Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years' Experience

The Rise of Syphilis Infections and Reinfections over a Decade (2009-2019) in the Bolognese Area: A Retrospective Analysis

Syphilis has resurged globally, especially in urban areas of developed countries. This study analyses syphilis cases over a decade at an STD centre in Bologna, Italy, examining new diagnoses, reinfections, and impacts on high-risk subgroups, compared with national and European data. Data from 2009-2019 were retrospectively reviewed, including primary, secondary, early latent, late latent, and indeterminate syphilis cases, as per WHO guidelines. Cases of tertiary syphilis and serological-only diagnoses were excluded. Statistical analysis was conducted using IBM SPSS Statistics 26 with logistic regression and chi-square tests. A total of 1086 syphilis cases were identified, rising from 43 cases in 2009 to 157 in 2019-a 265% increase over the decade. In 2019, reinfections accounted for 23.7% of cases, primarily among men who have sex with men (MSM, 82.1%), with an HIV co-infection rate of 37.6%. The most affected age group was over 45 years. Bologna's syphilis rates consistently exceeded European averages, with a higher median age, indicating unique transmission patterns and public health challenges. The high reinfection rate among MSM and older individuals emphasises the need for targeted public health initiatives. The sharp rise in cases highlights potential influences such as Bologna's population dynamics and the increased use of Pre-Exposure Prophylaxis (PrEP). Focused public health efforts, particularly on high-risk groups, are critical to address this challenge effectively.

Slovenia's national HIV PrEP programme: Evaluation of real-world implementation

BACKGROUND

The aim of our study was to evaluate real-world implementation of Slovenia's national HIV PrEP programme, which is fully covered by our national health insurance.

METHODS

In retrospective cohort study we analysed the data from all men who have sex with men (MSM) who were enrolled in PrEP programme of our clinic between 1 January 2022 and 31 December 2022.

RESULTS

A total of 190 MSM with an average age of 36.7 years were included in our analysis. 151 (79.5%) decided for event-driven PrEP and 39 (20.5%) opted for daily PrEP. Self-reported adherence was 95%. Among eligibility criteria, unprotected sex was the most common one, followed by one or more STIs in the past, use of chemsex and use of HIV post-exposure prophylaxis in the past. No new cases of HIV infection and no significant deterioration of kidney or liver function were observed during the follow-up. Sixty-seven episodes of STIs were diagnosed and treated. Gonorrhea (32), chlamydia (14), and Mpox (10) were the most common ones.

CONCLUSIONS

PrEP was successfully implemented into everyday clinical practice, proving to be both safe and effective. High number of diagnosed STIs suggests that the PrEP programme, combined with STI screening and vaccination, provides a strong public health impact among MSM in Slovenia.

Application of the Delphi Method for Content Validity Analysis of a Questionnaire to Determine the Risk Factors of the Chemsex

Chemsex is understood as "the intentional use of stimulant drugs to have sex for an extended time among gay, bisexual, and other men who have sex with men". It is a public health problem because of the increased incidence of cases and because of the consequences on the physical and mental health of those who practice it.

AIM

This study aimed to analyze, with the help of the Delphi method, the content validity of a new instrument to assess the risk of behaviors associated with the chemsex phenomenon.

METHOD

First, a bank of items identified from the literature was elaborated. Secondly, 50 experts with knowledge of the chemsex phenomenon at the national level were contacted. A Delphi group was formed with them to carry out two rounds of item evaluation. The linguistic evaluation (comprehension and appropriateness) was assessed using a Likert scale from 1 to 5 for each item. Items that did not reach a mean score of 4 were eliminated. Content assessment was calculated using each item's content validity index (CVI) and Aiken's V (VdA). A minimum CVI and VdA value of 0.6 was established to include the items in the questionnaire.

RESULTS

A total of 114 items were identified in the literature. In the first round of Delphi evaluation, 36 experts evaluated the items. A total of 58 items were eliminated for obtaining a CVI or VdA of less than 0.6, leaving 56 items. In a second Delphi round, 30 experts re-evaluated the 56 selected items, where 4 items were eliminated for being similar, and 10 items were also eliminated for not being relevant to the topic even though they had values higher than 0.6, leaving the scale finally composed of 52 items.

CONCLUSION

A questionnaire has been designed to assess the risk of behaviors associated with the chemsex phenomenon. The items that make up the questionnaire have shown adequate content and linguistic validity. The Delphi method proved to be a helpful technique for the proposed objective.