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Harney BL, Sacks-Davis R, van Santen DK, Traeger MW, Wilkinson AL, Asselin J, Fairley CK, Roth N, Bloch M, Matthews GV, Donovan B, Guy R, Stoové M, Hellard ME, Doyle JS. Hepatitis C virus reinfection incidence among gay and bisexual men with HIV in Australia from 2016 to 2020. Liver Int 2024; 44:1024-1031. [PMID: 38291946 DOI: 10.1111/liv.15841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND There is some concern that hepatitis C virus (HCV) reinfection might impact HCV micro-elimination efforts among gay and bisexual men (GBM) with HIV. However, there is a limited understanding of reinfection incidence in the context of unrestricted government-funded HCV treatment. We aimed to estimate HCV reinfection incidence among GBM with HIV in Australia from 2016 to 2020. METHODS Data were from 39 clinics participating in ACCESS, a sentinel surveillance network for blood borne viruses and sexually transmissible infections across Australia. GBM with HIV who had evidence of treatment or spontaneous clearance with at least one positive HCV RNA test, a subsequent negative HCV RNA test, and at least one additional HCV RNA test between 1st January 2016 and 31st December 2020 were eligible for inclusion. A new HCV RNA positive test and/or detectable viral load was defined as a reinfection. Generalised linear modelling was used to examine trends in reinfection. RESULTS Among 12 213 GBM with HIV who had at least one HCV test, 540 were included in the reinfection incidence analysis, of whom 38 (7%) had evidence of reinfection during the observation period. Over 1124 person-years of follow-up, the overall rate of reinfection was 3.4/100PY (95% CI 2.5-4.6). HCV reinfection incidence declined on average 30% per calendar year (Incidence Rate Ratio 0.70, 95% CI 0.54-0.91). CONCLUSION HCV reinfection incidence has declined among GBM with HIV in Australia since government-funded unrestricted DAAs were made available. Ongoing HCV RNA testing following cure and prompt treatment for anyone newly diagnosed is warranted to sustain this.
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Affiliation(s)
- Brendan L Harney
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Anna L Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, Victoria, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
- Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
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Harney BL, Sacks-Davis R, Agius P, van Santen DK, Traeger MW, Wilkinson AL, Asselin J, Fairley CK, Roth N, Bloch M, Matthews GV, Donovan B, Guy R, Stoové M, Hellard ME, Doyle JS. Risk of Primary Incident Hepatitis C Infection Following Bacterial Sexually Transmissible Infections Among Gay and Bisexual Men in Australia From 2016 to 2020. Open Forum Infect Dis 2024; 11:ofae099. [PMID: 38560602 PMCID: PMC10977630 DOI: 10.1093/ofid/ofae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024] Open
Abstract
Background In Australia, the incidence of hepatitis C virus (HCV) has declined among gay and bisexual men (GBM) with human immunodeficiency virus (HIV) since 2015 and is low among GBM using HIV preexposure prophylaxis (PrEP). However, ongoing HCV testing and treatment remains necessary to sustain this. To assess the potential utility of sexually transmissible infections (STIs) to inform HCV testing among GBM with HIV and GBM using PrEP, we examined the association between bacterial STI diagnoses and subsequent primary HCV infection. Methods Data were from a national network of 46 clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance. GBM included had ≥1 HCV antibody negative test result and ≥1 subsequent HCV antibody and/or RNA test. Discrete time survival analysis was used to estimate the association between a positive syphilis, rectal chlamydia, and rectal gonorrhea diagnosis in the previous 2 years and a primary HCV diagnosis, defined as a positive HCV antibody or RNA test result. Results Among 6529 GBM with HIV, 92 (1.4%) had an incident HCV infection. A prior positive syphilis diagnosis was associated with an incident HCV diagnosis (adjusted hazard ratio, 1.99 [95% confidence interval, 1.11-3.58]). Among 13 061 GBM prescribed PrEP, 48 (0.4%) had an incident HCV diagnosis. Prior rectal chlamydia (adjusted hazard ratio, 2.75 [95% confidence interval, 1.42-5.32]) and rectal gonorrhea (2.54 [1.28-5.05]) diagnoses were associated with incident HCV. Conclusions Diagnoses of bacterial STIs in the past 2 years was associated with HCV incidence. These findings suggest that STIs might be useful for informing HCV testing decisions and guidelines for GBM with HIV and GBM using PrEP.
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Affiliation(s)
- Brendan L Harney
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, VictoriaAustralia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Agius
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Anna L Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, Victoria, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, VictoriaAustralia
- Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, VictoriaAustralia
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Cornelisse VJ, Murphy D, Lee SJ, Stoove M, Traeger MW, Wright EJ. Physical and mental health of long-term users of HIV preexposure prophylaxis in Australia. AIDS 2024; 38:363-372. [PMID: 37877295 DOI: 10.1097/qad.0000000000003768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
INTRODUCTION HIV preexposure prophylaxis (PrEP) is highly effective at preventing HIV. We aimed to assess mental and physical health among long-term PrEP users in Australia's X-PLORE cohort. METHODS In early 2021, 1485 X-PLORE participants were emailed a survey covering demographics, sexual practices, ongoing PrEP use, physical and psychological diagnoses received since commencing PrEP, substance use, and impacts of the COVID-19 pandemic. Current anxiety and depression were assessed using GAD-7 and PHQ-9 questionnaires. RESULTS Of 476 participants (completion rate 32.1%), 99.8% were cis-gender men. Median PrEP use duration was 48 months (2002 person-years), with 81.7% currently using PrEP. PrEP-related toxicity was uncommon: 2.9% reported bone fractures, 1.3% low bone density, and 4.0% reported kidney problems, largely not necessitating PrEP cessation. Most (92.0%) rated their health as 'good' to 'excellent', and 22.6% reported improved health since starting PrEP, often because of improved mental health. Only 6.2% reported deterioration in health since starting PrEP, largely unrelated to PrEP. The most common diagnoses were hypertension (9.9%), depression (13.2%) and anxiety (14.9%); 17% had PHQ-9 scores indicating current moderate-to-severe depression, which was associated with unemployment [adjusted odds ratio (aOR) 3.90], regular cannabis use (aOR 2.49), and having ceased PrEP (aOR 2.13). CONCLUSION Among long-term PrEP users, of which over 80% were currently using PrEP, self-reported PrEP toxicity was uncommon. With almost one in five PrEP users categorized as having depression, and with higher risk among those having ceased PrEP, we recommend routine screening for depression and anxiety in PrEP users and corresponding follow-up of patients no longer attending for PrEP.
