An Online HIV Self-Sampling Strategy for Gay, Bisexual and Other Men Who Have Sex with Men and Trans Women in Spain

We aimed to evaluate the feasibility of an online self-sampling pilot intervention for HIV testing addressed to gay, bisexual, and other men who have sex with men (GBMSM) and trans women (TW) users of dating apps in Spain. The website https://www.testate.org/ was designed to offer self-sampling kits for HIV testing and online consultation of the results. It was advertised on gay dating apps. Participants requested the delivery of a saliva self-sampling kit by mail and a postage-paid envelope to send the sample to the reference laboratory. An anonymous acceptability survey was conducted. The cascade of care was estimated. From November 2018 to December 2021, 4623 individual users ordered self-sampling kits, 3097 returned an oral fluid sample to the reference laboratory (67.5% return rate). 87 reactive results were detected. 76 were confirmed to be HIV-positive, we estimated an HIV prevalence of 2.45% (95% CI 1.9-3.0%). 100% of those referred to specialized care are in treatment. 45.8% of participants took more than one test. 23 incident cases were detected among repeat testers, of which 20 were confirmed. The estimated incidence was 1.00 confirmed case per 100 individual-years of follow-up. 98.01% of participants would recommend it to a friend. The most identified advantages were convenience and privacy. We demonstrated that the online offer of oral self-sampling kits for HIV detection and reporting results online among GBMSM and TW users of dating apps is feasible. The intervention counted with a high acceptability and high efficacy (in terms of reactivity, confirmation and linkage to care rates).

Corrigendum: Feasibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen self-testing in school and summer camp attendees

[This corrects the article DOI: 10.3389/fped.2022.975454.].

Feasibility and impact of online HIV/STI screening addressed to men who have sex with men and transgender women users of pre-exposure prophylaxis (PrEP) in Spain (TESTATE PrEP): a study protocol for a non-blinded randomised controlled trial

INTRODUCTION

The objectives of the study are: to design and implement a pilot intervention to offer self-sampling kits to detect HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Treponema pallidum (TP) among gay, bisexual and other men who have sex with men and transgender women users of pre-exposure prophylaxis (PrEP) as part of PrEP follow-up. To evaluate if the pilot intervention causes a reduction of the retention to PrEP follow-up among the target population. To analyse the capacity of the intervention to reduce the healthcare burden on the PrEP service. To evaluate the acceptability of the intervention among PrEP users and PrEP service healthcare workers and; to validate dried blood samples for treponemal and non-treponemal antibody detection using the Dual Path Platform syphilis screening and confirmatory assay compared with blood drawn by venous puncture.

METHODS AND ANALYSIS

We will perform a non-blinded randomised controlled non-inferiority trial among PrEP users on follow-up. Participants on the control arm will follow the usual follow-up protocol with quarterly face-to-face visits where they will be tested for HIV and sexually transmitted infections (STIs). Participants in the experimental arm will alternate face-to-face meetings with online screening of HIV and STIs. The website https://testate.org/ will include a module for online follow-up visits of participants. Participants of the experimental arm will order self-sampling kits for HIV, CT, NG and TP through the website, will send the samples to the laboratory and check their results online. We will compare the retention to follow up and the healthcare burden in both arms. The acceptability of the intervention among participants and healthcare workers will be assessed.

ETHICS AND DISSEMINATION

The project has been approved by the CEIC-HUGTIP (Reference: PI-22-051). Subjects will be included after giving their informed consent. Final conclusions and recommendations will be shared with stakeholders. Two publications in peer-reviewed journals are expected.

TRIAL REGISTRATION NUMBER

NCT05752643.

