributed to persons living in a household or having sexual contact with HBV infected, people living with HIV, people living with hepatitis C, and people who inject drugs

Policy and practice implications: Further intervention could improve immunisation rates for high risk populations.

PEP, HIV, MSM

Comparing non-occupational post-exposure prophylaxis drug regimens for HIV: insights from a linked HIV surveillance system. A. B. Pierce.

What they did: Examined the potential for excess HIV seroconversions among high-risk MSM reporting receptive anal intercourse with a source of unknown HIV serostatus (RAIU) following a two-drug versus a three-drug non-occupational post-exposure prophylaxis (NPEP) regimen.

What they found: In this study, two-drug NPEP regimens do not result in excess seroconversions compared with three-drug regimens when used following RAIU.

Policy and practice implications: Clinical services consideration of whether resources may be better invested in PrEP.

Domestic violence, STI

Experience of domestic violence routine screening in family planning NSW clinics. T. Hunter.

What they did: Reviewed the Domestic Violence Routine Screening program at Family Planning NSW and outcomes of screening to determine the feasibility of routine screening in a family planning setting and the suitability of this program in the context of women’s reproductive and sexual health.

What they found: Four percent of eligible women disclosed domestic violence. Factors associated with disclosure were clinic attendance, age group, region of birth, employment status, education and disability. Women who disclosed domestic violence were more likely discuss issues related to STIs.

Policy and practice implications: Given associations between domestic violence and sexual and reproductive health, a Domestic Violence Routine Screening program is considered appropriate in sexual and reproductive health clinics.

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Gender diversity, teenagers, schools

Teacher positivity towards gender diversity: exploring relationships and school outcomes for transgender & gender-diverse students. J. Ullman.

What they did: Surveyed same sex attracted and gender diverse Australian teenagers to examine school gender climate as a potential stressor for the students who identified as gender diverse.

What they found: Teacher positivity regarding diverse gender expression significantly predicted gender diverse students sense of connection with their school environment after multiple regression analysis.

Policy and practice implications: Educators that are knowledgeable and affirming of gender diversity have the potential to have a positive impact on students and schools.

HPV, vaccine, education

‘Is it like one of those infectious kind of things?’ the importance of educating young people about HPV and HPV vaccination at school. C. Davies.

What they did: Implemented a cluster randomised controlled trial of a complex intervention in schools. This study aimed to improve: student knowledge about HPV vaccination; psycho-social outcomes and vaccination uptake.

What they found: Improved student knowledge and understanding of HPV vaccination, and attitudes and confidence towards vaccination.

Policy and practice implications: Education programs may increase HPV vaccine uptake.

Sexuality education, primary school

Responsibilities, tensions & ways forward: parents’ perspectives on children’s sexuality education. K. H. Robinson.

What they did: Explored Australian parents perceptions surrounding primary school sexuality education.

What they found: The majority of parents believed sexuality education was relevant, important and required a collaborative approach between families and schools.

Policy and practice implications: Collaboration with parents may reduce tension and controversy associated with primary school sexuality education.

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HCV, treatment

Time to viral suppression is not related to achievement of SVR12 in HCV GT1-infected patients treated with ombitasvir/ paritaprevir/ritonavir and dasabuvir with or without ribavirin. S. Alqahtani.

What they did: Assessed whether the time to the first HCV RNA value below the lower limit of quantification in patients with or without cirrhosis was associated with achievement of sustained virologic response at 12 weeks post-treatment (SVR12).

What they found: The absence of a relationship between time to suppression and SVR12 was not affected by the presence of cirrhosis.

Policy and practice implications: Early virologic suppression of HCV RNA is nearly universal by week four following treatment with ombitasvir and paritaprevir co-administered with 100mg ritonavir, with or without RBV.

HBV, treatment

Determination of hepatitis B phenotype using biochemical and serological markers. A. M. Di Bisceglie.

What they did: Assessed the validity of categorisation of chronic hepatitis B viral infection into stages or phases based upon measures of disease activity and viral load.

What they found: A relatively large number of individuals who did not fit neatly into one of the well-described phenotypes.

Policy and practice implications: These findings call into question the validity of conventional staging of hepatitis B, in large part because of the substantial proportion of patients who do not fit readily into one of the usual stages or phases.

HBV, treatment

The association between hepatitis B self-awareness and depression: Exploring the modifying effects of socio-economic factors. Y. Liu.

What they did: Explored the strength of the association and the modifying effects of participants' self-awareness of HBV and their socio-economic status.

What they found: A strong association between hepatitis B self-awareness and depression was found. Lower socio-economic status could modify the association between hepatitis B status and depression.

Policy and practice implications: For future public health interventions, psychosocial support of HBV+ positive patients needs to be integrated into a comprehensive healthcare package to enhance patients' psychosomatic health. For clinical and psychological researchers, the underlying pathways between HBV and major depression still need further clarification. For policymakers, ensuring HBV+ positive populations' access to the basic health services and providing psychosocial support should be integrated into the overall health system planning in the future.

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HIV,  young people, education, prevention, women

Advice for prevention from HIV-positive African-American women: ‘My story is not just a story’. A. Robillard.

What they did: Documented advice given from HIV-positive African-American women to young African-American women in order to better inform HIV prevention interventions within cultural narratives.

What they found: Advice given highlighted personal experiences as well as social determinants linked to HIV (stigma, education, societal characteristics, socioeconomic status). Importance was placed on the role of families as a tool for intervention through the effective communication of HIV prevention strategies.

Policy and practice implications: Narratives which use engaging characters, culturally realistic content can affect the manner in which recipients identify and engage with the story, in addition to whether or not they are compelled to share the story with other members of their community.

HIV, stigma, service delivery, women

‘We talk, we do not have shame’: addressing stigma by reconstructing identity through enhancing social cohesion among female sex workers living with HIV in the Dominican Republic. M. A. Carrasco.

What they did: Explored the use of social cohesion as a strategy to address stigma experienced by female sex workers in the Dominican Republic.

What they found: The women who formed a group or community and disclosed their HIV status to one another were able to work and exist in an environment where they felt ‘normal’. The environment offered them to develop de-stigmatised narratives and practice positive values, such as courage, solidarity, and resilience.

Policy and practice implications: Interventions which provide opportunities to challenge stigma and address power imbalances enable communities to create a de-stigmatised identity while also advocating for societal and change.

HIV, service delivery, prevention, women

Challenging HIV vulnerability discourse: the case of professional and entrepreneurial women in Dar Es Salaam, Tanzania. N. W. Jangu.

What they did: Compared governmental discourse on HIV with the knowledge and lived experience of professional and entrepreneurial women in Tanzania. The study aimed to challenge the government representations of HIV vulnerability occurring solely within individuals of low socioeconomic status.

What they found: The study’s findings challenge the Tanzanian government’s discourse that women vulnerable to HIV as uneducated, poor, submissive, or sex workers. The women interviewed described persistent sexual harassment, resistance to marriage, and using their sexuality and connections to leverage their position in society.

Policy and practice implications: HIV prevention strategies need to broaden their lens to encompass women of all backgrounds and social standings. An understanding of the complexities of the female experience is required for effective, targeted HIV prevention.