Campbell Aitken

SMS STI: A Review of the Uses of Mobile Phone Text Messaging in Sexual Health:

Short messaging service (SMS) (a.k.a. text messaging) is a fast, low cost and popular mode of communication among young people, and these advantages can be used in a variety of ways in the field of sexual health. This paper reviews the current published and grey literature and discusses applications of SMS in sexual health and the evidence base for their effectiveness. Examples of uses of SMS in sexual health include: communication between sexual health clinics and patients, partner notification and contact tracing, contraception reminders and sexual health promotion and education. However, although SMS has been applied in many ways to improve sexual health and there is some evidence of its effectiveness, very few of the applications described in this article have been evaluated. As SMS is likely to become more and more commonly used for sexual health purposes, evaluation of its benefits and effectiveness is essential.

The impact of a police crackdown on a street drug scene: evidence from the street

This article documents the impact of a police crackdown on a street heroin market in a suburb of Melbourne, Australia, as perceived by individuals involved in the market. While our data suggest that ‘Operation Clean Heart’ achieved its objective of reducing the visible aspects of this street drug scene, they also imply that the drug market rapidly adapted to its new conditions and that the impact of the operation was essentially superficial and temporary. In addition, we contend that the operation had numerous (unintended) negative consequences, some of which are potentially harmful to public health. Negative outcomes implied by our data included the partial displacement of the drug scene to nearby metropolitan areas; the discouragement of safe injecting practice and safe needle and syringe disposal; and more frequent occurrences of violence and fraud. These outcomes may outweigh the perceived positive impacts, which were achieved at significant public expense. We conclude that police crackdowns are inappropriate responses to illicit drug problems; instead, in line with longstanding Australian policy, approaches which incorporate and balance demand reduction, supply reduction and harm reduction principles should be followed.

High incidence of hepatitis C virus reinfection in a cohort of injecting drug users

An estimated 170 million people worldwide carry the hepatitis C virus (HCV), and in more developed countries the prevalence and incidence of HCV is particularly high among injecting drug users (IDUs). Spontaneous clearance of HCV infection and reinfection is well recognized but the level of protection against further infection conferred by HCV infection and clearance remains uncertain. We conducted a prospective study of HCV infection in IDUs recruited in Melbourne, Australia, using a much shorter median testing interval than in previous studies. Incidences of naive infection and reinfection were calculated by the person‐year method and Cox proportional hazards regression used to adjust for covariates. A significantly higher HCV incidence rate was measured in previously infected IDUs (46.8% per year) compared with HCV‐naive IDUs (15.5% per year). The hazard ratio for previously infected IDUs compared to HCV‐naive IDUs, after adjustment for time‐dependent covariates, was 2.54 (95% confidence interval, 1.11–5.78, P > |z| < 0.05). Viral persistence after reinfection appeared similar to that following naive infection. Conclusion: Our data suggest that HCV infection in IDUs is more likely following prior infection and clearance than in HCV‐naive individuals, implying no increased immunity against further infection. This result has important implications for the future development of an HCV vaccine. (HEPATOLOGY 2008;48:1746‐1752.)

Impact of text and email messaging on the sexual health of young people: a randomised controlled trial

Objective To carry out a randomised controlled trial on the effect of a new method of health promotion—email and mobile phone text messages (short messaging service (SMS))—on young peoples sexual health. Methods 994 people aged 16–29 were recruited at a music festival to a non-blinded randomised controlled trial. Participants were randomised to either receive sexual health promotion messages (n=507) or the control group (n=487). The 12-month intervention included SMS (catchy sexually transmissible infections prevention slogans) and emails. Participants completed questionnaires at the festival at baseline and online after 3, 6 and 12 months. Outcomes were differences between the control and intervention groups in health-seeking behaviour, condom use with risky partners (new or casual partners or two or more partners within 12 months) and STI knowledge. Results 337 (34%) completed all three follow-up questionnaires and 387 (39%) completed the final questionnaire. At 12 months, STI knowledge was higher in the intervention group for both male (OR=3.19 95% CI 1.52 to 6.69) and female subjects (OR=2.36 95% CI 1.27 to 4.37). Women (but not men) in the intervention group were more likely to have had an STI test (OR=2.51, 95% CI 1.11 to 5.69), or discuss sexual health with a clinician (OR=2.92, 95% CI 1.66 to 5.15) than their control counterparts. There was no significant impact on condom use. Opinions of the messages were favourable. Conclusion This simple intervention improved STI knowledge in both sexes and STI testing in women, but had no impact on condom use. SMS and email are low cost, popular and convenient, and have considerable potential for health promotion. Clinical trial registration number Australian Clinical Trials Registry - ACTRN12605000760673.

Analysis of FOXP3+ regulatory T cells that display apparent viral antigen specificity during chronic hepatitis C virus infection.

We reported previously that a proportion of natural CD25(+) cells isolated from the PBMC of HCV patients can further upregulate CD25 expression in response to HCV peptide stimulation in vitro, and proposed that virus-specific regulatory T cells (Treg) were primed and expanded during the disease. Here we describe epigenetic analysis of the FOXP3 locus in HCV-responsive natural CD25(+) cells and show that these cells are not activated conventional T cells expressing FOXP3, but hard-wired Treg with a stable FOXP3 phenotype and function. Of approximately 46,000 genes analyzed in genome wide transcription profiling, about 1% were differentially expressed between HCV-responsive Treg, HCV-non-responsive natural CD25(+) cells and conventional T cells. Expression profiles, including cell death, activation, proliferation and transcriptional regulation, suggest a survival advantage of HCV-responsive Treg over the other cell populations. Since no Treg-specific activation marker is known, we tested 97 NS3-derived peptides for their ability to elicit CD25 response (assuming it is a surrogate marker), accompanied by high resolution HLA typing of the patients. Some reactive peptides overlapped with previously described effector T cell epitopes. Our data offers new insights into HCV immune evasion and tolerance, and highlights the non-self specific nature of Treg during infection.

