Catriona Ooi

Human papillomavirus prevalence in unvaccinated heterosexual males following a national female vaccination program

Background In Australia, high uptake of the quadrivalent human papillomavirus (4vHPV) vaccine has led to reductions in the prevalence of human papillomavirus (HPV) genotypes 6, 11, 16, and 18 in women and girls aged ≤25 years. We evaluated the impact of the program impact on HPV prevalence in unvaccinated male subjects. Methods Sexually active heterosexual male subjects aged 16-35 years were recruited in 2014-2016. Participants provided a self-collected penile swab sample for HPV genotyping (Roche Linear Array) and completed a demographic and risk factor questionnaire. Results The prevalence of 4vHPV genotypes among 511 unvaccinated male subjects was significantly lower in those aged ≤25 than in those aged >25 years: 3.1% (95% confidence interval, 1.5%-5.7%) versus 13.7% (8.9%-20.1%), respectively (P < .001); adjusted prevalence ratio, 0.22 (.09-.51; P < .001). By contrast, the prevalence of high-risk HPV genotypes other than 16 and 18 remained the same across age groups: 16.8% (95% confidence interval, 12.6%-21.9%) in men aged ≤25 years and 17.9% (12.4%-25.0%) in those aged >25 years (P = .76); adjusted prevalence ratio, 0.98, (.57-1.37; P = .58). Conclusions A 78% lower prevalence of 4vHPV genotypes was observed among younger male subjects. These data suggest that unvaccinated men may have benefited from herd protection as much as women from a female-only HPV vaccination program with high coverage.

The rise of targeted HIV oral rapid testing in Australia.

Objective: To assess the performance and acceptability of the OraQuick Advance Rapid HIV‐1/2 Antibody Test (ORT) in Australia.

Validation of participant eligibility for pre-exposure prophylaxis: Baseline data from the PRELUDE demonstration project

Background In Australia, pre-exposure prophylaxis (PrEP) is targeted to individuals at high risk for HIV infection. We describe the HIV risk profile and characteristics of PRELUDE participants, and evaluate the population validity of the sample in representing high-risk gay and bisexual men (GBM) eligible for PrEP. Methods PRELUDE is an on-going, open-label, single-arm observational study. Participants were identified in clinics and screened for eligibility using a paper-based risk assessment tool which followed the New South Wales (NSW) PrEP guidelines. Selection was validated using an independent online behavioural survey, completed by study participants upon enrolment. Demographic information was analysed using descriptive statistics, and kappa tests were used to determine agreement between reporting of high-risk practices in the risk assessment and behavioural survey. Results During 2014–15, 471 individuals were targeted for enrolment; 341 were assessed for PrEP eligibility and 313 were enrolled. Of these, 303 (97%) identified as GBM. Overall, 85% of GBM met at least one high-risk criterion; 68% reported receptive intercourse with an HIV-positive or unknown status casual male partner, and 37% reported methamphetamine use in the three months preceding enrolment. The remaining 15% were enrolled based on medium-risk behaviours, or at the clinicians’ discretion. We found an 82% total agreement between self-reported high-risk behaviour and clinicians’ categorisation of GBM as being at high risk for HIV based on PrEP eligibility criteria. Conclusions Behavioural eligibility criteria used by clinicians successfully identified individuals at high risk for HIV infection. This targeted approach ensures that the greatest public health and HIV prevention benefits can be derived in a setting without universal access to PrEP.

Sexual behaviour and HIV prevention needs of men attending a suburban Sex on Premises Venue.

