Trends and predictors of linkage to HIV outpatient care following diagnosis in the era of expanded testing in England, Wales and Northern Ireland: Results of a national cohort study

Epidemiology of HIV infection and associated behaviours among people who inject drugs in England, Wales, and Northern Ireland: Nearly 40 years on

Introduction

People who inject drugs are at high risk of blood‐borne infections. We describe the epidemiology of HIV among people who inject drugs in England, Wales, and Northern Ireland (EW&NI) since 1981.

Methods

National HIV surveillance data were used to describe trends in diagnoses (1981–2019), prevalence (1990–2019), and behaviours (1990–2019) among people who inject drugs aged ≥15 years in EW&NI. HIV care and treatment uptake were assessed among those attending in 2019.

Results

Over the past four decades, the prevalence of HIV among people who inject drugs in EW&NI remained low (range: 0.64%–1.81%). Overall, 4978 people who inject drugs were diagnosed with HIV (3.2% of cases). Diagnoses peaked at 234 in 1987, decreasing to 78 in 2019; the majority were among white men born in the UK/Europe (90%), though the epidemic diversified over time. Late diagnosis (CD4 <350 cells/µl) was common (2010–2019: 52% [429/832]). Of those who last attended for HIV care in 2019, 97% (1503/1550) were receiving HIV treatment and 90% (1375/1520) had a suppressed viral load (<200 copies/ml).

HIV testing uptake has steadily increased among people who inject drugs (32% since 1990). However, in 2019, 18% (246/1404) of those currently injecting reported never testing. The proportion of people currently injecting reporting sharing needles/syringes decreased from 1999 to 2012, before increasing to 20% (288/1426) in 2019, with sharing of any injecting equipment at 37% (523/1429).

Conclusion

The HIV epidemic among people who inject drugs in EW&NI has remained relatively contained compared with in other countries, most likely because of the prompt implementation of an effective national harm reduction programme. However, risk behaviours and varied access to preventive interventions among people who inject drugs indicate the potential for HIV outbreaks.

Sexually transmitted infections epidemiology and risk assessment at the main correctional facility in Malta (2017-2019)

BACKGROUND

Inmates suffer from mental and physical ailments combined with substance misuse and addiction which are often underreported or disregarded by sufferers, for fear of being stigmatized. This vulnerable group has complex medical and psychosocial needs and hence gathering data is essential for a holistic approach to care.

OBJECTIVES

Understanding the interplay between sexually transmitted (STIs) and blood borne infections, substance misuse and mental health is essential to enable targeted interventions and outreach programmes. The aim was to analyse the occurrence of STIs, hepatitis and tuberculosis in inmates at the main custodial facility in Malta; to assess risk behaviours and vulnerabilities through an outreach programme; to offer treatment and referral and to develop recommendations for screening of prison inmates.

METHODS

A mixed methodology study was used which involved analysis of health data pooled from the Genitourinary Clinic (GUC) and Corradino Correctional Facility (CCF) in Malta.

RESULTS

In the study period, 206 inmates were tested for STIs, 67.9% males, aged between 14 and 72. Only 27% were not sexually active in the 6 months prior to testing. Among those sexually active, 31% had had sex with casual partners and 43% had never used condoms for sexual intercourse. Seventy-five percent admitted to drug use. The most common STI diagnosed was HPV (16.5%), followed by syphilis (5.8%). Genital dermatoses were also frequent (9.2%). The prevalence of Hepatitis C was high (24.5%), in relation to intravenous drug use.

CONCLUSION

The authors advocate for more collaboration between sexual health clinics and prisons to address educational interventions and STIs' testing. Cultural and linguistic barriers should be considered when devising national health strategies and screening recommendations in custodial settings. Adequate follow-up should extend into the community setting once inmates leave the prison to ensure a continuum of care.