Self-sampling monkeypox virus testing in high-risk populations, asymptomatic or with unrecognized Mpox, in Spain

The recent monkeypox virus (MPXV) outbreak was of global concern and has mainly affected gay, bisexual and other men who have sex with men (GBMSM). Here we assess prevalence of MPXV in high-risk populations of GBMSM, trans women (TW) and non-binary people without symptoms or with unrecognized monkeypox (Mpox) symptoms, using a self-sampling strategy. Anal and pharyngeal swabs are tested by MPXV real-time PCR and positive samples are tested for cytopathic effect (CPE) in cell culture. 113 individuals participated in the study, 89 (78.76%) were cis men, 17 (15.04%) were TW. The median age was 35.0 years (IQR: 30.0-43.0), 96 (85.02%) individuals were gay or bisexual and 72 (63.72%) were migrants. Seven participants were MPXV positive (6.19% (95% CI: 1.75%-10.64%)). Five tested positive in pharyngeal swabs, one in anal swab and one in both. Six did not present symptoms recognized as MPXV infection. Three samples were positive for CPE, and showed anti-vaccinia pAb staining by FACS and confocal microscopy. This suggests that unrecognized Mpox cases can shed infectious virus. Restricting testing to individuals reporting Mpox symptoms may not be sufficient to contain outbreaks.

Determinants of Depressive Symptoms in People Living with HIV: Findings from a Population-Based Study with a Gender Perspective

Depressive symptoms are common among people living with HIV (PLWH). The aim of this study was to identify the determinants of depressive symptoms in PLWH in Spain. A total of 1060 PLWH participated in this cross-sectional study and completed the Patient Health Questionnaire-9. The odds ratios for the presence of depressive symptoms were analyzed in a multivariable logistic regression model, including sociodemographic data, comorbidities, health-related behaviors, and social-environment-related variables. We found an overall prevalence of depressive symptoms of 21.42%; by subgroup, namely men, women, and transgender persons, prevalence was 18.13%, 32.81%, and 37.14%, respectively. Moreover, social isolation (OR = 1.05 [CI, 1.02-1.08]) and poor physical and mental quality of life (OR = 1.06 [CI, 1.02-1.09] and OR = 1.13 [CI, 1.09-1.17], respectively) were associated with depressive symptoms. As protective factors, we identified serodisclosure to more people (vs. none; OR = 0.39 [CI, 0.17-0.87]), satisfaction with social roles (OR = 0.86 [CI, 0.79-0.94]), better cognitive function (OR = 0.92 [CI, 0.89-0.95]), and sexualized drug use once in a lifetime (OR = 0.52 [CI, 0.29-0.93]). This study showed a high prevalence of depressive symptoms in PLWH, especially among women and transgender people. The association between psychosocial variables and depressive symptoms highlights the multidimensionality of the problem and identifies areas for intervention. This study found that the management of mental health issues is an area that needs to be improved and tailored to specific groups, with the aim of enhancing the well-being of PLWH.

Feasibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen self-testing in school and summer camp attendees

Background

SARS-CoV-2 screening is one of the pillars of non-pharmaceutical preventive strategies to early identify and isolate infected individuals and therefore decrease community incidence.

Methods

We assessed the feasibility of severe acute respiratory syndrome coronavirus 2 self-testing with antigen-detecting rapid diagnostic tests in attendees of educational settings.

Results

A total of 305 students (88.15%) and 41 staff (11.85%) from 9 to 56 years old participated in the self-testing procedure and answered the survey at the end of the study. 91.3% (n = 313) did not need help, 96.1% of participants reported the same outcome as the healthcare workers. 94.5% strongly or slightly agree with the statement "I would repeat the experience".

Conclusion

The study demonstrates that self-testing is acceptable and usable in children, adolescents and adults when the epidemiological situation may require a systematic screening of these populations, although supervision by health care or previously trained personnel is recommended for younger age groups.