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Affiliation(s)
- Vincent J Cornelisse
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- The Kirby Institute, UNSW Sydney, Sydney
| | - Dean Murphy
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- The Kirby Institute, UNSW Sydney, Sydney
| | - Sue J Lee
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
| | - Mark Stoove
- Burnet Institute
- Australian Research Centre in Sex, Health and Society, LaTrobe University
- School of Public Health and Preventive Medicine, Monash University
| | - Michael W Traeger
- Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
| | - Edwina J Wright
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- Burnet Institute
- Doherty Institute, Melbourne, Australia
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Hayes MJ, Beavon E, Traeger MW, Dillon JF, Radley A, Nielsen S, Byrne CJ, Richmond J, Higgs P, Hellard ME, Doyle JS. Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102489. [PMID: 38440399 PMCID: PMC10909633 DOI: 10.1016/j.eclinm.2024.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Background The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Methods Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Findings Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%-23.0%; heterogeneity I2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. Interpretation These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. Funding None.
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Affiliation(s)
| | | | - Michael W. Traeger
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
| | - John F. Dillon
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | - Suzanne Nielsen
- Burnet Institute, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher J. Byrne
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | | | - Peter Higgs
- Burnet Institute, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
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Chan C, Holt M, Broady TR, Traeger MW, Mao L, Grulich AE, Prestage G, MacGibbon J, Rule J, Bavinton BR. Trends in Testing and Self-Reported Diagnoses of Sexually Transmitted Infections in Gay and Bisexual Men in Australia, 2017 to 2021: Analysis of National Behavioral Surveillance Surveys. Sex Transm Dis 2023; 50:789-795. [PMID: 37820259 DOI: 10.1097/olq.0000000000001870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBM) are overrepresented in diagnoses of sexually transmitted infections (STIs) relative to their population size. This study assessed trends in STI testing and diagnoses among GBM in Australia. METHODS The Gay Community Periodic Surveys are repeated cross-sectional behavioral surveillance surveys of GBM. Participants reported the number of anal swabs, throat swabs, urine samples, and blood tests for syphilis they undertook in the last year. "Frequent comprehensive testing" was defined as ≥3 of each test in the previous year. Participants reported STI diagnoses of chlamydia, gonorrhea, syphilis, and other STIs in the last year. Trends in testing and diagnoses from 2017 to 2020 and 2020 to 2021 were assessed with logistic regression models. RESULTS We analyzed 24,488 survey responses from participants reporting casual sex in the last 6 months. Between 2017 and 2020, frequent comprehensive STI testing decreased among HIV-negative GBM on preexposure prophylaxis (PrEP) from 71.7% to 68.9% and declined further to 58.6% in 2021. Frequent comprehensive STI testing was stable during 2017-2020 among HIV-negative/untested GBM not on PrEP (17.4%-14.6%) and HIV-positive GBM (30.4%-35.1%) but declined in 2021 to 7.5% among non-PrEP-users and 25.7% among HIV-positive participants. There were minimal changes in STI diagnoses during 2017-2020, but diagnoses declined in 2021. CONCLUSIONS Many GBM do not meet Australian STI testing guidelines that recommend quarterly testing. Further evaluation of whether this recommendation is realistic or necessary to reduce STIs among GBM is recommended.
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Affiliation(s)
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney
| | | | | | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney
| | | | | | | | - John Rule
- National Association of People With HIV Australia, Sydney, Australia
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Munari SC, Traeger MW, Menon V, Latham NH, Manoharan L, Luhmann N, Baggaley R, MacDonald V, Verster A, Siegfried N, Conway B, Klein M, Bruneau J, Stoové MA, Hellard ME, Doyle JS. Determining reinfection rates by hepatitis C testing interval among key populations: A systematic review and meta-analysis. Liver Int 2023; 43:2625-2644. [PMID: 37817387 DOI: 10.1111/liv.15705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND & AIMS Detecting hepatitis C virus (HCV) reinfection among key populations helps prevent ongoing transmission. This systematic review aims to determine the association between different testing intervals during post-SVR follow-up on the detection of HCV reinfection among highest risk populations. METHODS We searched electronic databases between January 2014 and February 2023 for studies that tested individuals at risk for HCV reinfection at discrete testing intervals and reported HCV reinfection incidence among key populations. Pooled estimates of reinfection incidence were calculated by population and testing frequency using random-effects meta-analysis. RESULTS Forty-one single-armed observational studies (9453 individuals) were included. Thirty-eight studies (8931 individuals) reported HCV reinfection incidence rate and were included in meta-analyses. The overall pooled estimate of HCV reinfection incidence rate was 4.13 per 100 per person-years (py) (95% confidence interval [CI]: 3.45-4.81). The pooled incidence estimate among people who inject drugs (PWID) was 2.84 per 100 py (95% CI: 2.19-3.50), among men who have sex with men (MSM) 7.37 per 100 py (95% CI: 5.09-9.65) and among people in custodial settings 7.23 per 100 py (95% CI: 2.13-16.59). The pooled incidence estimate for studies reporting a testing interval of ≤6 months (4.26 per 100 py; 95% CI: 2.86-5.65) was higher than studies reporting testing intervals >6 months (5.19 per 100 py; 95% CI: 3.92-6.46). CONCLUSIONS HCV reinfection incidence was highest in studies of MSM and did not appear to change with retesting interval. Shorter testing intervals are likely to identify more reinfections, help prevent onward transmission where treatment is available and enable progress towards global HCV elimination, but additional comparative studies are required.
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Affiliation(s)
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vinay Menon
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Ned H Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Niklas Luhmann
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Virginia MacDonald
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Annette Verster
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Brian Conway
- Vancouver Infectious Diseases Centre & Simon Fraser University Vancouver, Canada
| | - Marina Klein
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Julie Bruneau
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
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Traeger MW, Krakower DS, Mayer KH, Marcus JL. Prioritising the values of potential users to promote uptake of HIV pre-exposure prophylaxis. Lancet HIV 2023; 10:e690-e692. [PMID: 37573870 DOI: 10.1016/s2352-3018(23)00171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023]
Abstract
Benefits of pre-exposure prophylaxis (PrEP) extend beyond HIV risk reduction. Users report a range of physical, emotional, and social effects, including reduced anxiety, increased intimacy, and greater sexual satisfaction. For some people, these benefits are the primary motivation for using PrEP. To successfully engage in shared decision making about HIV prevention methods, clinicians need to be able to discuss all potential risks and benefits of PrEP. These risks and benefits include not only those related to HIV risk reduction and other clinical outcomes, but also those related to experiences and relationships that people value. However, national and international clinical resources on the provision of PrEP do not include user-reported outcomes that are values-based or reflect positive effects on personal, social, or sexual wellbeing. To better integrate the values of potential users into discussions about PrEP, clinician training programmes and clinical guidelines need to be guided by community-driven frameworks and expanded to include user-reported outcomes of PrEP use, including beneficial effects. Achieving PrEP uptake and equity goals will require an approach to PrEP provision that centres the values and desired experiences of potential users, particularly those from populations with the greatest unmet need for PrEP.