Reliability and validity of the Kessler 10 and Patient Health Questionnaire among injecting drug users

Objective: To examine the reliability and validity of the Kessler 10 (K10) and the Patient Health Questionnaire (PHQ) in a sample of injecting drug users (IDUs). Method: Participants were 103 IDUs with a current substance use disorder accessing a needle and syringe programme. Presence of mental health disorders was assessed using the Mini International Neuropsychiatric Interview (MINI). Results: Both the K10 and PHQ had high levels of internal consistency and concurrent validity. Individuals with a positive screen on the K10 were ten lines more likely to have a current affective disorder, while those with a positive PHQ screen had nearly 14 times the risk. Conclusions: The K10 and PHQ are recommended as brief screening and diagnostic tools for current affective disorders among IDUs.

The impact of injecting networks on hepatitis C transmission and treatment in people who inject drugs

With the development of new highly efficacious direct‐acting antiviral (DAA) treatments for hepatitis C virus (HCV), the concept of treatment as prevention is gaining credence. To date, the majority of mathematical models assume perfect mixing, with injectors having equal contact with all other injectors. This article explores how using a networks‐based approach to treat people who inject drugs (PWID) with DAAs affects HCV prevalence. Using observational data, we parameterized an exponential random graph model containing 524 nodes. We simulated transmission of HCV through this network using a discrete time, stochastic transmission model. The effect of five treatment strategies on the prevalence of HCV was investigated; two of these strategies were (1) treat randomly selected nodes and (2) “treat your friends,” where an individual is chosen at random for treatment and all their infected neighbors are treated. As treatment coverage increases, HCV prevalence at 10 years reduces for both the high‐ and low‐efficacy treatment. Within each set of parameters, the treat your friends strategy performed better than the random strategy being most marked for higher‐efficacy treatment. For example, over 10 years of treating 25 per 1,000 PWID, the prevalence drops from 50% to 40% for the random strategy and to 33% for the treat your friends strategy (6.5% difference; 95% confidence interval: 5.1‐8.1). Conclusion: Treat your friends is a feasible means of utilizing network strategies to improve treatment efficiency. In an era of highly efficacious and highly tolerable treatment, such an approach will benefit not just the individual, but also the community more broadly by reducing the prevalence of HCV among PWID. (Hepatology 2014;60:1860–1869)

A very low response rate in an on-line survey of medical practitioners

Objective: To report on the response rate achieved in a survey of medical practitioners and discuss the reasons for it.

Sexual-risk behaviour, self-perceived risk and knowledge of sexually transmissible infections among young Australians attending a music festival

BACKGROUND Prevalences of sexually transmissible infections (STI), unsafe sex and abortions are increasing in Australia and people aged 16 to 29 are particularly at risk. We conducted a survey of behaviour, knowledge and perceptions of STI risk among young people attending a longstanding annual music festival called the Big Day Out. METHODS A structured questionnaire was administered to a cross-sectional sample of people aged 16 to 29 years attending a music festival (Big Day Out). RESULTS Completed questionnaires were collected from 939 participants (507 females, 432 males) whose median age was 20 years. Of the participants, 751 (80%) had ever had vaginal or anal sex. In the previous year, 48% had multiple partners and in the past 3 months 66% had a new partner. Of these, 224 (39%; 30% of those who had ever had sex) did not use condoms all or most of the time and were classified as being at risk of STI; however, only 24% of those so classified perceived that they were at risk of an STI. In total, 43% of all sexually experienced participants had not used a condom because they reported being drunk or high at the time. STI knowledge was poor overall and male participants, those living in non-metropolitan regions, those under the age of 20 and those with less schooling scored relatively poorly. CONCLUSIONS Our data suggest that young men and women who attend the Big Day Out are sexually active young adults with limited knowledge of STI and blood-borne viruses who regularly engage in behaviours that put them at risk of infection.

Pumping iron, risking infection? Exposure to hepatitis C, hepatitis B and HIV among anabolic–androgenic steroid injectors in Victoria, Australia

AIMS To measure exposure to the hepatitis C and B viruses and HIV among Victorian steroid injectors and evaluate associations between exposure and risk behaviour, and report other characteristics of the study group. DESIGN Seroprevalence study using a convenience sample. SETTING Victoria, Australia. PARTICIPANTS Current injectors of illicit anabolic steroids. MEASUREMENTS Prevalences of exposure to HIV and the hepatitis B and C viruses; associations of characteristics and behaviours with exposure; descriptive statistics for the sample. FINDINGS Six of 63 blood samples (9.5%) contained hepatitis C virus antibodies; 12.0% tested positive for hepatitis B core antibody; none contained anti-HIV. Hepatitis C virus exposure was associated with heroin injection, imprisonment, sharing needles to inject other drugs, number of tattoos, and hepatitis B virus exposure. No significant differences existed in the steroid-related risk behaviour of exposed and non-exposed individuals. Hepatitis B virus exposure was associated only with hepatitis C virus exposure, past imprisonment and age of first injection. CONCLUSIONS Exposure to the hepatitis B and C viruses was detected; hepatitis C virus exposure was at much lower prevalence than normally found among other drug injectors. Factors other than steroid injecting were associated with exposure. Nonetheless, the hepatitis C-exposed reported many steroid-related and other risk behaviours which could spread the virus. Steroid injectors should not be neglected in blood-borne virus prevention efforts.