Feasibility of an online antigen self-testing strategy for SARS-CoV-2 addressed to health care and education professionals in Catalonia (Spain). The TESTA’T- COVID Project

We aimed to assess the feasibility of TESTA’T COVID strategy among healthcare and education professionals.in Spain during the peak of the 6^th wave caused by Omicron variant. Kits were ordered online and sent by mail, participants answered an online acceptability/usability survey and uploaded the picture of results. 492 participants ordered a test, 304 uploaded the picture (61.8%). Eighteen positive cases were detected (5.9%). 92.2% were satisfied/very satisfied with the intervention; and 92.5% found performing the test easy/very easy. We demonstrated that implementing online COVID-19 self-testing in schools and healthcare settings in Spain is feasible.

Substance use in sexual context among Spanish resident men who have sex with men

We analysed patterns of sexualized drug use (SDU) and pinpointed the one with the highest risk for the acquisition/transmission of HIV/Sexually Transmitted Infections (STIs) in a sample of men who have sex with men (MSM) residing in Spain. Additionally, we also identified the most affected subpopulations by highest risk SDU pattern. In 2016, we promoted an online survey in gay dating apps. We estimated the prevalence of several HIV/STI risk indicators for each identified SDU pattern. We built two different Poisson regression models identifying factors associated to the pattern associated with the highest risk. All analyses were carried out by HIV status. Of 2,883 MSM, 21.9% self-reported SDU in the last 12 months. All patterns of SDU were more frequent in HIV+ MSM. Of the four SDU patterns identified (chemsex, recreational drugs, sexual performance enhancing drugs, and cannabinoids), the most frequent was chemsex (21.9% in HIV+ vs 6.6% in HIV-). It also comprised the highest risk profile for HIV/STI. Among HIV-, chemsex was associated with living in a city of > 1,000,000 inhabitants, living sexuality in an open way and having been paid for sex, having had unprotected anal intercourse (UAI) in the last 12 months and having ever received an STI diagnosis. Among HIV+, it was associated with being 30-49 years old, having paid for sex, having had UAI and having been diagnosed with an STI in the last 12 months. Given its high prevalence, especially among HIV positive individuals, and its association with subpopulations with high-risk behaviour, chemsex could be playing a relevant role in the acquisition/transmission of HIV and other STIs.

Monitoring of SARS-CoV-2 seroprevalence among primary healthcare patients in the Barcelona Metropolitan Area: the SeroCAP sentinel network protocol

INTRODUCTION

SARS-CoV-2 seroprevalence studies are currently being recommended and implemented in many countries. Forming part of the COVID-19 monitoring and evaluation plan of the Catalan Government Health Department, our network aims to initiate a primary healthcare sentinel monitoring system as a surrogate of SARS-CoV-2 exposure in the Barcelona Metropolitan Area.

METHODS AND ANALYSIS

The seroCAP is a serial cross-sectional study, which will be performed in the Barcelona Metropolitan Area to estimate antibodies against SARS-CoV-2. From February 2021 to March 2022, the detection of serum IgG antibodies against SARS-CoV-2 trimeric spike protein will be performed on a monthly basis in blood samples collected for diverse clinical purposes in three reference hospitals from the three Barcelona healthcare areas (BCN areas). The samples (n=2588/month) will be from patients attended by 30 primary healthcare teams at 30 basic healthcare areas (BHA). A lab software algorithm will systematically select the samples by age and sex. Seroprevalence will be estimated and monitored by age, sex, BCN area and BHA. Descriptive and cluster analysis of the characteristics and distribution of SARS-CoV-2 infections will be performed. Sociodemographic, socioeconomic and morbidity-associated factors will be determined using logistic regression. We will explore the association between seroprevalence, SARS-CoV-2 confirmed cases and the implemented measures using interrupted time series analysis.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University Institute Foundation for Primary Health Care Research Jordi Gol i Gurina ethics committee. An informed consent is not required regarding the approval of the secondary use of biological samples within the framework of the COVID-19 pandemic. A report will be generated quarterly. The final analysis, conclusions and recommendations will be shared with the stakeholders and communicated to the general public. Manuscripts resulting from the network will be submitted for publication in peer-reviewed journals.

