Evidence Update Issue 7, 2018

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Title and first author

Summary

PWID, Indigenous, HCV

Hepatitis C virus prevalence and associated risk factors among Indigenous Australians who inject drugs. M. Doyle.

What they did: Examined factors associated with HCV infection among a national sample of Indigenous and non-Indigenous PWID in Australia.
What they found: Indigenous respondents were significantly more likely to be exposed to HCV infection.
Policy and practice implications: There is a need for increased access to culturally sensitive harm reduction programs among Indigenous PWID.

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HIV, PLWH

A Rapid Review of eHealth Interventions Addressing the Continuum of HIV Care (2007–2017). K.D. Henny.

What they did: A qualitative review to synthesize technology types, Continuum of Care (CoC) outcomes, theoretical frameworks, and behavior change mechanisms.
What they found: Mobile texting was the most commonly reported technology. Many eHealth interventions with preliminary or proven efficacy relied on mobile technology and integrated knowledge/cognition as behavior change mechanisms.
Policy and practice implications: Having a two-way interactive component between providers and client, designing eHealth interventions based on behavioral theory, and integrating content that facilitates behavior change using knowledge and cognition show preliminary or proven evidence of efficacy for improving HIV care-related outcomes, particularly adherence to HIV medication.

STis, Young people, safe sex, prevention

The Effects of School-Based Condom Availability Programs (CAPs) on Condom Acquisition, Use and Sexual Behavior: A Systematic Review. T. Wang

What they did: A systematic review to assess the impact of school-based condom availability programs (CAPs) on condom acquisition, use and sexual behavior.
What they found: Most studies showed that school-based CAPs increased the odds of students obtaining condoms. Three studies showed that school-based CAPs positively influenced sexual behavior, while no studies reported increase in sexual activity.
Policy and practice implications: School-based CAPs may be an effective strategy for improving condom coverage and promoting positive sexual behaviours.

HIV, MSM

Financial Hardship, Condomless Anal Intercourse and HIV Risk Among Men Who Have Sex with Men. D.T. Duncan.

What they did: Examined the association between financial hardship, condomless anal intercourse and HIV risk among a sample of MSM.
What they found: High financial hardship (compared to low financial hardship) was associated with engagement in condomless anal intercourse, engagement in condomless receptive anal intercourse, engagement in condomless insertive anal intercourse, engagement in transactional sex and infection with non-HIV STIs.
Policy and practice implications: Interventions to reduce financial hardships (e.g., income-based strategies to ensure meeting of basic necessities) could decrease sexual risk behaviours in MSM.

HIV, PLWH, PWID,

A Strengths-Based Case Management Intervention to Reduce HIV Viral Load Among People Who Use Drugs. A.H. Kral.

What they did: Assessed whether a strengths-based case management intervention may help PWID or smoke crack cocaine (PWSC) achieve undetectable HIV viral load.
What they found: HIV viral load became undetectable for significantly more participants receiving strengths-based case management than participants already receiving care.
Policy and practice implications: Strengths-based case management may help this highly vulnerable group achieve undetectable HIV viral load over time.

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HIV, STI, prevention, women, safe sex

Women’s decision-making about self-protection during sexual activity in the deep south of the USA: a grounded theory study. D. Konkle-Parker.

What they did: Explored how women in living in the Mississippi came to decide to protect or not protect themselves when engaging in sexual behaviours.
What they found: Three key themes were identified, these themes impacted on women’s understandings of HIV-related risk, making it difficult to put self-protection above other interests and diminishing their motivation to protect themselves.
Policy and practice implications: Future interventions should seek to empower both women and men to challenge concepts of ‘sexual silence’.

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Title and first author

Summary

HCV, harm reduction

Using peer advocates to improve access to services among hard-to-reach populations with hepatitis C: a qualitative study of client and provider relationships. J. MacLellan.