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Affiliation(s)
- Michael W Traeger
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Burnet Institute, Melbourne, VIC, Australia.
| | - Douglas S Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
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8
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Traeger MW, Mayer KH, Krakower DS, Gitin S, Jenness SM, Marcus JL. Potential impact of doxycycline post-exposure prophylaxis prescribing strategies on incidence of bacterial sexually transmitted infections. Clin Infect Dis 2023:ciad488. [PMID: 37595139 DOI: 10.1093/cid/ciad488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Doxycycline post-exposure prophylaxis (doxyPEP) reduces bacterial sexually transmitted infection (STI) incidence in people with HIV (PWH) or using HIV preexposure prophylaxis (PrEP). Given concerns about widespread antibiotic use, we identified doxyPEP prescribing strategies to minimize use while maximizing impact on STIs. METHODS We used electronic health records of gay and bisexual men (GBM), transgender women, and non-binary people assigned male sex at birth with ≥2 STI tests (chlamydia, gonorrhea, syphilis) at an LGBTQ-focused health center during 2015-2020. We defined 10 hypothetical doxyPEP prescribing strategies based on PrEP use, HIV status, or STI history. We estimated doxyPEP use and STI diagnoses averted in counterfactual scenarios in which people meeting prescribing criteria received doxyPEP, assuming STI rates during use would have been reduced by clinical trial efficacy estimates. RESULTS Among 10,546 individuals (94% GBM), rate of any STI was 35.9/100 person-years. Prescribing doxyPEP to all individuals would have averted 71% of STI diagnoses (number needed to treat for one year to avert one STI diagnosis, NNT = 3.9); prescribing to PrEP users/PWH (52%/12% of individuals) would have averted 60% of STI diagnoses (NNT = 2.9). Prescribing doxyPEP for 12 months after STI diagnosis would have reduced the proportion using doxyPEP to 38% and averted 39% of STI diagnoses (NNT = 2.4). Prescribing after concurrent or repeated STIs would have maximized efficiency (lowest NNTs) but prevented fewer STIs. CONCLUSIONS Prescribing doxyPEP to individuals with STIs, particularly concurrent or repeated STIs, could avert a substantial proportion of all STI diagnoses. The most efficient prescribing strategies are based on STI history rather than HIV status or PrEP use.
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Affiliation(s)
- Michael W Traeger
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
- Burnet Institute, Melbourne, Australia
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Douglas S Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Sy Gitin
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
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9
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Traeger MW, Harney BL, Sacks-Davis R, van Santen DK, Cornelisse VJ, Wright EJ, Hellard ME, Doyle JS, Stoové MA. Incidence and Prevalence of Hepatitis C Virus Among HIV-Negative Gay and Bisexual Men Using HIV Pre-exposure Prophylaxis (PrEP): A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad401. [PMID: 37593532 PMCID: PMC10428087 DOI: 10.1093/ofid/ofad401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
Background Gay and bisexual men using HIV pre-exposure prophylaxis (PrEP) are at increased risk for sexually transmissible infections. Hepatitis C virus (HCV) risk among PrEP users is less clear. We explored HCV prevalence and incidence among cohorts of gay and bisexual men using PrEP and sources of heterogeneity across studies. Methods This was a systematic review and meta-analysis of open-label PrEP studies to April 2022 reporting HCV prevalence at baseline or incidence during follow-up among gay and bisexual men using PrEP. Pooled prevalence and incidence estimates were calculated using random-effects meta-analysis, and subgroup analyses were performed by study- and country-level characteristics, including availability of HCV direct-acting antiviral (DAA) therapy at time of study. Results Twenty-four studies from 9 countries were included, with a total sample of 24 733 gay and bisexual men. Pooled HCV antibody baseline prevalence was 0.97% (95% CI, 0.63%-1.31%), and pooled HCV RNA baseline prevalence was 0.38% (95% CI, 0.19%-0.56%). Among 19 studies reporting HCV incidence, incidence ranged from 0.0 to 2.93/100 person-years (py); the pooled estimate was 0.83/100py (95% CI, 0.55-1.11). HCV incidence was higher in 12 studies that began follow-up before broad DAA availability (1.27/100py) than in 8 studies that began follow-up after broad DAA availability (0.34/100py) and higher in studies in Europe compared with North America and Australia. Conclusions Early reports of high HCV incidence among PrEP-using cohorts likely reflect enrollment of individuals based on specific risk-based eligibility criteria for smaller studies and enrollment before DAA scale-up. In contexts where both DAAs and PrEP have been implemented at scale, studies report lower HCV incidence. PrEP-specific HCV testing guidelines should be guided by local epidemiology.
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Affiliation(s)
- Michael W Traeger
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brendan L Harney
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniela K van Santen
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vincent J Cornelisse
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
- Kirketon Road Centre, Sydney, Australia
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Edwina J Wright
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Mark A Stoové
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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10
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Manoharan L, Latham NH, Munari SC, Traeger MW, Menon V, Luhmann N, Baggaley R, Macdonald V, Verster A, Siegfried N, Matthews GV, Stoové M, Hellard ME, Doyle JS. Immediate treatment for recent hepatitis C infection in people with high-risk behaviors: a systematic review and meta-analysis. Hepatol Commun 2023; 7:02009842-202304010-00002. [PMID: 36930865 PMCID: PMC10027039 DOI: 10.1097/hc9.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/27/2022] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND AND AIMS Direct-acting antivirals (DAAs) are almost exclusively approved for the treatment of chronic HCV. This poses a significant barrier to the treatment of recently acquired HCV because of the limited access to DAAs. This review seeks to address this issue by synthesizing evidence of the benefits and harms of immediate treatment after the detection of recently acquired HCV in people at higher risk of infection. APPROACH AND RESULTS A systematic review and meta-analysis were conducted reporting on populations with recently acquired HCV at higher risk of infection. Studies were included if they assessed standard duration DAA treatment regimens and reported on the benefits and harms of immediate treatment (within one year of diagnosis). Outcomes included sustained virological response at 12 weeks post-treatment (SVR12), incidence, treatment initiation and adherence, overtreatment, engagement in care, and adverse events. Eight cohort studies, 3 open-label trials, and 1 case series study were included, reporting on 2085 participants with recently acquired HCV infection. No studies included a comparison group. Eight studies assessed DAA treatment in either men who have sex with men or men who have sex with men with HIV, 2 studies assessed treatment in people who inject drugs, and 2 among people living with HIV. Immediate treatment of HCV was associated with a pooled SVR12 of 95.9% (95% CI, 92.6%-99.3%). Three studies reported on hepatitis C incidence, where most participants were treated in the chronic phase of infection. A treatment completion rate of 100% was reported in 2 studies, and only 1 serious adverse event was described. CONCLUSIONS High rates of cure were achieved with the treatment of recently acquired hepatitis C in people at higher risk of infection. Serious adverse events were rare, highlighting individual benefits consistent with the treatment of chronic hepatitis C. The impact of immediate treatment on HCV incidence requires further evaluation.