Preference towards HIV Self-Testing above Other Testing Options in a Sample of Men Who Have Sex with Men from Five European Countries

We analyzed men who have sex with men (MSM) from Denmark, Germany, Greece, Portugal and Spain to identify who would choose HIV self-testing as their preferred testing method and assessed their preferred setting to acquire a self-testing kit and to confirm a reactive result. In 2016, we recruited an online sample of 3725 HIV-negative MSM. We used Poisson regression to identify factors associated with choosing self-testing as the preferred testing option. For those choosing it as their preferred option, we assessed the preferred settings to acquire a self-testing kit and to confirm a reactive result. Not being open about one's sexual behaviors with men was associated with choosing self-testing as the preferred option, except in Greece; older age in Greece and Spain; reporting condomless anal intercourses (CAI) in Germany and Portugal; reporting one previous test in Greece; between 2 and 5 in Spain and with having been tested ≥ 12 months ago in Germany, Portugal and Spain. The internet (32.8%) was the preferred place to acquire a self-testing kit and primary care (34.0%) for confirmation purposes. Self-testing was highly valued, especially among individuals who were not open about their sexual behaviors with men. In certain countries, it was also associated with older age, CAI and being undertested.

Opinions Towards Key Operational Aspects for the Implementation of HIV Self-Testing in Spain: A Comparison between Stakeholders and Potential Users

We assessed previous knowledge about the existence of HIV self-testing of stakeholders in Spain, as well as their personal position towards this methodology. We also assessed their views on potential users’ (PU) opinions towards several key operational aspects surrounding self-testing, and compared them to those expressed by a sample of PU comprised of men who have sex with men. In 2017, we recruited three types of stakeholders: public health professionals and policy makers (PHPPM) (n = 33), clinical providers (n = 290) and community-based/non-governmental organization (CBO/NGO) workers (n = 55). Data on PU (n = 3537) were collected in 2016. Previous knowledge about the existence of self-testing was higher in stakeholders than in PU, but being in favor was less frequent. PUs’ willingness to pay 25–30 euros for a self-test was higher than that which stakeholders considered. According to clinical providers and PHPPM, pharmacies would be PUs’ preferred place to obtain a self-test, which was in line with PUs’ actual choice. CBO/NGO workers on the other hand thought it would be CBO/NGOs. PHPPM and clinical providers considered primary care as PUs’ preferred setting to confirm a reactive self-test and CBO/NGO chose CBO/NGOs, but PUs preferred an HIV/STI testing service or clinic. Stakeholders’ opinions significantly differed from those of PUs. This divergence needs to be brought up to stakeholders as it could vary their position towards self-testing as well as the actions taken in the implementation of a testing option with the potential of increasing testing frequency.

Association of Sexualized Drug Use Patterns with HIV/STI Transmission Risk in an Internet Sample of Men Who Have Sex with Men from Seven European Countries

We estimated the prevalence of overall sexualized drug use (SDU) and of chemsex in particular, assessed patterns of drug use, and identified subpopulations of men who have sex with men (MSM) where SDU and chemsex are more frequent. Using data from an online survey of 9407 MSM recruited during 2016 in 7 European countries, we calculated the proportion of participants who reported SDU and chemsex (mephedrone, methamphetamine, and/or GHB/GBL) in the last 12 months. We grouped the different drug-use combinations in patterns and described sexual risk behaviors, sexually transmitted infections (STI), and HIV seropositivity for each one of them. Factors associated with SDU and chemsex were assessed with two logistic regression models. SDU was reported by 17.7% and chemsex by 5.2%. Risk indicators increased through the different SDU patterns but were higher within those including chemsex drugs. In the multivariate analysis, chemsex was independently associated with living in Slovenia. Both SDU and chemsex were independently associated with living in Spain; being < 50 years old; living in cities of > 500,000 inhabitants; being open about their sex life; reporting transactional sex; condomless anal intercourse; having received an STI diagnosis and with being HIV positive or having been tested ≤ 12 months ago. Magnitude of associations was higher in the chemsex model. One in five participants reported SDU, but prevalence of chemsex was notably lower. However, the risk profiles and higher prevalence of HIV/STIs among those involved in chemsex suggest the existence of a subpopulation of MSM that could be playing a relevant role in the HIV and STI epidemics, especially in very large cities of some countries.