What they did: Explored how a group of peer advocates with experience of homelessness, alcohol and drug misuse made and sustained relationships with their client group.
What they found: Peer advocates build rapport with clients through disclosing personal details about their lives. While this runs counter to assumptions about the need to maintain distance in client-patient relationships, the therapeutic benefits appear to outweigh the potential costs of this engagement.
Policy and practice implications: The therapeutic benefits of self-disclosure between peer advocates and their clients offer a moral grounding for self-disclosure as a means of building relationships with key hard-to-reach populations.

HCV, prevention, harm reduction

Why is there still hepatitis C transmission in Australian prisons? A case report. B. Harkness.

What they did: Report a case of re-infection of hepatitis C in a prisoner treated with a direct-acting antiviral. What makes this case so remarkable is that it was entirely predictable and preventable.
What they found: Hepatitis C infection will continue to test both the strengths and the weaknesses in the relationship between health and corrective services in Australia.
Policy and practice implications: Full implementation of all harm minimisation modalities is necessary to eliminate the clinical and public health risks of hepatitis C infection, both in prison and by extension into the general community.

HCV, Indigenous, education, prevention

Evaluation of the Deadly Liver Mob program: insights for roll-out and scale-up of a pilot program to engage Aboriginal Australians in hepatitis C and sexual health education, screening, and care. C. Treloar.

What they did: Evaluated the pilot study of the Deadly Liver Mob program – a peer-driven incentivised health promotion program targeted at Aboriginal people in Western Sydney.
What they found: Clients strongly endorsed the program, however some staff raised concerns regarding the workforce capacity needed to effectively engage with clients.
Policy and practice implications: The Deadly Liver Mob has high acceptability and engagement with Aboriginal communities. Additional sites should consider alignment with workforce capacity and governing strategies prior to implementation.

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MSM, young people, HIV, prevention, research

Developing Online Recruitment and Retention Methods for HIV Prevention Research Among Adolescent Males Who Are Interested in Sex with Males: Interviews with Adolescent Males. K.M. Nelson

What they did: This study aimed to identify efficient methods to recruit and retain adolescent males interested in sex with males (AMSM) in online research.
What they found: Soliciting input from AMSM provides critical guidance regarding recruitment and retention procedures to increase the efficiency of HIV prevention research for this at-risk group.
Policy and practice implications: Designing recruitment and retention procedures with the input of the target audience will increase the efficiency, reach, validity, and scientific yield of HIV prevention research.

HIV, AIDS, education,

The Use of Avatar Counseling for HIV/AIDS Health Education: The Examination of Self-Identity in Avatar Preferences. S. Canidate.

What they did:  Identified patterns in the choice of avatar among health information seekers using the Internet to obtain HIV/AIDS information.
What they found: Web-based health information seekers using the Internet to access medical research information may feel more comfortable receiving the answers to HIV stigma-laden questions from avatars, rather than receiving information directly from a health care provider.
Policy and practice implications: Providers seeking to utilize avatars to deliver interventions in health care settings may benefit from offering individuals choices in how they receive health information. Having the ability to choose whom you seek information from may lead to an increase in knowledge and awareness and could motivate HIV-positive individuals to seek care.

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Title and first author

Summary

HCV, HIV, MSM, prevention

On the potential of a short-term intensive intervention to interrupt HCV transmission in HIV-positive men who have sex with men: A mathematical modelling study. L. Salazar-Vizcaya.

What they did: Assessed the potential to interrupt HCV transmission among HCV-positive MSM of the Swiss-HCVree-trial and a similar intensive intervention where all HCV genotypes could be treated.
What they found: Intensive interventions could reduce future HCV treatment costs and boost the benefits of long-term efforts to prevent high-risk behaviour and to reduce treatment delay.
Policy and practice implications: Projections suggest that a 1-year intensive intervention could save HCV treatment costs while boosting the benefits of long-term efforts to prevent high-risk behaviour and to increase treatment rate in clinical routine.

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Title and first author

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Men, STIs, safe sex, prevention, education

Contraception – what about the men? Experience, knowledge and attitudes: a survey of 2438 heterosexual men using an online dating service. M. Stewart.

