Evidence Update Issue 3, 2017

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Summary

Safe injecting facility, heroin, overdose

The medical coalface of the heroin epidemic. I. M. Rio

What they did: A reflection piece that argues it is time for Victoria to follow the lead of New South Wales and establish a supervised injecting facility

What they found: Describes the experience of working at the North Richmond Community Health centre: the epicentre of the current heroin epidemic.

Policy and practice implications: There are currently no safe injecting facilities in Victoria. Safe injecting facilities reduce the risk of heroin overdose deaths and are needed in Victoria.  

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HIV, service delivery

Barriers and Facilitators to Interventions Improving Retention in HIV Care: A Qualitative Evidence Meta-Synthesis. D. J. Hall

What they did: Undertook a review of qualitative research to identify facilitators and barriers to HIV retention in care interventions.

What they found: Factors identified include: stigma and discrimination; fear of HIV status disclosure; task shifting to lay health workers; human resource and institutional challenges; Mobile Health; family and friend support; intensive case management; and relationships with caregivers.

Policy and practice implications: Task shifting interventions with lay health workers were feasible and acceptable. Mobile Health interventions and stigma reduction interventions appear to be promising interventions to improve retention in care.

GBM, sexual compulsivity

Feasibility of an Emotion Regulation Intervention to Improve Mental Health and Reduce HIV Transmission Risk Behaviors for HIV-Positive Gay and Bisexual Men with Sexual Compulsivity. J. T. Parsons.

What they did: Gay and bisexual men (GBM) report high rates of sexual compulsivity (SC), yet no empirically based treatments exist. This study tested the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in a small sample of HIV-positive GBM.

What they found: Despite problems with session attendance (only 4 men completed all 10 sessions), improvements were observed in all psychological outcomes, including SC, depression, and anxiety. Decreases were observed in drug use and HIV risk.

Policy and practice implications: The Unified Protocol may be useful in improving the health of HIV-positive GBM, however challenges with session attendance must be addressed.

HIV, Care Coordination

Come as You Are: Improving Care Engagement and Viral Load Suppression Among HIV Care Coordination Clients with Lower Mental Health Functioning, Unstable Housing, and Hard Drug Use. M. K. Irvine.  

What they did: Lower mental health functioning, unstable housing, and drug use can complicate HIV clinical management. This study examined characteristics and outcomes for HIV Care Coordination clients.

What they found: Care engagement and viral suppression improved in all subgroups, including those with lower mental health functioning, unstable housing, or hard drug use.

Policy and practice implications: Findings support the role of Care Coordination in increasing health and survival opportunities among those at highest risk for suboptimal HIV health outcomes.

Older adults, HIV, service delivery

The Impact of Comorbidities, Depression, and Substance Use Problems on Quality of Life Among Older Adults Living With HIV. B. M. Millar.

What they did: Explored associations between physical health, psychological health, substance use, and overall quality of life in older adults living with HIV (OALWH).

What they found: The number of comorbid conditions was associated with reduced quality of life. Depression and substance use were also negatively associated with quality of life.

Policy and practice implications: Care for OALWH, particularly when related to mental health and substance use, should also focus on the comparatively high number of current comorbid conditions that often accompany, and potentially complicate, HIV treatment and quality of life.

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Sexual minorities, internet information seeking

Understanding health information seeking on the internet among sexual minority people: Cross-sectional analysis from the Health Information National Trends Survey. J. M. Jacobson.

What they did: Analysed data from the 2015 Health Information National Trends Survey Food and Drug Administration Cycle to describe and summarise health information seeking behaviour among sexual minority and heterosexual people.

What they found: Almost all sexual minority people in this sample reported having access to the internet and were equally as likely as heterosexual people to seek health information on the internet and to report incidental exposure to health information online. Sexual minority people were more likely to watch a health related video on YouTube than heterosexual people.

Policy and practice implications: Online interventions could be valuable for delivering or promoting health information to sexual minority people.

STI, prevention

Using Computer Simulations for Investigating a Sex Education Intervention: An Exploratory Study. A. Eleftheriou.

What they did: Explored the use of games in interventions for increasing condom use by challenging the false sense of security associated with judging the presence of an STI based on attractiveness.

What they found: The overall confidence of participants to evaluate sexual risks reduced after playing the game.

Policy and practice implications: Games have the potential to be a valuable strategy for sex education.