Potential of HIV Self-Sampling to Increase Testing Frequency Among Gay, Bisexual, and Other Men Who Have Sex With Men, and the Role of Online Result Communication: Online Cross-Sectional Study

Background

Late HIV diagnosis remains frequent among the gay, bisexual, and other men who have sex with men (GBMSM) population across Europe. HIV self-sampling could help remove barriers and facilitate access to testing for this high-risk population.

Objective

We assessed the capacity of HIV self-sampling to increase the testing frequency among GBMSM living in Denmark, Germany, Greece, Portugal, Romania, and Spain, and evaluated the role of new technologies in the result communication phase.

Methods

We analyzed a convenience sample of 5019 GBMSM with prior HIV testing experience who were recruited during 2016 through gay dating websites. We estimated the proportion of GBMSM who reported that the availability of self-sampling would result in an increase of their current testing frequency. We constructed a Poisson regression model for each country to calculate prevalence ratios and 95% CIs of factors associated with an increase of testing frequency as a result of self-sampling availability.

Results

Overall, 59% (between country range 54.2%-77.2%) of the participants considered that they would test more frequently for HIV if self-sampling was available in their country. In the multivariate analysis, the increase of testing frequency as a result of self-sampling availability was independently associated with reporting a higher number of unprotected anal intercourse events in all countries except for Greece. Independent associations were also observed among GBMSM who were not open about their sex life in Germany, Greece, Portugal, and Spain; those with a lower number of previous HIV tests in Denmark, Greece, Portugal, and Spain; and for those that took their last test more than 3 months previously in Germany, Portugal, Romania, and Spain. In addition, 58.4% (range 40.5%-73.6%) of the participants indicated a preference for learning their result through one-way interaction methods, mainly via email (25.6%, range 16.8%-35.2%) and through a secure website (20.3%, range 7.3%-23.7%). Almost two thirds (65%) of GBMSM indicated preferring one of these methods even if the result was reactive.

Conclusions

Availability of HIV self-sampling kits as an additional testing methodology would lead to a much-needed increase of testing frequency, especially for the hidden, high-risk, and undertested GBMSM population. Online-based technologies without any personal interaction were preferred for the communication of the results, even for reactive results.

The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain)

BACKGROUND

Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates.

METHODS

Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012-2016) and associated risk factors at the small area level (ABS, acronym for "basic health area" in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level.

RESULTS

New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15-44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation.

CONCLUSIONS

Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.

Outreach HIV testing using oral fluid and online consultation of the results: Pilot intervention in Catalonia

INTRODUCTION

The aim of the intervention was to describe the feasibility and cost-effectiveness of offering HIV testing in outreach interventions and subsequent consultation of the results through a secure web page.

METHODS

The HIV test was offered "in situ" to men who have sex with men (MSM), migrant sex workers and trans women recruited in places of leisure and sex. Four collaborating NGOs recruited the participants and assisted them to register on the study website (www.swab2know.eu) through a tablet or the smartphone of the same participant. The samples were sent to the reference laboratory and the results were published on the website.

RESULTS

834 participants (612 MSMs, 203 women sex workers and 19 trans women) were recruited. In total 22 reagent results (2.6%) were detected: 21 among MSMs (3.4%) and 1 in a trans women (5.3%). While 82.6% of MSMs consulted their outcome, only 39.9% and 26.3% of women sex workers and trans women respectively consulted their outcome CONCLUSIONS: Providing self-sampling in outreach activities, dispatch and analysis in a reference laboratory as well as online communication of test results is feasible. A high proportion of participants with a HIV reactive result were detected among MSMs and trans women.