What they did: Investigated contraceptive experiences, knowledge, attitudes and beliefs of a sample of sexually active, heterosexual men via an online dating site.
What they found: Among this sample there is high contraceptive use, especially vasectomy in older men and a desire to share contraceptive decision-making with their partners, especially in long-term relationships.
Policy and practice implications: Low awareness of some methods and misperceptions about hormonal contraceptive method safety, especially the emergency contraceptive pill, highlight the need for education for men.

STIs, testing, surveillance, Indigenous, women

Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001–2013: a population-based cohort study. J. Reekie.

What they did: Examined trends in chlamydia and gonorrhoea testing and positivity in Aboriginal and non-Aboriginal women of reproductive age.
What they found: The proportion of women tested annually for chlamydia increased significantly between 2001 and 2013 in both Aboriginal and non-Aboriginal women.
Policy and practice implications: Chlamydia and gonorrhoea positivity remained highest in young Aboriginal women despite chlamydia positivity increasing among young non-Aboriginal women. More effective prevention strategies, particularly for young Aboriginal women, are needed to address these disparities.

STI, education, young people

Sexual health and students: the pathways travelled by those with sexual health concerns. G. Freeman.

What they did: Identified the types of research undertaken by university students with sexual health concerns and the effects the research has on their healthcare-seeking behaviour.
What they found: Although the internet was the most popular type of research reported by participants, it was also not deemed as useful as health professionals. Men were more likely to go straight to a doctor, while women were more likely to talk to a friend.
Policy and practice implications: University students should be educated about reliable and targeted sexual health websites. Doctors should also encourage patients to discuss their research to ensure they are accessing reliable information and to strengthen the doctor-patient relationship.

Indigenous, young people, STI, prevention, education, testing

Low education levels are associated with early age of sexual debut, drug use and risky sexual behaviours among young Indigenous Australians. H. Wand.

What they did: Conducted a study of 2320 young Indigenous Australians to determine characteristics of young Aboriginal men and women by age at sexual debut.
What they found:  Most participants reported having sex for the first time at the age of 14 years or younger. Earlier onset sex was significantly associated with not completing high-school, engaging in risky sexual behaviours, and illicit drug use.
Policy and practice implications: Sex education and STI prevention should start early when targeting young Indigenous people. Education should be comprehensive and address individual risk behaviours, sexual agency, and societal vulnerability.

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STIs, sexual health, transmission, prevention

Finding sexual partners online: prevalence and associations with sexual behaviour, STI diagnoses and other sexual health outcomes in the British population. M. Cabecinha.

What they did: Investigated the prevalence of, and factors associated with, use of the internet to find sexual partners using data from a national probability sample survey in the UK.
What they found: Finding sexual partners online was associated with reporting sexual risk behaviour in men and women, while associations with sexual health service use outcomes were observed for men only.
Policy and practice implications: These data suggest a mismatch between need for and uptake of sexual health services in those using the internet to find sexual partners, who might be at higher risk of STIs.

HIV, syphilis, testing

A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis. H.D. Gliddon.

What they did: evaluate the operational characteristics of dual rapid diagnostic tests (RDTs) for HIV/syphilis and evaluate whether they are cost effective, acceptable and easy to use.
What they found: Dual screening for HIV and syphilis was more cost effective than single rapid tests for HIV and syphilis and prevented more adverse pregnancy outcomes. Qualitative data suggested dual RDTs were highly acceptable to clients.
Policy and practice implications: When considering performance, cost-effectiveness and feasibility, these tests should be prioritised for use in settings and among populations where HIV and syphilis screening are recommended, namely, antenatal care settings.

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Young people, risk taking, sexual health, drug use

Risky behaviour: a new framework for understanding why young people take risks. L. Jordan.

What they did: Explores the theories of youth risk taking range from the realist to the sociocultural.
What they found: A Youth Risk Interpretation Framework (Y-RIF) has been developed from insights gained during an ethnographic study conducted in South Africa. The framework offers new ways of understanding why some young people take risks while others are more cautious.
Policy and practice implications: The Y-RIF could be used to inform youth behaviour surveillance research and interventions. However, it will need to be rigorously tested.