HIV, text messaging, treatment

Mobile Text Messaging to Improve Medication Adherence and Viral Load in a Vulnerable Canadian Population Living With Human Immunodeficiency Virus: A Repeated Measures Study. M. C. M. Murray.

What they did: Assessed whether a weekly text-messaging intervention applied to a vulnerable, predominantly female, population improved Combination antiretroviral therapy (cART) adherence and HIV Viral Load (VL).

What they found: Mean HIV VL decreased significantly and adherence to cART significantly improved.

Policy and practice implications: Standardised text messaging may be an effective tool for improving cART adherence and reducing VL among high-risk, vulnerable HIV-positive persons.

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Digital interventions, sexual health

The role of digital interventions in sexual health. T. Nadarzynski.

What they did: An editorial piece that highlights the role of digital interventions in sexual health.

What they found: Digital sexual health interventions are promising, but more research is required.

Policy and practice implications: Robust digital sexual health interventions need to be evidence-based, theory-driven and person-based and should be developed in collaboration with healthcare providers and potential service users.

Sexual health, STI, health apps, health technology

‘Can you recommend any good STI apps?’ A review of content, accuracy and comprehensiveness of current mobile medical applications for STIs and related genital infections. J. Gibbs.

What they did: Undertook a comprehensive review of the content and accuracy of apps for people seeking information about STIs.

What they found: Marked variation in content, quality and accuracy of available apps. Nearly one-third contained potentially harmful information.

Policy and practice implications: The risk of misleading or potentially harmful advice undermines the potential benefits of an e-Health approach to sexual health and wellbeing.

HIV, STI, MSM, sex work

 A cross-sectional study of HIV and STIs among male sex workers attending Australian sexual health clinics. D. Callander.

What they did: Investigated the prevalence of chlamydia, gonorrhoea, infectious syphilis and HIV among gay, bisexual or other men who have sex with men (MSM) attending Australian publicly funded sexual health clinics and compared prevalence between sex workers and non-sex workers.

What they found: After controlling for demographic and behavioural factors sex work was not independently associated with HIV or STI diagnosis in gay, bisexual or other MSM.

Policy and practice implications: These findings challenge assumptions of sex work as inherently risky to the sexual health of gay, bisexual and other MSM.

STI, testing

Pilot study for the ‘Test n Treat’ trial of on-site rapid chlamydia/gonorrhoea tests and same day treatment. A Balendra.

What they did: Explored the feasibility of providing rapid, on-site chlamydia/gonorrhoea testing with results within 2 hours, and same day treatment if required (‘Test n Treat’) with students at a Further Education college.

What they found: The test had a 54% acceptance rate and of those tested there was an 8% chlamydia prevalence.

Policy and practice implications: This is the first college based study of rapid chlamydia/gonorrhoea testing and on-site treatment. It was well received by students.

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NEP, HCV, PWID

Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis. S. M. Davis.

What they did: Examined the association between Needle Exchange Programs (NEP) use and HCV prevention in PWID.

What they found: The impact of NEP on HCV prevention in PWID remains unclear.

Policy and practice implications: Future studies incorporating standardised populations, interventions, comparisons, outcomes, and analyses are critically needed to inform public health practice and policy.

Harm reduction, PWID, service delivery

Expanding conceptualizations of harm reduction: results from a qualitative community-based participatory research study with people who inject drugs. L. M. Boucher.

What they did: Studied the perspective of people who inject drugs (PWID) on the use of harm reduction strategies.

What they found: PWID incorporate many personal harm reduction practices in their daily lives to improve their well-being, and these practices highlight the importance of agency, self-care, and community building.

Policy and practice implications: Health and social services are needed to better support personal harm reduction practices because the many socio-structural barriers this community faces often interfere with harm reduction efforts.

PWID, young people, drugs,

The association between residential eviction and syringe sharing among a prospective cohort of street-involved youth. A. Pilarinos.

What they did: Assessed whether residential eviction was associated with syringe sharing among street-involved youth in Canada.

What they found: Syringe sharing was significantly elevated among youth who had recently been evicted from housing.

Policy and practice implications: Policy and programmatic interventions that increase housing stability may help mitigate high-risk substance use practices among vulnerable youth.

PWID, harm reduction

Harm reduction in hospitals. M. Sharma.

What they did: A commentary that describes several harm reduction practices to be considered in hospitals.