[HIV screening in leisure spaces in Barcelona and Sitges in men who have sex with men]

Description of the implementation of the field work of a pilot intervention whose objective was to promote the early diagnosis of HIV infection by offering a screening test for HIV in gay venues and cruising areas (outdoor sexual contact areas) frequented by men who have sex with men (MSM) in the city of Barcelona and Sitges, and consulting the result through the project website. The pilot intervention was viable and counted with the acceptability of the target group.

The COBATEST network: monitoring and evaluation of HIV community-based practices in Europe, 2014-2016

OBJECTIVE

The objective of this paper is to describe the data collected by the CBVCT services from the Community-based testing (COBATEST) network, from 2014 to 2016, in order to provide an insight into community-based voluntary counselling and testing (CBVCT) services' testing activity in Europe.

METHODS

A descriptive analysis of HIV testing activity in CBVCT services that are using the COBATEST tools was performed for the period 2014-2016.

RESULTS

During the study period, a total of 30 329 HIV tests were performed on 27 934 individuals, of which 1.8% were reactive. Of these reactive tests, 75.8% had a confirmatory test, 92.2% of those were confirmed as positive, and 90.38% of the confirmed positives were linked to care. The total number of tests performed over the study period increased 19.31%. The proportion of confirmatory tests increased from 63.0% to 90.0% and proportion linked to care increased from 84.1% to 93.8%. Most of the tested individuals were men (70.6%), aged between 21 and 35 years (58.5%) and non-foreign born (68.1%). A high proportion of individuals tested were men who have sex with men (MSM; 42.2%). The percentage of reactive screening tests was particularly high among transgender people (8.37%) and among male sex workers (6.38%). Repeat testers had a higher percentage of reactive tests (2.02%) than those tested for first time (1.1%).

CONCLUSIONS

These results prove the feasibility of collecting standardized data from CBVCT services in different countries across Europe and demonstrate the usefulness of such data.

Knowledge, actual and potential use of HIV self-sampling testing kits among MSM recruited in eight European countries

AIM

To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method.

METHODS

We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence.

RESULTS

A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result.

CONCLUSION

The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.

[Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin]

Objetivos

Estimar la prevalencia de la infección por VIH en pacientes diagnosticados con una condición indicadora (CI) para el VIH y/o que habían tenido una conducta de riesgo para su adquisición y/o que provenían de países con elevada prevalencia. Determinar la aceptabilidad y viabilidad de ofrecer la prueba del VIH basada en CI y criterios conductuales y de origen en atención primaria (AP).

Diseño

Estudio transversal en una muestra de conveniencia.

Emplazamiento

Seis centros de AP en España.

Participantes

Los criterios de inclusión fueron: pacientes entre 16 y 65 años que presentaban al menos una de las CI propuestas y/o al menos uno de los criterios conductuales y/o de origen propuestos. Participaron 388 pacientes.

Intervención

Se ofreció la serología del VIH a todos los pacientes que cumplían con los criterios de inclusión.

Mediciones principales

Descripción de la frecuencia de CI, criterios conductuales y de origen. Prevalencia de infección por VIH. Nivel de aceptabilidad y viabilidad de la oferta de la prueba del VIH basada en criterios conductuales y de origen y CI.

Resultados

Un total de 174 pacientes presentaron una CI (44,84%). El criterio conductual más común fue: haber mantenido relaciones sexuales desprotegidas alguna vez en la vida con personas que desconocían su estado serológico para el VIH (298; 76,8%). Se diagnosticaron 4 pacientes VIH+ (1,03%). Todos presentaban una CI y eran hombres que mantenían sexo con hombres. El nivel de aceptabilidad en AP fue elevada.

Conclusiones

Ofrecer la prueba del VIH a pacientes con CI y criterios conductuales es viable y efectiva en AP.

