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MacPhail C, Manlik K, Dews H, Mao L, Rutherford A. Ending HIV Transmission in Australia: Expanding PrEP to Cisgender Women: A Scoping Review. AIDS Behav 2024:10.1007/s10461-024-04386-z. [PMID: 38806843 DOI: 10.1007/s10461-024-04386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
Pre-exposure prophylaxis (PrEP) availability through the Pharmaceutical Benefits Scheme provides real potential for the elimination of HIV transmission in Australia, as evidenced by a rapid decline in HIV incidence among gay and bisexual men (GBM). However, HIV elimination will not be possible without also extending PrEP to other populations, including cisgender women. We conducted a scoping review to examine the extent to which PrEP access for cisgender women has been considered in Australia. A comprehensive search across five databases, grey literature, and hand search of references was conducted. A single reviewer conducted title and abstract screening and two reviewers completed full-text screening and data extraction. Nineteen documents were included in the final review and included both peer-reviewed journal articles and guidelines and strategies. Focused discussion of cisgender women's use of PrEP was largely missing from the literature and, although their use of PrEP is supported in some relevant guidelines, little has been done to actively develop strategies to inform cisgender women about PrEP as a precursor to prescribing for HIV prevention. Healthcare providers' narrow view of PrEP as being the domain of GBM further limits cisgender women's potential access. If HIV elimination in Australia is to be a reality, we need to develop mechanisms to specifically engage with cisgender women about PrEP.
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Affiliation(s)
- Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, Australia.
| | - Kate Manlik
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Hannah Dews
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Alison Rutherford
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
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McDonald K, Kirkman M. HIV-positive women in Australia explain their use and non-use of antiretroviral therapy in preventing mother-to-child transmission. AIDS Care 2010; 23:578-84. [DOI: 10.1080/09540121.2010.482124] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Karalyn McDonald
- a Australian Research Centre in Sex, Health and Society/Mother & Child Health Research , La Trobe University , 215 Franklin Street, Melbourne , VIC , 3000 , Australia
| | - Maggie Kirkman
- b Key Centre for Women's Health in Society, Melbourne School of Population Health , University of Melbourne , 2nd Floor, 723 Swanston St., VIC , 3010 , Australia
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Giles ML, Hellard ME, Lewin SR, O'Brien ML. The "work" of women when considering and using interventions to reduce mother-to-child transmission (MTCT) of HIV. AIDS Care 2010; 21:1230-7. [PMID: 20024698 DOI: 10.1080/09540120902803166] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper explores HIV-infected women's experiences of considering and using recommended interventions during pregnancy and postpartum to reduce mother-to-child transmission of HIV. Data were collected from 45 HIV-infected women aged 18-44 years living in Melbourne, Australia. A semi-structured interview was used to collect qualitative information on women's reproductive experience and intentions. The 15 women who had their children after their HIV diagnosis engaged in significant work including surveillance and safety work to minimise stigma and infection, information work to inform decisions and actions, accounting work to calculate risk and benefit, hope and worry work concerning a child's infection status and impact of interventions, work to redefine an acceptable maternal identity, work to prepare an alternative story to counter the disclosure effect of the intervention and emotional work to reconcile guilt when considering these interventions. This study provides a framework to help clinicians understand the real and on-going "work" that women engage in when they are considering interventions recommended by their physicians to reduce transmission of HIV. Even in circumstances where access to and acceptance of interventions are high, women continue to engage in this work even after they have a made a decision about a particular intervention.
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Affiliation(s)
- Michelle L Giles
- The Alfred Hospital, Infectious Diseases Unit, Melbourne, Australia.