UNLABELLED Background Sexual behaviour and HIV prevention needs of men who have sex with men (MSM) attending suburban Sex on Premises Venues (SOPVs) are understudied. METHODS A cross-sectional survey examining sexual activity, health services utilisation, sexual health services needs and STI knowledge was conducted among MSM over 18 years old attending a SOPV in Western Sydney between June and July 2013. RESULTS A total of 213 MSM were sampled; approximately half of the respondents (51%) reported that they only had sex with other men, and 46% had sex with both men and women. Condom use varied considerably, with ~50% of responders not using condoms consistently during anal sex. Consistent condom usage was not associated with having regular, casual or a mix of regular and casual partners during anal sex (P=0.09). The majority (59.5%) obtained sexual health screening services from general practitioners; only 15.0% sought services from a local sexual health clinic. Over half of respondents (57.7%) believed that SOPVs should offer on-site and free testing services. Those with the highest level of previous STI diagnoses were gay men (41%), those who only had casual partners (38%) and those who did not complete high school (65%). CONCLUSIONS Sexual health services and non-government organisations should consider targeting bisexual men with rapid HIV testing and condom usage campaigns. Low cost or free on-site HIV and STI testing at SOPVs and stronger partnerships between general practitioners and sexual health services are needed.

Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy

Objectives: We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy. Design: Cross-sectional. Methods: Patients recruited into a nationwide cohort and assessed for prevalence and type of concomitant medication (including polypharmacy, defined as ≥5 concomitant medications), pharmacokinetic or pharmacodynamic interactions, potential concomitant medication adverse effects and concomitant medication adherence. Factors associated with concomitant medication polypharmacy and with imperfect adherence were identified using multivariable logistic regression. Results: Of 522 participants, 392 (75%) took a concomitant medication (mostly cardiovascular, nonprescription or antidepressant). Overall, 280 participants (54%) had polypharmacy of concomitant medications and/or a drug interaction or contraindication. Polypharmacy was present in 122 (23%) and independently associated with clinical trial participation, renal impairment, major comorbidity, hospital/general practice-based HIV care (versus sexual health clinic) and benzodiazepine use. Seventeen participants (3%) took at least one concomitant medication contraindicated with their antiretroviral therapy, and 237 (45%) had at least one pharmacokinetic/pharmacodynamic interaction. Concomitant medication use was significantly associated with sleep disturbance and myalgia, and polypharmacy of concomitant medications with diarrhoea, fatigue, myalgia and peripheral neuropathy. Sixty participants (12%) reported imperfect concomitant medication adherence, independently associated with requiring financial support, foregoing necessities for financial reasons, good/very good self-reported general health and at least 1 bed day for illness in the previous 12 months. Conclusion: In a resource-rich setting with universal healthcare access, the majority of this sample took a concomitant medication. Over half had at least one of concomitant medication polypharmacy, pharmacokinetic or pharmacodynamic interaction. Concomitant medication use was associated with several adverse clinical outcomes.

Deadly Liver Mob: opening the door – improving sexual health pathways for Aboriginal people in Western Sydney