Economic evaluation of HIV testing for men who have sex with men in community-based organizations - results from six European cities

The non-decreasing incidence of HIV among men who have sex with men (MSM) has motivated the emergence of Community Based Voluntary Counselling and Testing (CBVCT) services specifically addressed to MSM. The CBVCT services are characterized by facilitated access and linkage to care, a staff largely constituted by voluntary peers, and private not-for-profit structures outside the formal health system institutions. Encouraging results have been measured about their effectiveness, but these favourable results may have been obtained at high costs, questioning the opportunity to expand the experience. We performed an economic evaluation of HIV testing for MSM at CBVCT services, and compared them across six European cities. We collected retrospective data for six CBVCT services from six cities (Copenhagen, Paris, Lyon, Athens, Lisbon, and Ljubljana), for the year 2014, on the number of HIV tests and HIV reactive tests, and on all expenditures to perform the testing activities. The total costs of CBVCTs varied from 54,390€ per year (Ljubljana) to 245,803€ per year (Athens). The cost per HIV test varied from to 41€ (Athens) to 113€ (Ljubljana). The cost per HIV reactive test varied from 1966€ (Athens) to 9065€ (Ljubljana). Our results show that the benefits of CBVCT services are obtained at an acceptable cost, in comparison with the literature (values, mostly from the USA, range from 1600$ to 16,985$ per HIV reactive test in clinical and non-clinical settings). This result was transversal to several European cities, highlighting that there is a common CBVCT model, the cost of which is comparable regardless of the epidemiological context and prices. The CBVCT services represent an effective and "worth it" experience, to be continued and expanded in future public health strategies towards HIV.

The clinical value of biomarkers in respiratory complications in hematopoietic SCT

To determine the role of biomarkers in the clinical management of respiratory complications (RC) in hematopoietic stem cell transplantation (HSCT) recipients, we have prospectively evaluated a cohort of 175 patients followed-up for 1 year after HSCT. To avoid misinterpretation, we have excluded both unidentified respiratory infections (RI) and mixed RI. A total of 64 RC were included. Plasma levels of C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) were measured at diagnosis and on day 3 and 7. Different cytokines were evaluated in serum on the first day. No HSCT recipients without RC were included as a control group. Compared with RI, non-infectious RC showed a significant increase in CRP, proADM and interleukin 6 on day 0 (P=0.005; P=0.03 and P=0.04, respectively). When only RI were considered, we observed that bacterial–fungal PI showed higher levels of CRP (P=0.02), PCT (P=0.04) and proADM (P<0.01). Persistent low levels of proADM biomarkers suggest viral infection (specificity and positive predictive value 100%). Patients dying of RC had PCT and proADM levels higher than survivors (P=0.002 and P=0.03, respectively). In HSCT recipients biomarkers increase in both infectious and non-infectious RC. They may have utility in the assessment of the severity of RC and in suspecting a viral etiology.

COBA-Cohort: a prospective cohort of HIV-negative men who have sex with men, attending community-based HIV testing services in five European countries (a study protocol)

INTRODUCTION

Community-based voluntary counselling and testing (CBVCT) services for men who have sex with men (MSM) can reach those most-at-risk and provide an environment for gay men that is likely to be non-stigmatising. Longitudinal data on the behaviour of HIV-negative MSM are scarce in Europe. The aim of this protocol, developed during the Euro HIV Early Diagnosis And Treatment (EDAT) project, is to implement a multicentre community-based cohort of HIV-negative MSM attending 15 CBVCT services in 5 European countries.

RESEARCH OBJECTIVES

(1) To describe the patterns of CBVCT use, (2) to estimate HIV incidence, and to identify determinants of (3) HIV seroconversion and (4) HIV and/or sexually transmitted infection (STI) test-seeking behaviour.