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Affiliation(s)
| | | | | | - Michael W Traeger
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Niklas Luhmann
- World Health Organization, Global HIV, Geneva, Switzerland
| | | | | | | | | | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, the Alfred Hospital and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, the Alfred Hospital and Monash University, Melbourne, Australia
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11
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Traeger MW, Guy R, Asselin J, Patel P, Carter A, Wright EJ, Grulich A, McManus H, Fairley CK, Chow EPF, McNulty A, Finlayson R, Bell C, Owen L, Marshall L, Russell D, O'Donnell D, Donovan B, Hellard ME, Stoové MA. Real-world trends in incidence of bacterial sexually transmissible infections among gay and bisexual men using HIV pre-exposure prophylaxis (PrEP) in Australia following nationwide PrEP implementation: an analysis of sentinel surveillance data. Lancet Infect Dis 2022; 22:1231-1241. [PMID: 35643090 DOI: 10.1016/s1473-3099(22)00175-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although data from large implementation trials suggest that sexually transmissible infection (STI) risk increases among gay and bisexual men who initiate HIV pre-exposure prophylaxis (PrEP), there are few data on the trends in population-level STI incidence in the years following widespread PrEP implementation. We aimed to describe trends in bacterial STI incidence among gay and bisexual men using PrEP across Australia in the context of broad PrEP availability through Australia's subsidised medicines scheme. METHODS We analysed linked clinical data from HIV-negative gay and bisexual men aged 16 years or older who had been prescribed PrEP across a sentinel surveillance clinical network, including 37 clinics in Australia, between Jan 1, 2016, and Dec 31, 2019. Patients were included if they had STI testing at least twice during the observation period. Repeat testing methods were used to calculate chlamydia, gonorrhoea, syphilis, and any STI incidence rates during individuals' periods of PrEP use. Incidence rate ratios (IRRs) for estimated change in incidence per half calendar year (6-month) period were calculated using negative binomial regression. Secondary analyses compared STI incidence rates across individuals initiating PrEP in each year from 2016 to 2019, as well as by length of time using PrEP (per each additional 6 months of PrEP use). FINDINGS 22 730 men were included in the analyses. During the observation period, 11 351 chlamydia infections were diagnosed in 6630 (30·1%) of 22 034 men over 25 991·2 person-years of PrEP use (incidence rate 43·7 cases [95% CI 42·9-44·5] per 100 person-years). Chlamydia incidence decreased from 48·7 cases per 100 person-years in July-December, 2016, to 42·0 cases per 100 person-years in July-December, 2019 (IRR for estimated change per 6-month period 0·98 [95% CI 0·97-0·99]; p=0·0031). 9391 gonorrhoea infections were diagnosed in 5885 (26·9%) of 21 845 men over 24 858·7 person-years of PrEP use (incidence rate 37·8 cases [95% CI 37·0-38·5] per 100 person-years). Gonorrhoea incidence decreased from 45·5 cases per 100 person-years in July-December, 2016, to 37·2 cases per 100 person-years in July-December, 2019 (IRR 0·97 [95% CI 0·96-0·98]; p<0·0001). Declines in chlamydia and gonorrhoea incidence were most prominent in the first 18 months of observation and incidence was stable thereafter. 2062 syphilis infections were diagnosed in 1488 (7·7%) of 19 262 men over 21 978·9 person-years of PrEP use (incidence rate 9·4 cases [95% CI 9·0-9·8] per 100 person-years). Syphilis incidence increased from 6·2 cases per 100 person-years in July-December, 2016, to 9·8 cases per 100 person-years in July-December, 2019 (IRR 1·08 [95% CI 1·05-1·10]; p<0·0001). INTERPRETATION Chlamydia and gonorrhoea incidence among gay and bisexual men using PrEP were highest in the early months of PrEP implementation in Australia and stabilised at slightly lower rates thereafter following wider PrEP uptake. Lower prospective STI risk among people initiating PrEP in later years contributed to the observed trends in STI incidence. Widespread PrEP implementation can contribute to increased STI screening and detection. FUNDING Australian Department of Health, National Health and Medical Research Council.
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Affiliation(s)
- Michael W Traeger
- Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Prital Patel
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Allison Carter
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia; Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Edwina J Wright
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health, Central Clinical School, Monash University, Melbourne, VIC, Australia; Peter Doherty Institute, Melbourne, VIC, Australia
| | | | | | - Christopher K Fairley
- Department of Infectious Diseases, Alfred Health, Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anna McNulty
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney, NSW, Australia
| | | | | | - Louise Owen
- Tasmanian Sexual Health Service, Hobart, TAS, Australia
| | - Lewis Marshall
- Sexual Health Service, Fremantle Hospital, Fremantle, WA, Australia; University of Notre Dame Australia, Fremantle, WA, Australia; University of Western Australia, Perth, WA, Australia
| | - Darren Russell
- Cairns Sexual Health Centre, Cairns, QLD, Australia; James Cook University, Cairns, QLD, Australia
| | - Darryl O'Donnell
- Australian Federation of AIDS Organisations, Sydney, NSW, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health, Central Clinical School, Monash University, Melbourne, VIC, Australia; Peter Doherty Institute, Melbourne, VIC, Australia
| | - Mark A Stoové
- Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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12
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Traeger MW, van Santen DK, Sacks‐Davis R, Asselin J, Carter A, Doyle JS, Pedrana A, Wilkinson AL, Howell J, Thatcher R, Didlick J, Donovan B, Guy R, Hellard ME, Stoové MA. Impact of COVID-19 lockdown restrictions on hepatitis C testing in Australian primary care services providing care for people who inject drugs. J Viral Hepat 2022; 29:908-918. [PMID: 35722739 PMCID: PMC9350356 DOI: 10.1111/jvh.13723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/31/2022] [Accepted: 05/26/2022] [Indexed: 12/09/2022]
Abstract
In 2020, the Australian state of Victoria experienced the longest COVID-19 lockdowns of any jurisdiction, with two lockdowns starting in March and July, respectively. Lockdowns may impact progress towards eliminating hepatitis C through reductions in hepatitis C testing. To examine the impact of lockdowns on hepatitis C testing in Victoria, de-identified data were extracted from a network of 11 services that specialize in the care of people who inject drugs (PWID). Interrupted time-series analyses estimated weekly changes in hepatitis C antibody and RNA testing from 1 January 2019 to 14 May 2021 and described temporal changes in testing associated with lockdowns. Interruptions were defined at the weeks corresponding to the start of the first lockdown (week 14) and the start (week 80) and end (week 95) of the second lockdown. Pre-COVID, an average of 80.6 antibody and 25.7 RNA tests were performed each week. Following the first lockdown in Victoria, there was an immediate drop of 23.2 antibody tests and 8.6 RNA tests per week (equivalent to a 31% and 46% drop, respectively). Following the second lockdown, there was an immediate drop of 17.2 antibody tests and 4.6 RNA tests per week (equivalent to a 26% and 33% drop, respectively). With testing and case finding identified as a key challenge to Australia achieving hepatitis C elimination targets, the cumulative number of testing opportunities missed during lockdowns may prolong efforts to find, diagnose and engage or reengage in care of the remaining population of PWID living with hepatitis C.