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McDonald AM, Zurynski YA, Wand HC, Giles ML, Elliott EJ, Ziegler JB, Kaldor JM. Perinatal exposure to HIV among children born in Australia, 1982–2006. Med J Aust 2009; 190:416-20. [DOI: 10.5694/j.1326-5377.2009.tb02488.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 12/09/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Ann M McDonald
- National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW
| | - Yvonne A Zurynski
- Australian Paediatric Surveillance Unit, Children's Hospital at Westmead, Sydney, NSW
| | - Handan C Wand
- National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW
| | - Michelle L Giles
- Infectious Diseases Unit, Alfred Hospital, Melbourne, VIC
- Department of Medicine, University of Melbourne, Melbourne, VIC
| | - Elizabeth J Elliott
- Australian Paediatric Surveillance Unit, Children's Hospital at Westmead, Sydney, NSW
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney NSW
| | - John B Ziegler
- Sydney Children's Hospital, Sydney, NSW
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - John M Kaldor
- National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW
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Giles ML, McDonald AM, Elliott EJ, Ziegler JB, Hellard ME, Lewin SR, Kaldor JM. Variable uptake of recommended interventions to reduce mother‐to‐child transmission of HIV in Australia, 1982–2005. Med J Aust 2008; 189:151-4. [DOI: 10.5694/j.1326-5377.2008.tb01949.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 03/02/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle L Giles
- Department of Medicine, Monash University, Melbourne, VIC
- Centre for Epidemiology and Population Health Research, Burnet Institute, Melbourne, VIC
- Infectious Disease Unit, Alfred Hospital, Melbourne, VIC
| | - Ann M McDonald
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW
- Children's Hospital at Westmead, Sydney, NSW
- Australian Paediatric Surveillance Unit, Sydney, NSW
| | - John B Ziegler
- Department of Immunology, Sydney Children's Hospital, Sydney, NSW
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - Margaret E Hellard
- Centre for Epidemiology and Population Health Research, Burnet Institute, Melbourne, VIC
- Infectious Disease Unit, Alfred Hospital, Melbourne, VIC
| | - Sharon R Lewin
- Department of Medicine, Monash University, Melbourne, VIC
- Infectious Disease Unit, Alfred Hospital, Melbourne, VIC
| | - John M Kaldor
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW
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Gilles MT, Dickinson JE, Cain A, Turner KA, McGuckin R, Loh R, Prescott SL, French MA. Perinatal HIV transmission and pregnancy outcomes in indigenous women in Western Australia. Aust N Z J Obstet Gynaecol 2008; 47:362-7. [PMID: 17877592 DOI: 10.1111/j.1479-828x.2007.00758.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Implementation of obstetric and neonatal interventions has reduced mother to child transmission of HIV. Health outcomes for Aboriginal people are often worse than for non-Aboriginal people; was this the case for HIV infection in pregnancy? AIMS To compare the management and outcomes of pregnancy in Aboriginal and non-Aboriginal HIV-positive women in Western Australia (WA). METHODS A retrospective study of all pregnancies delivered in WA to HIV-infected women from 1991 until 2005. Managed pregnancies were compared in Aboriginal and non-Aboriginal women. Outcome measures were HIV status of the babies, birthweight, rates of caesarean delivery and perinatal mortality. RESULTS Fifty-six pregnancies occurred in 41 HIV-infected women resulting in 54 live births. Of the 41 women, 16 (39%) were Aboriginal. In regard to birthweight, perinatal mortality, rates of caesarean section and rates of HIV perinatal transmission, there was no significant difference between babies born to Aboriginal and those born to non-Aboriginal mothers. In contrast, of the eight pregnancies, with no contact with the multidisciplinary team, five babies (63%) were infected with HIV (2% vs 63%P = 0.001). There was no case of perinatal HIV infection in 22 pregnancies of the Aboriginal women that received care through the multidisciplinary team; perinatally acquired HIV occurred in the first pregnancy of one of these women before she was aware of her status when she was not managed by the team. CONCLUSIONS Similar outcomes can be achieved in both HIV-positive Aboriginal and non-Aboriginal women, through intensive, culturally appropriate, multidisciplinary care and without elective caesarean delivery.
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Affiliation(s)
- Marisa T Gilles
- Combined Universities Centre for Rural Health, Geraldton, WA, Australia.
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Zurynski YA, Peadon E, Bower C, Elliott EJ. Impacts of national surveillance for uncommon conditions in childhood. J Paediatr Child Health 2007; 43:724-31. [PMID: 17924937 DOI: 10.1111/j.1440-1754.2007.01216.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The Australian Paediatric Surveillance Unit (APSU) facilitates the conduct of national collaborative research that is consistent with national health priorities, has potential to impact on public health, and addresses gaps in knowledge. Since 1993 paediatricians and other child health specialists have contributed monthly data on rare childhood conditions to the APSU. Over 40 conditions, including infectious diseases, injuries, vaccine-preventable diseases and genetic disorders have been studied. Information on epidemiology, frequency, diagnosis, management and short-term outcomes of these conditions is collected and provides evidence to support changes to clinical practice, prevention policy and allocation of health resources. In this review we give examples of the value of information gathered through the APSU surveillance system in the last 14 years.