Background: The Deadly Liver Mob project (DLM) is an incentive-based, peer-driven health promotion intervention for Aboriginal people, focusing on hepatitis C and offering education and screening for sexually transmissible infections (STI) and blood-borne viruses (BBV). This study aims to assess the DLM effect on attendance and STI/BBV screening, describe BBV risk factors and report infection rates among Aboriginal people attending Western Sydney Sexual Health Centre (WSSHC). Methods: A retrospective review of Aboriginal clients during the first year of the DLM project was compared with Aboriginal clients who attended during the 5.3 years before implementation of the project. Data on attendance, screening rates, demographics, lifestyle information and STI/BBV results were extracted. Results: There was a 10-fold increase in the number of Aboriginal people attending, via the DLM project (P < 0.01). The DLM group were more likely to be male (47 vs 28%), ≥ 35 years (46 vs 27%), report injecting drug use (IDU) (43 vs 26%), a history of incarceration (48 vs 24%) or unsafe tattooing (36 vs 16%) and have comprehensive STI/BBV testing (85 vs 54%); (P < 0.01 for all). There were 79 positive results and 30 commenced hepatitis B vaccination in the DLM period, compared with 15 and 19, in the non-DLM period. Conclusions: The DLM project effectively increased sexual healthcare attendance and screening for Aboriginal people in Western Sydney. The DLM has fostered ongoing care and facilitated service engagement for individuals at high risk of contracting STIs and BBVs.BACKGROUND The Deadly Liver Mob project (DLM) is an incentive-based, peer-driven health promotion intervention for Aboriginal people, focusing on hepatitis C and offering education and screening for sexually transmissible infections (STI) and blood-borne viruses (BBV). This study aims to assess the DLM effect on attendance and STI/BBV screening, describe BBV risk factors and report infection rates among Aboriginal people attending Western Sydney Sexual Health Centre (WSSHC). METHODS A retrospective review of Aboriginal clients during the first year of the DLM project was compared with Aboriginal clients who attended during the 5.3 years before implementation of the project. Data on attendance, screening rates, demographics, lifestyle information and STI/BBV results were extracted. RESULTS There was a 10-fold increase in the number of Aboriginal people attending, via the DLM project (P<0.01). The DLM group were more likely to be male (47 vs 28%),≥35 years (46 vs 27%), report injecting drug use (IDU) (43 vs 26%), a history of incarceration (48 vs 24%) or unsafe tattooing (36 vs 16%) and have comprehensive STI/BBV testing (85 vs 54%); (P<0.01 for all). There were 79 positive results and 30 commenced hepatitis B vaccination in the DLM period, compared with 15 and 19, in the non-DLM period. CONCLUSIONS The DLM project effectively increased sexual healthcare attendance and screening for Aboriginal people in Western Sydney. The DLM has fostered ongoing care and facilitated service engagement for individuals at high risk of contracting STIs and BBVs.

P4.22 Crossing the bridge: exploring sexual risk profiles of men who have sex with men attending a sex on premises venue and a public sexual health clinic for sti screening in sydney, australia

Introduction In Australia, men who have sex with men (MSM) are targeted to curb the spread of HIV and STIs. ‘Non-gay’ identifying MSM (NGMSM) may not identify with health messages, impacting knowledge of HIV/STI harm minimisation and result in poorer health-seeking behaviours. NGMSM and other men who have sex with men and women are often hidden to clinical services. These men may act as bridges for HIV/STI transmission to female partners. Novel strategies to reach this group include opportunistic HIV/STI screening at sex on premises venues (SOPV). We compared the demographics, testing and sexual behaviour of MSM attending a SOPV to MSM attending an established sexual health clinic (SHC). Method A daytime SOPV HIV/STI screening service was conducted 2–3 consecutive days per month from November 2015 for 12 months. All patrons were offered testing. The comparison group were MSM attending a local SHC for screening the week following each SOPV clinic. The SHC operates weekdays with appointment and walk-in options. At both sites, participants consented to provide demographic information, contact details and a brief sexual history. Demographics, sexual behaviour and testing practices were compared between the 2 groups. Results During the study period 84 men tested at the SOPV and 108 at the SHC. SOPV testers were older (mean age, 48.4 years. vs 34.6 years.; p<0.001) and were more likely to have had sex with a female in the past 12 months (49/84, 58% vs. 19/105, 18%; p<0.001). Compared with SHC testers, more SOPV testers had never had an HIV test (23/84, 27% vs. 12/108, 11%; p<0.01). In the previous 3 months, 100% condom use with regular partners was similar in both groups (SOPV 33/84, 39% vs. SHC 37/105, 35%; p=0.67). Conclusion Inconsistent condom use with casual and regular sex partners, combined with higher reported rates of sex with females, may enable SOPV testers to act as bridges for STI/HIV transmission between MSM and heterosexual populations. Our findings have implications for HIV/STI service provision, contact tracing and local health promotion initiatives.

Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project

Introduction The effectiveness of daily pre-exposure prophylaxis (PrEP) is well established. However, there has been increasing interest in non-daily dosing schedules among gay and bisexual men (GBM). This paper explores preferences for PrEP dosing schedules among GBM at baseline in the PRELUDE demonstration project. Materials and methods Individuals at high-risk of HIV were enrolled in a free PrEP demonstration project in New South Wales, Australia, between November 2014 and April 2016. At baseline, they completed an online survey containing detailed behavioural, demographic, and attitudinal questions, including their ideal way to take PrEP: daily (one pill taken every day), event-driven (pills taken only around specific risk events), or periodic (daily dosing during periods of increased risk). Results Overall, 315 GBM (98% of study sample) provided a preferred PrEP dosing schedule at baseline. One-third of GBM expressed a preference for non-daily PrEP dosing: 20% for event-driven PrEP, and 14% for periodic PrEP. Individuals with a trade/vocational qualification were more likely to prefer periodic to daily PrEP [adjusted odds ratio (aOR) = 4.58, 95% confidence intervals (95% CI): (1.68, 12.49)], compared to individuals whose highest level of education was high school. Having an HIV-positive main regular partner was associated with strong preference for daily, compared to event-driven PrEP [aOR = 0.20, 95% CI: (0.04, 0.87)]. Participants who rated themselves better at taking medications were more likely to prefer daily over periodic PrEP [aOR = 0.39, 95% CI: (0.20, 0.76)]. Discussion Individuals’ preferences for PrEP schedules are associated with demographic and behavioural factors that may impact on their ability to access health services and information about PrEP and patterns of HIV risk. At the time of data collection, there were limited data available about the efficacy of non-daily PrEP schedules, and clinicians only recommended daily PrEP to study participants. Further research investigating how behaviours and PrEP preferences change correspondingly over time is needed. Trial registration ClinicalTrials.gov NCT02206555. Registered 28 July 2014.

An express sexual health service: in and out in a jiffy

Objectives The aims of the present study were to assess client satisfaction with existing services, gauge the interest in an express service option and to compare waiting times before and after the introduction of an express service. Methods A survey evaluating satisfaction with existing services, waiting times and interest in an express service was offered to all clients attending the Western Sydney Sexual Health Centre in May 2013. A pilot of the express service ran from May to December 2013, and a follow-up survey was conducted in December 2013. Results There was a high level of interest in the express service. Median waiting times and satisfaction with waiting times improved following introduction of the express clinic. A high level of satisfaction was reported in those who had used the express service. Conclusions The express service was well received by clients and has the potential to improve client waiting times, increase clinic capacity and improve the overall client journey through the clinic. What is known about the topic? Express service options for testing for sexually transmitted infections (STIs) are being introduced both in Australia and overseas. Express services have been shown to increase clinic capacity and can create cost savings. They appear to be acceptable to clients. What does this paper add? This paper demonstrates that an express service option can be successfully introduced in an at-risk multicultural population. What are the implications for practitioners? The present study helps show that new models can be successfully introduced into long-standing traditional service models. Such models can help improve efficiency, clinic capacity and may produce cost savings. An express clinic is an option for screening asymptomatic clients for STIs. Clients complete a self-collected history and take self-collected specimens, and clinician-collected blood tests and throat swabs are advised accordingly.

Cervical screening uptake and abnormalities among women attending sexual health clinics for HIV care

The aim of this study was to describe cervical screening uptake and assess correlates of screen-detected abnormalities in women attending sexual health services for HIV care. Of 156 women, 115 had documentation of a Pap test at least once in 3 years and 9.6% had an annual Pap test performed. Pap abnormalities were associated with younger age, being born in Sub-Saharan Africa, more recent arrival in Australia, lower CD4 count, detectable viral load, shorter time on antiretroviral therapy and more recent HIV diagnosis. Women accessing sexual health services for HIV care, especially those from culturally and linguistically diverse backgrounds, appear to be substantially under-screened and efforts to optimise screening are needed.