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Affiliation(s)
- Michael W. Traeger
- Burnet InstituteMelbourneVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Daniela K. van Santen
- Burnet InstituteMelbourneVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Department of Infectious Disease, Research and PreventionPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Rachel Sacks‐Davis
- Burnet InstituteMelbourneVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | | | - Allison Carter
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia,Faculty of Health SciencesSimon Fraser UniversityVancouverBritish ColumbiaCanada,Australian Human Rights InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Joseph S. Doyle
- Burnet InstituteMelbourneVictoriaAustralia,Department of Infectious DiseasesThe Alfred and Monash UniversityMelbourneVictoriaAustralia
| | - Alisa Pedrana
- Burnet InstituteMelbourneVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Anna L. Wilkinson
- Burnet InstituteMelbourneVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jessica Howell
- Burnet InstituteMelbourneVictoriaAustralia,Department of GastroenterologySt Vincent's HospitalMelbourneVictoriaAustralia,Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | | | - John Didlick
- Hepatitis AustraliaCanberraAustralian Capital TerritoryAustralia
| | - Basil Donovan
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia,Sydney Sexual Health CentreSydneyNew South WalesAustralia
| | - Rebecca Guy
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Margaret E. Hellard
- Burnet InstituteMelbourneVictoriaAustralia,Department of Infectious DiseasesThe Alfred and Monash UniversityMelbourneVictoriaAustralia,Peter Doherty InstituteMelbourneVictoriaAustralia
| | - Mark A. Stoové
- Burnet InstituteMelbourneVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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13
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Dawe J, Wilkinson AL, Asselin J, Carter A, Pedrana A, Traeger MW, Thomas AJ, Curtis M, Cooper M, Howell J, Doyle JS, Hellard ME, Stoové M. Hepatitis C antibody testing among opioid agonist therapy recipients, Victoria, Australia, 2012 to 2020. International Journal of Drug Policy 2022; 104:103696. [DOI: 10.1016/j.drugpo.2022.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
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14
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Traeger MW, Murphy D, Ryan KE, Asselin J, Cornelisse VJ, Wilkinson AL, Hellard ME, Wright EJ, Stoové MA. Latent Class Analysis of Sexual Behaviours and Attitudes to Sexually Transmitted Infections Among Gay and Bisexual Men Using PrEP. AIDS Behav 2022; 26:1808-1820. [PMID: 34782934 DOI: 10.1007/s10461-021-03529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
Gay and bisexual men (GBM) who use pre-exposure prophylaxis (PrEP) are at increased risk of sexually transmitted infections (STIs) compared to those who don't use PrEP. Since the implementation of PrEP in Australia, it is possible that attitudes towards STIs have shifted in line with changes in risk and transmission dynamics in the context of increased screening. As the extent to which GBM utilise STI prevention strategies likely depends on their attitudes towards STIs and STI prevention, the aims of this study were to use latent class analysis (LCA) to classify GBM using PrEP on the basis of their attitudes towards STIs and reported risk behaviours, and examine how these categorisations relate to risk of STI acquisition. 1225 GBM who were previously enrolled in a PrEP implementation study (The PrEPX Study) completed a survey focused on sexual behaviours and attitudes towards STIs 1 year post-study follow-up. Data on chlamydia, gonorrhoea and syphilis testing and positivity were available through a sentinel network of participating study clinics. Using LCA, participants were allocated into four classes; Class 1, "Some concern and lowest risk"; Class 2, "Low concern and lower risk"; Class 3, " High concern and higher risk"; and Class 4, "Low concern and highest risk". The majority (78%) of participants were classified into Class 3 or Class 4, two groups which were distinguished by highly disparate attitudes towards STIs but with a similar proportion of participants diagnosed with a bacterial STI in the last 12 months (48% and 57%, respectively). Findings suggest that attitudes towards STIs among GBM using PrEP in Australia vary considerably, and this will likely influence their receptivity to different STI prevention strategies.
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15
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Howell J, Traeger MW, Williams B, Layton C, Doyle JS, Latham N, Draper B, Bramwell F, Membrey D, McPherson M, Roney J, Stoové M, Thompson AJ, Hellard ME, Pedrana A. The impact of point-of-care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study. J Viral Hepat 2022; 29:375-384. [PMID: 35274403 DOI: 10.1111/jvh.13664] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/20/2022] [Indexed: 12/13/2022]
Abstract
Point-of-care (POC) diagnostics overcome barriers to conventional hepatitis C (HCV) testing in people who inject drugs. This study assessed impact on hepatitis C treatment uptake of POC HCV testing in needle and syringe exchange programs (NSPs). Rapid EC was a single-arm interventional pilot study of HCV POC testing conducted in three inner-city community clinics with NSPs. Twelve months after the POC testing, a retrospective medical record and Pharmaceutical Benefits Scheme audit was performed to determine the number of HCV RNA-positive participants who were prescribed HCV treatment. 70 HCV RNA-positive Rapid EC study participants were included. 44 (63%) were prescribed DAAs; 26 (59%) completed treatment and 15 (34%) had SVR testing, all of whom were cured. Age ≥ 40 years (aOR 3.45, 95% CI 1.10-11.05, p = .03) and secondary school education (aOR 5.8, 95% CI 1.54-21.80, p = .009) had higher likelihood of being prescribed DAAs, whereas homelessness was inversely associated with prescription of DAAs (aOR 0.30, 95% CI 0.09-1.04, p = .057). Median time to receive a DAA script from date of diagnosis was seven days (IQR 0 to 14 days), and time to filling the DAA prescription was 2 days (IQR 0-12 days). In conclusion, provision of POC testing through NSPs was effective for linking new clients to HCV treatment and reduced the time to treatment. Further studies are needed to define the most cost-effective use of POC testing in models of care for people who inject drugs to increase HCV treatment uptake.
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Affiliation(s)
- Jessica Howell
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bridget Williams
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Chloe Layton
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Ned Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Bridget Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Dean Membrey
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Maggie McPherson
- North Richmond Community Health, General Practice, Melbourne, Victoria, Australia
| | - Janine Roney
- Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Cohealth, General Practice, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia.,Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Laher F, Richardson SI, Smith P, Sullivan PS, Abrahams AG, Asowata OE, Bitangumutwenzi P, Dabee S, Dollah A, Fernandez N, Langat RK, Bose DL, Likhitwonnawut U, Mullick R, Resop RS, Sutar J, Thompson-Hall A“N, Traeger MW, Tuyishime M, Wambui J, Bekker LG, Kaleebu P, McCormack S, O'Connor DH, Warren M, Torri T, Thyagarajan B. HIV Prevention in a Time of COVID-19: A Report from the HIVR4P // Virtual Conference 2021. AIDS Res Hum Retroviruses 2022; 38:350-358. [PMID: 34714100 PMCID: PMC9131040 DOI: 10.1089/aid.2021.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The HIV Research for Prevention (HIVR4P) conference catalyzes knowledge sharing on biomedical HIV prevention interventions such as HIV vaccines, antibody infusions, pre-exposure prophylaxis, and microbicides in totality-from the molecular details and delivery formulations to the behavioral, social, and structural underpinnings. HIVR4P // Virtual was held over the course of 2 weeks on January 27-28 and February 3-4, 2021 as the coronavirus disease 2019 (COVID-19) pandemic continued to inflict unprecedented harm globally. The HIVR4P community came together with 1,802 researchers, care providers, policymakers, implementers, and advocates from 92 countries whose expertise spanned the breadth of the HIV prevention pipeline from preclinical to implementation. The program included 113 oral and 266 poster presentations. This article presents a brief summary of the conference highlights. Complete abstracts, webcasts, and daily rapporteur summaries may be found on the conference website (https://www.hivr4p.org/).