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Affiliation(s)
- Yvonne A Zurynski
- Australian Paediatric Surveillance Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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Grenier D, Elliott EJ, Zurynski Y, Rodrigues Pereira R, Preece M, Lynn R, von Kries R, Zimmermann H, Dickson NP, Virella D. Beyond counting cases: public health impacts of national Paediatric Surveillance Units. Arch Dis Child 2007; 92:527-33. [PMID: 17158859 PMCID: PMC2066170 DOI: 10.1136/adc.2006.097451] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2006] [Indexed: 11/04/2022]
Abstract
Paediatric Surveillance Units (PSUs) have been established in 14 countries and facilitate national, prospective, active surveillance for a range of conditions, with monthly reporting by child health specialists. The International Network of Paediatric Surveillance Units (INoPSU) was established in 1998 and facilitates international collaboration among member PSUs and allows for sharing of resources, simultaneous data collection and hence comparison of data from different geographical regions. The impact of data collected by PSUs, both individually and collectively as members of INoPSU, on public health outcomes, clinical care and research is described.
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Affiliation(s)
- D Grenier
- Canadian Paediatric Surveillance Program, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Canada
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Garland SM, Ung L, Vujovic OV, Said JM. Cosmetic tattooing: A potential transmission route for HIV? Aust N Z J Obstet Gynaecol 2006; 46:458-9. [PMID: 16953864 DOI: 10.1111/j.1479-828x.2006.00635.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Suzanne M Garland
- Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Carlton, Victoria, Australia.
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Abstract
In 2004, the diagnosis of established human immunodeficiency virus (HIV) infection can be made with close to 100% assurity. The extraordinarily engineered performances of HIV-screening assays are unprecedented. The well-established confirmatory tests performed by well-versed laboratories using criteria that are well understood in order to interpret the results of these tests give highly accurate outcomes of diagnostic testing strategies. Furthermore, the ability to monitor the progress of the infection and the viral pathogenesis is possible through the use of tests that quantify viral load or the peripheral CD4+ T-cells and other lymphocyte sub-type levels. Newer laboratory testing mechanisms, such as assessment of reverse transcriptase activity and sophisticated cell staining and flow cytometric analyses, have been used to map disease processes and progress on a research level and may be used in future to fine-tune therapy and to follow disease progression in even greater detail. Regulation of all HIV tests is of the highest level in Australia. In-house tests will be expected to conform to the levels specified for commercially produced tests.
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Affiliation(s)
- Elizabeth M Dax
- National Serology Reference Laboratory, Australia, Fitzroy, Victoria, Australia.
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Ziegler JB, Graves N. The time to recommend antenatal HIV screening for all pregnant women has arrived. Med J Aust 2004; 181:124-5. [PMID: 15287826 DOI: 10.5694/j.1326-5377.2004.tb06199.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 06/01/2004] [Indexed: 11/17/2022]
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Mak DB, Murray JC, Bulsara MK. Antenatal screening for sexually transmitted infections in remote Australia. Aust N Z J Obstet Gynaecol 2003; 43:457-62. [PMID: 14712951 DOI: 10.1046/j.0004-8666.2003.00144.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Antenatal screening for, and prompt management of, sexually transmitted infections (STI) can prevent adverse maternal, fetal and perinatal outcomes. This is particularly important in areas of high STI endemicity. AIMS To assess adherence with antenatal STI screening guidelines in a large remote region, and whether completeness of antenatal syphilis screening improved after the onset of a regional syphilis outbreak in April 2001. METHODS Data from the regional antenatal syphilis screening database from 1997 to 2002 were analysed to identify time trends in the completeness of antenatal syphilis screening. Adherence to antenatal screening guidelines was assessed by examining pathology request forms of women undergoing antenatal syphilis screening to determine whether screening for gonorrhoea, chlamydia, hepatitis B and HIV had also been carried out. Logistic regression was used to analyse associations between adherence to the guidelines and patient's age and race, and health service characteristics. RESULTS Adherence to syphilis screening guidelines improved from 44.6% in 1997 to 68.9% in 2001 and 81.4% in 2002. After controlling for the time interval between the first antenatal syphilis test and date of delivery, being younger and Aboriginal, and delivering after the syphilis outbreak had been identified were positively associated with adherence to syphilis screening guidelines. Proportions of antenates screened for gonorrhoea/chlamydia, hepatitis B and HIV at booking and for gonorrhoea/chlamydia in the third trimester were 69%, 91%, 68% and 77%, respectively. Aboriginal women were more likely to have been screened for gonorrhoea and chlamydia. Women seen by a doctor were more likely to have undergone HIV screening than those who saw a nurse. CONCLUSIONS Significant improvement in adherence to antenatal syphilis screening guidelines occurred after identification of a syphilis outbreak. This achievement is reason for optimism regarding the potential to achieve more complete antenatal screening of other STI.
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Affiliation(s)
- Donna B Mak
- Kimberley Public Health Unit, Derby, Western Australia, Australia.
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