What they found: Authors provided recommendations for the implementation of de-stigmatising interventions, the establishment of addiction consultation services, the provision of needle and syringe exchange programs, and improvement of patient retention.

Policy and practice implications: A pragmatic, patient-centered, non-judgmental approach to the care of PWID is needed.

PWID, supervised injecting facilitates

Supervised injection facilities in Canada: past, present, and future. T. Kerr.

What they did: Reviewed Canada’s experience with supervised injection facilities.

What they found: Although considerable progress has been made towards integrating this form of intervention into the continuum of programs offered to PWID, continued activism, research advocacy, and litigation has been necessary in order to advance this evidence-based approach in Canada.  

Policy and practice implications: Models that are more responsive to the needs of PWID (e.g., assisted injection services, peer-run models) should be implemented and evaluated, and supervised injection facilities should be extended into new settings.

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HIV, ATSI

Prevalence of HIV among Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis. S. Graham.

What they did: Reviewed and analysed the prevalence of HIV among Aboriginal people overall and by subgroups.

What they found: The prevalence of HIV among Aboriginal people in Australia is low.

Policy and practice implications: Community-based programs that include both prevention messages for those at risk of infection and culturally appropriate clinical management and support for Aboriginal people living with HIV are needed to prevent HIV prevalence increasing among Aboriginal people.

GBM, HIV,

Australian gay and bisexual men’s online preferences about sex with HIV-positive partners. G. Prestage.

What they did: Reviewed 57,178 Australian online profiles obtained directly from a popular gay website then identified factors associated with preferences for meeting HIV-positive partners.

What they found: Being younger, living outside major cities, not identifying as gay, always preferring safer sex and either Caucasian or Asian background were associated with excluding HIV-positive men as potential sex partners. The disinclination to include HIV-positive men as potential sex partners may be due to fear of infection, stigma or poor information about HIV.

Policy and practice implications: The fact that most men chose not to select HIV-positive men as potential sex partners on their profiles raises questions about stigma. HIV stigma needs to be addressed among gay and bisexual men, particularly through more explicit and direct education about the meaning of undetectable viral load and its effect on transmission.

Sexual health, young people

Sexual health knowledge and behaviour of young Sudanese Queenslanders: a cross-sectional study. J. Dean.

What they did: Used a cross-sectional survey to explore the sexual health knowledge, attitudes and behaviours of a sample of 16 to 24 year-old Sudanese youth in Australia.

What they found: Patterns of sexual behaviour among this group are not dissimilar to those of other young Australians. Nonetheless, the patterns of risk behaviour combined with the low and inaccurate levels of sexual health knowledge suggest this group remain sexually vulnerable, particularly early within their resettlement experience.

Policy and practice implications: Culturally and contextually informed sexual health interventions are needed early within the resettlement experience.

Sexual health, education

Sex education: findings from the Second Australian Study of Health and Relationships. A. Yeung.

What they did: Data collected from 20,091 randomly selected Australians were analysed to determine the proportion of those who had received school-based sex education and to examine the associations between sex education and sexual health outcomes, specifically a history of a STI, early pregnancy, contraception use at first sex, and level of STI knowledge.

What they found: The results showed that sex education increases contraception use at first sex and increased knowledge leading to better sexual behaviour outcomes; although there appear to be no effect of sex education on the prevalence of STIs or early pregnancy.

Policy and practice implications: Further prospective work in Australia is needed to investigate the effects of changes in the sex education curriculum, particularly the forms that include information on a wider spectrum of sexuality and relationships.

STI, treatment

Patient, staffing and health centre factors associated with annual testing for sexually transmissible infections in remote primary health centres. B. Hengel.

What they did: Examined the frequency of annual testing for chlamydia and gonorrhoea, and the patient, staffing and health centre factors associated with re-testing in 67 remote Aboriginal communities.

What they found: Both males and females were more likely to have a re-test if they were aged 16–24 years, attended a health centre that saw a very high proportion of Aboriginal clients, and a health centre which used electronic medical records. Males were also more likely to be re-tested if they attended centres that employed Aboriginal health workers and that employed more male staff.

Policy and practice implications: Encouraging centres to better utilise or adopt electronic systems of recall, along with supporting the roles of Aboriginal health workers and trying to maintain adequate male staffing levels, may increase re-testing.