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Affiliation(s)
- Fatima Laher
- University of the Witwatersrand, Johannesburg, South Africa
| | - Simone I. Richardson
- University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Philip Smith
- The Desmond Tutu HIV Research Centre, Cape Town, South Africa
| | | | | | | | | | - Smritee Dabee
- Seattle Children's Research Institute, Seattle, Washington, USA
| | | | | | | | - Devi Leena Bose
- International AIDS Vaccine Initiative (IAVI), New Delhi, India
| | | | - Ranajoy Mullick
- International AIDS Vaccine Initiative (IAVI), New Delhi, India
| | - Rachel S. Resop
- The George Washington University, Washington, District of Columbia, USA
| | - Jyoti Sutar
- Indian Council of Medical Research (ICMR), Mumbai, India
| | | | | | | | - Jacque Wambui
- AFROCAB Treatment Access Partnerships, Nairobi, Kenya
| | | | - Pontiano Kaleebu
- Uganda Virus Research Institute & MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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17
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Wilkinson AL, van Santen DK, Traeger MW, Sacks-Davis R, Asselin J, Scott N, Harney BL, Doyle JS, El-Hayek C, Howell J, Bramwell F, McManus H, Donovan B, Stoové M, Hellard M, Pedrana A. Hepatitis C incidence among patients attending primary care health services that specialise in the care of people who inject drugs, Victoria, Australia, 2009 to 2020. Int J Drug Policy 2022; 103:103655. [PMID: 35349964 DOI: 10.1016/j.drugpo.2022.103655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Monitoring trends in hepatitis C virus (HCV) incidence is critical for evaluating strategies aimed at eliminating HCV as a public health threat. We estimate HCV incidence and assess trends in incidence over time among primary care patients. METHODS Data were routinely extracted, linked electronic medical records from 12 primary care health services. Patients included were aged ≥16 years, tested HCV antibody negative on their first test recorded and had at least one subsequent HCV antibody or RNA test (January 2009-December 2020). HCV incident infections were defined as a positive HCV antibody or RNA test. A generalised linear model assessed the association between HCV incidence and calendar year. RESULTS In total, 6711 patients contributed 17,098 HCV test records, 210 incident HCV infections and 19,566 person-years; incidence was 1.1 per 100 person-years (95% confidence interval (CI): 0.9 to 1.2). Among 559 (8.2%) patients ever prescribed opioid-related pharmacotherapy (ORP) during the observation period, 135 infections occurred during 2,082 person-years (incidence rate of 6.5 per 100 person-years (95% CI: 5.4 to 7.7)). HCV incidence declined 2009-2020 overall (incidence rate ratio per calendar year 0.8 (95% CI: 0.8 to 0.9) and among patients ever prescribed ORT (incidence rate ratio per calendar year 0.9, 95% CI: 0.75 to 1.0). CONCLUSION HCV incidence declined among patients at primary care health services including among patients ever prescribed ORP and during the period following increased access to DAA therapy. SUMMARY Among a retrospective cohort of ∼6,700 primary care health services patients, this study estimated a hepatitis C virus (HCV) infection incidence of 1.1 per 100 person-years (95% confidence interval: 0.9 to 1.2). HCV infection incidence declined between 2009 and 2020.
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Affiliation(s)
- Anna Lee Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brendan L Harney
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Carol El-Hayek
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jessica Howell
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | | | | | | | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia; Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3000, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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18
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van Santen DK, Asselin J, Haber NA, Traeger MW, Callander D, Donovan B, El-Hayek C, McMahon JH, Petoumenos K, McManus H, Hoy JF, Hellard M, Guy R, Stoové M. Improvements in transition times through the HIV cascade of care among gay and bisexual men with a new HIV diagnosis in New South Wales and Victoria, Australia (2012-19): a longitudinal cohort study. Lancet HIV 2021; 8:e623-e632. [PMID: 34508660 DOI: 10.1016/s2352-3018(21)00155-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most studies assessing the HIV care cascade have typically been cross-sectional analyses, which do not capture the transition time to subsequent stages. We aimed to assess the longitudinal HIV cascade of care in Australia, and changes over time in transition times and associated factors. METHODS In this longitudinal cohort study, we included linked data for gay and bisexual men (GBM) with a new HIV diagnosis who attended clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance in New South Wales and Victoria between Jan 1, 2012, and Dec 31, 2019. We assessed three cascade transition periods: diagnosis to linkage to care (stage 1 transition); linkage to care to antiretroviral therapy (ART) initiation (stage 2 transition); and ART initiation to virological suppression (viral load ≤200 copies per mL; stage 3 transition). We also calculated the probability of remaining virologically suppressed after the first recorded viral load of less than 200 copies per mL. We used the Kaplan-Meier method to estimate transition times and cumulative probability of stage transition. FINDINGS We included 2196 GBM newly diagnosed with HIV between 2012 and 2019 contributing 6747 person-years of follow-up in our analysis. Median time from HIV diagnosis to linkage to care (stage 1 transition) was 2 days (IQR 1-3). Median time from linkage to care to ART initiation (stage 2 transition) was 33 days (30-35). Median time from ART initiation to first recorded virological suppression (stage 3 transition) was 49 days (47-52). The cumulative probability of ART initiation within 90 days of linkage to care increased from 36·9% (95% CI 32·9-40·6) in the 2012-13 calendar period to 94·1% (91·2-96·0) in the 2018-19 calendar period and cumulative probability of virological suppression within 90 days of ART initiation increased from 54·3% (48·8-59·3) in the 2012-13 calendar period to 82·9% (78·4-86·4) in the 2018-19 calendar period. 91·6% (90·1-93·1) of GBM remained virologically supressed up to 2 years after their first recorded virological suppression event. INTERPRETATION In countries with high cross-sectional cascade estimates such as Australia, the impact of treatment as prevention is better estimated using longitudinal cascade analyses. FUNDING National Health and Medical Research Council Australia.