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Education, young people,

Relationships and sexuality education topics taught in Western Australian secondary schools during 2014. E. McKay.

What they did: Report on findings from the first Western Australian Survey of Educators of Sexuality Education, which aimed to assess the state of relationships and sexuality education (RSE) in the state of Western Australia.

What they found: Secondary school teachers provided more hours of RSE instruction than the national average. However, they mainly taught curriculum topics such as abstinence from intercourse until married, effects of alcohol/drug use on decision-making, puberty, and sex and ethics (respectful relationships). The least taught subjects included STIs and HIV/AIDS, birth control, the impact of media on sexual identity and sexual orientation.

Policy and practice implications: Results reveal that West Australian secondary school teachers are prioritising time to deliver RSE. However, they need support to deliver the key RSE topic areas of STI, pregnancy prevention and sexual diversity.

Education, young people

Supporting school teachers: primary teachers’ conceptions of their responses to diverse sexualities. L. van Leent.

What they did: Reported on teachers’ experiences of the ways in which they respond to actions and events they see as non-heteronormative.

What they found: Findings from this study suggest that primary school teachers are not supported in responding to non-heteronormative sexualities in a pedagogically informed manner or using a social equity approach. Yet, teachers’ decisions impact on student outcomes and the implications of this for the wider community are likely to be significant, especially for gender and sexuality diverse young people.

Policy and practice implications: Changes to policy and to the curriculum to in-service and pre-service training and to heteronormative institutional cultures are needed to help teachers make critically aware pedagogical decisions about how best to promote the values of a socially just society.

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HCV, treatment

Chronic hepatitis C and chronic kidney disease: Advances, limitations and unchartered territories. M. Mendizabal.

What they did: Studied the effects of direct acting antivirals used to treat HCV infection in patients with chronic kidney disease and in kidney transplant recipients.

What they found: Recent clinical trial data support the use of new direct-acting antiviral regimens, including grazoprevir/elbasvir, and ombitasvir/paritaprevir/ritonavir and dasabuvir, in patients with stage 4/5 chronic kidney disease, including those on haemodialysis. These regimens are, however, restricted to genotypes 1 and 4, while genotype 3 is globally highly prevalent.

Policy and practice implications: Future studies are expected to focus on the optimal timing of anti-HCV therapy both before and after kidney transplantation, with potential implications for widening the pool of kidney transplant donors and recipients.

HCV, treatment

A systematic model improves hepatitis C virus birth cohort screening in hospital-based primary care. A. Goel.

What they did: Looked at the impact of an HCV screening and link-to-care programme with patient navigation in two New York City primary care practices.

What they found: A structured, multifaceted HCV screening programme using well-studied principles and patient navigation identifies a large number of undiagnosed baby boomers within hospital-based primary care.

Policy and practice implications: The interventions brought importance to a public health issue within a hospital serving a large urban area. The study may serve as a model for other hospitals or primary care practices interested in establishing similar HCV screening and link-to-care programmes.

HCV, treatment, older people

Safety and efficacy of direct-acting antivirals for the treatment of chronic hepatitis C in a real-world population aged 65 years and older. F. Conti.

What they did: Evaluated the efficacy and safety of direct-acting antivirals in patients with advanced fibrosis/cirrhosis in real-life practice with the focus on those aged ≥65 years.

What they found: The rate of adverse events in patients aged 65-74 years was not different from that observed in patients aged 75 years or older. In this setting, fatigue and skin complaints were confirmed to be the most common adverse events. Finally, some complications of liver disease occurred during the short period of the study, including hepatocellular carcinoma. 

Policy and practice implications: Based on the evidence, there are no reasons to deny treatment with new direct-acting antivirals using the age as a criterion for prescription.

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Migrants, sexual health, education

Exposure to culturally sensitive sexual health information and impact on health literacy: a qualitative study among newly arrived refugee women in Sweden. P. Svensson.

What they did: Explored how information on sexual and reproductive health and rights was perceived by female recipients and whether being exposed to such information contributed to enhanced sexual and reproductive health and rights literacy.

What they found: Culturally sensitive health education provided by civic and health communicators facilitated the transfer of sexual and reproductive health and rights information to newly arrived refugee women, but cultural barriers created restrictions for information access.

Policy and practice implications: Sexual and reproductive health and rights literacy, in addition to being crucial for migrants’ health, may facilitate their acculturation into the new society.