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Affiliation(s)
- Daniela K van Santen
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Infectious Disease, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Jason Asselin
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia
| | - Noah A Haber
- Meta-Research Innovation Center at Stanford University, Stanford, CA, USA
| | - Michael W Traeger
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Denton Callander
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Basil Donovan
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Carol El-Hayek
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - James H McMahon
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC, Australia; Department of Infectious Diseases, Monash Medical Centre, Melbourne, VIC, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Hamish McManus
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Margaret Hellard
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Mark Stoové
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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19
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Donovan LC, Fairley CK, Aung ET, Traeger MW, Wright EJ, Stoové MA, Chow EPF. The Presence or Absence of Symptoms Among Cases of Urethral Gonorrhoea Occurring in a Cohort of Men Taking Human Immunodeficiency Virus Pre-exposure Prophylaxis in the PrEPX Study. Open Forum Infect Dis 2021; 8:ofab263. [PMID: 34189177 PMCID: PMC8231363 DOI: 10.1093/ofid/ofab263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/20/2021] [Indexed: 12/02/2022] Open
Abstract
We aimed to estimate how often urethral gonorrhoea is symptomatic among men in the Pre-Exposure Prophylaxis Expanded Victoria study. Eighty-seven percent of 213 cases of urethral gonorrhoea were symptomatic. Ensuring men with urethral gonorrhoea both recognize and present early for treatment is critical to reduce transmission.
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Affiliation(s)
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edwina J Wright
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Alfred Hospital, Monash Central Clinical School, Melbourne, Victoria, Australia.,Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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20
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Traeger MW, Patel P, Guy R, Hellard ME, Stoové MA. Changes in HIV preexposure prophylaxis prescribing in Australian clinical services following COVID-19 restrictions. AIDS 2021; 35:155-157. [PMID: 33273185 DOI: 10.1097/qad.0000000000002703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael W Traeger
- Disease Elimination, Burnet Institute
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Prital Patel
- Kirby Institute, UNSW Sydney, Sydney, New South Wales
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, Sydney, New South Wales
| | - Margaret E Hellard
- Disease Elimination, Burnet Institute
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
- Department of Infectious Diseases, Alfred and Monash University, Melbourne, Victoria, Australia
| | - Mark A Stoové
- Disease Elimination, Burnet Institute
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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21
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Doyle JS, van Santen DK, Iser D, Sasadeusz J, O'Reilly M, Harney B, Traeger MW, Roney J, Cutts JC, Bowring AL, Winter R, Medland N, Fairley CK, Moore R, Tee B, Asselin J, El-Hayek C, Hoy JF, Matthews GV, Prins M, Stoové MA, Hellard ME. Micro-elimination of hepatitis C among people with HIV coinfection: declining incidence and prevalence accompanying a multi-center treatment scale-up trial. Clin Infect Dis 2020; 73:e2164-e2172. [PMID: 33010149 DOI: 10.1093/cid/ciaa1500] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gay and bisexual men (GBM) are a key population affected by HIV and hepatitis C (HCV) co-infection. Providing HCV treatment scale-up across specialist and non-hepatitis specialist settings may eliminate HCV in this population. We aimed to (1) deliver and measure HCV treatment effectiveness, and (2) determine the population impact of treatment on HCV prevalence and incidence longitudinally. METHODS The co-EC Study (Enhancing care and treatment among HCV/HIV co-infected individuals to Eliminate Hepatitis C transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, from 2016-2018. Individuals with HCV/HIV co-infection were prospectively enrolled from primary and tertiary-care services providing care for 85% of GBM with HIV in our jurisdiction. HCV-viraemic prevalence and HCV-antibody/viraemic incidence were measured using a state-wide, individually-linked, electronic surveillance system. RESULTS Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response among primary care participants (98%, 95%CI:93-100%) was not different to tertiary care (98%, 95%CI:86-100%). From 2012-2019, between 2434 and 3476 GBM with HIV-infection attended our primary-care sites annually providing 13,801 person-years of follow-up; 50-60% received an HCV test annually, 10-14% were anti-HCV positive. Among those anti-HCV positive, viraemic prevalence declined 83% during the study (54% to 9%; 2016 to 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio 0.75; CI:0.68-0.83;p<0.001). CONCLUSION High treatment effectiveness by non-specialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM with HIV-infection provides proof-of-concept for HCV micro-elimination. REGISTRATION ClinicalTrials.gov (Identifier: NCT02786758).
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Affiliation(s)
- J S Doyle
- Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - D K van Santen
- Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D Iser
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - J Sasadeusz
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service at the Doherty Institute, Melbourne, VIC, Australia
| | - M O'Reilly
- Prahran Market Clinic, Melbourne, VIC, Australia
| | - B Harney
- Burnet Institute, Melbourne, VIC, Australia
| | | | - J Roney
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - J C Cutts
- Burnet Institute, Melbourne, VIC, Australia
| | | | - R Winter
- Burnet Institute, Melbourne, VIC, Australia
| | - N Medland
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - R Moore
- Northside Clinic, Fitzroy North, VIC, Australia
| | - B Tee
- Centre Clinic, Melbourne, VIC, Australia
| | - J Asselin
- Burnet Institute, Melbourne, VIC, Australia
| | - C El-Hayek
- Burnet Institute, Melbourne, VIC, Australia
| | - J F Hoy
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - G V Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M Prins
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Infection and Immunity Institute Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - M A Stoové
- Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - M E Hellard
- Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne
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22
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Traeger MW, Pedrana AE, van Santen DK, Doyle JS, Howell J, Thompson AJ, El-Hayek C, Asselin J, Polkinghorne V, Membrey D, Bramwell F, Carter A, Guy R, Stoové MA, Hellard ME. The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services. PLoS One 2020; 15:e0235445. [PMID: 32603349 PMCID: PMC7326180 DOI: 10.1371/journal.pone.0235445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C elimination will require widespread access to treatment and responses at the health-service level to increase testing among populations at risk. We explored changes in hepatitis C testing and the cascade of care before and after the introduction of direct-acting antiviral treatments in Victoria, Australia. METHODS De-identified clinical data were retrospectively extracted from eighteen primary care clinics providing services targeted towards people who inject drugs. We explored hepatitis C testing within three-year periods immediately prior to (pre-DAA period) and following (post-DAA period) universal access to DAA treatments on 1st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods. RESULTS The number of individuals HCV-tested was 13,784 (12.2% of those with a consultation) in the pre-DAA period and 14,507 (10.4% of those with a consultation) in the post-DAA period. The pre-DAA care cascade included 2,515 RNA-positive individuals; 1,977 (78.6%) were HCV viral load/genotype tested; 19 (0.8%) were prescribed treatment; and 12 had evidence of cure (0.5% of those RNA-positive and 63.6% of those eligible for cure). The post-DAA care cascade included 3,713 RNA-positive individuals; 3,276 (88.2%) were HCV viral load/genotype tested; 1,674 (45.1%) were prescribed treatment; and 863 had evidence of cure (23.2% of those RNA-positive and 94.9% of those eligible for cure). CONCLUSION Marked improvements in the cascade of hepatitis C care among patients attending primary care clinics were observed following the universal access of DAA treatments in Australia, although improvements in testing were less pronounced.
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Affiliation(s)
- Michael W. Traeger
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alisa E. Pedrana
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela K. van Santen
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Jessica Howell
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | | | | | | | - Dean Membrey
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Fran Bramwell
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Allison Carter
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark A. Stoové
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
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23
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Traeger MW, Schroeder SE, Wright EJ, Hellard ME, Cornelisse VJ, Doyle JS, Stoové MA. Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis. Clin Infect Dis 2019; 67:676-686. [PMID: 29509889 DOI: 10.1093/cid/ciy182] [Citation(s) in RCA: 272] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is effective in reducing HIV risk in men who have sex with men (MSM). However, concerns remain that risk compensation in PrEP users may lead to decreased condom use and increased incidence of sexually transmitted infections (STIs). We assessed the impact of PrEP on sexual risk outcomes in MSM. Methods We conducted a systematic review of open-label studies published to August 2017 that reported sexual risk outcomes in the context of daily oral PrEP use in HIV-negative MSM and transgender women. Pooled effect estimates were calculated using random-effects meta-analysis, and a qualitative review and risk of bias assessment were performed. Results Sixteen observational studies and 1 open-label trial met selection criteria. Eight studies with a total of 4388 participants reported STI prevalence, and 13 studies with a total of 5008 participants reported change in condom use. Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99-1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users. Conclusion Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.
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Affiliation(s)
- Michael W Traeger
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Sophia E Schroeder
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Edwina J Wright
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,School of Public Health and Preventive Medicine, Monash University.,Department of Infectious Diseases, The Alfred and Monash University.,Peter Doherty Institute of Infection and Immunity, University of Melbourne
| | - Margaret E Hellard
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,School of Public Health and Preventive Medicine, Monash University.,Department of Infectious Diseases, The Alfred and Monash University
| | - Vincent J Cornelisse
- Department of Infectious Diseases, The Alfred and Monash University.,Central Clinical School, Monash University, Melbourne.,Melbourne Sexual Health Centre, Carlton, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,Department of Infectious Diseases, The Alfred and Monash University
| | - Mark A Stoové
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,School of Public Health and Preventive Medicine, Monash University
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24
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Traeger MW, Cornelisse VJ, Asselin J, Price B, Roth NJ, Willcox J, Tee BK, Fairley CK, Chang CC, Armishaw J, Vujovic O, Penn M, Cundill P, Forgan-Smith G, Gall J, Pickett C, Lal L, Mak A, Spelman TD, Nguyen L, Murphy DA, Ryan KE, El-Hayek C, West M, Ruth S, Batrouney C, Lockwood JT, Hoy JF, Hellard ME, Stoové MA, Wright EJ. Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection. JAMA 2019; 321:1380-1390. [PMID: 30964528 PMCID: PMC6459111 DOI: 10.1001/jama.2019.2947] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Emerging evidence suggests that risk of bacterial sexually transmitted infections (STIs) increases among gay and bisexual men following initiation of HIV preexposure prophylaxis (PrEP). OBJECTIVE To describe STI incidence and behavioral risk factors among a cohort of predominantly gay and bisexual men who use PrEP, and to explore changes in STI incidence following PrEP commencement. DESIGN, SETTING, AND PARTICIPANTS The Pre-exposure Prophylaxis Expanded (PrEPX) Study, a multisite, open-label intervention study, was nested within the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) clinic network. A total of 4275 participants were enrolled (July 26, 2016-April 1, 2018) in Victoria, Australia. Of these, 2981 enrolled at 5 ACCESS clinics (3 primary care, 1 sexual health, and 1 community-based HIV rapid testing service), had at least 1 follow-up visit, and were monitored until April 30, 2018. EXPOSURES Upon enrollment, participants received daily oral tenofovir disoproxil fumurate and emtricitabine for HIV PrEP, quarterly HIV and STI testing, and clinical monitoring. MAIN OUTCOMES AND MEASURES The primary outcome was incidence of chlamydia, gonorrhea, or syphilis. Incidence rates and hazard ratios describing behavioral risk factors of STI diagnosis were calculated. Incidence rate ratios (IRRs), adjusted for change in testing frequency, described changes in STI incidence from 1-year preenrollment to study follow-up among participants with preenrollment testing data (n = 1378). RESULTS Among the 2981 individuals (median age, 34 years [interquartile range, 28-42]), 98.5% identified as gay or bisexual males, 29% used PrEP prior to enrollment, 89 (3%) withdrew and were censored at date of withdrawal, leaving 2892 (97.0%) enrolled at final follow-up. During a mean follow-up of 1.1 years (3185.0 person-years), 2928 STIs were diagnosed among 1427 (48%) participants (1434 chlamydia, 1242 gonorrhea, 252 syphilis). STI incidence was 91.9 per 100 person-years, with 736 participants (25%) accounting for 2237 (76%) of all STIs. Among 2058 participants with complete data for multivariable analysis, younger age, greater partner number, and group sex were associated with greater STI risk, but condom use was not. Among 1378 participants with preenrollment testing data, STI incidence increased from 69.5 per 100 person-years prior to enrollment to 98.4 per 100 person-years during follow-up (IRR, 1.41 [95% CI, 1.29-1.56]). After adjusting for testing frequency, the increase in incidence from 1 year preenrollment to follow-up was significant for any STI (adjusted IRR, 1.12 [95% CI, 1.02-1.23]) and for chlamydia (adjusted IRR, 1.17 [95% CI, 1.04-1.33]). CONCLUSIONS AND RELEVANCE Among gay and bisexual men using PrEP, STIs were highly concentrated among a subset, and receipt of PrEP after study enrollment was associated with an increased incidence of STIs compared with preenrollment. These findings highlight the importance of frequent STI testing among gay and bisexual men using PrEP.
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Affiliation(s)
- Michael W. Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Vincent J. Cornelisse
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Prahran Market Clinic, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Brian Price
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | | | - Jeff Willcox
- Northside Clinic, Melbourne, Victoria, Australia
| | - Ban Kiem Tee
- Centre Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christina C. Chang
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jude Armishaw
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Olga Vujovic
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Matthew Penn
- PRONTO! Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Pauline Cundill
- PRONTO! Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | | | - John Gall
- ERA Health, Melbourne, Victoria, Australia
| | - Claire Pickett
- Ballarat Community Health Centre, Ballarat, Victoria, Australia
| | - Luxi Lal
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Anne Mak
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Tim D. Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Long Nguyen
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Dean A. Murphy
- Department of Gender and Cultural Studies, University of Sydney, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kathleen E. Ryan
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Carol El-Hayek
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Michael West
- Sexual Health and Viral Hepatitis Service, Department of Health and Human Services, Government of Victoria, Melbourne, Victoria, Australia
| | - Simon Ruth
- Thorne Harbour Health, Melbourne, Victoria, Australia
| | | | - John T. Lockwood
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Jennifer F. Hoy
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Margaret E. Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark A. Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edwina J. Wright
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
- The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
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