METHODS AND ANALYSIS

All MSM aged 18 years or over and who had a negative HIV test result are invited to participate in the COmmunity-BAsed Cohort (COBA-Cohort). Study enrolment started in February 2015, and is due to continue for at least 12 months at each study site. Follow-up frequency depends on the testing recommendations in each country (at least 1 test per year). Sociodemographic data are collected at baseline; baseline and follow-up questionnaires both gather data on attitudes and perceptions, discrimination, HIV/STI testing history, sexual behaviour, condom use, and pre- and post-exposure prophylaxis. Descriptive, exploratory and multivariate analyses will be performed to address the main research objectives of this study, using appropriate statistical tests and models. These analyses will be performed on the whole cohort data and stratified by study site or country.

ETHICS AND DISSEMINATION

The study was approved by the Public Health authorities of each country where the study is being implemented. Findings from the COBA-Cohort study will be summarised in a report to the European Commission, and in leaflets to be distributed to study participants. Articles and conference abstracts will be submitted to peer-reviewed journals and conferences.

Knowledge and use of unauthorized HIV self-test kits among men who have sex with men in Spain, following approval of an over-the-counter self-test in the U.S: a cross-sectional study

Background

Shortly after the approval of an over-the-counter HIV self-test in the US, we conducted a study to estimate the proportion of men who have sex with men (MSM) in Spain who knew that unauthorized HIV self-tests could be purchased online, and the proportion that had already used these tests, as well as their socio-demographic and behavioural correlates.

Methods

Between September 2012 and February 2013, MSM users of gay dating websites were invited to complete an online questionnaire. We calculated estimates of the knowledge and use of unauthorized HIV self-testing and assessed the associated factors by rare event logit regression models.

Results

Among 8620 participants, 4.2 % (95 % CI:3.8–4.6) knew they could buy an unauthorized HIV self-test kit online, and 12.7 % (95 % CI:12.0–13.4) thought that such a test might exist, although they had never seen one. Only 0.7 % (95 % CI:0.5–0.9) had ever self-tested. In the multivariable analysis, knowledge of online availability of self-tests was associated with being a non-Latin American foreigner, having at least two previous HIV tests, intending to test for HIV in the next year, and knowing about U.S. approval of self-testing. Ever-use of HIV self-testing was associated with being over 34 years of age, living outside Spain during the last 12 months, and knowing about U.S. approval of self-testing.

Conclusions

Both knowledge and use of unauthorized HIV self-testing among MSM in Spain was very low among HIV negative or untested MSM in Spain. The recent approval in the United Kingdom and France might increase the number of MSM seeking such testing and possibly using unauthorized test kits not meeting quality standards.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3204-9) contains supplementary material, which is available to authorized users.

Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or HIV/Hepatitis C Virus Coinfection

BACKGROUND

It has been suggested that routine CD4 cell count monitoring in human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads and CD4 cell counts >300 cell/μL could be reduced to annual. HIV/hepatitis C virus (HCV) coinfection is frequent, but evidence supporting similar reductions in CD4 cell count monitoring is lacking for this population. We determined whether CD4 cell count monitoring could be reduced in monoinfected and coinfected patients by estimating the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression.

METHODS

The PISCIS Cohort study included data from 14 539 patients aged ≥16 years from 10 hospitals in Catalonia and 2 in the Balearic Islands (Spain) since January 1998. All patients who had at least one period of 6 months of continuous HIV suppression were included in this analysis. Cumulative probabilities with 95% confidence intervals were calculated using the Kaplan-Meier estimator stratified by the initial CD4 cell count at the period of continuous suppression initiation.

RESULTS

A total of 8695 patients were included. CD4 cell counts fell to <200 cells/µL in 7.4% patients, and the proportion was lower in patients with an initial count >350 cells/µL (1.8%) and higher in those with an initial count of 200-249 cells/µL (23.1%). CD4 cell counts fell to <200 cells/µL in 5.7% of monoinfected and 11.1% of coinfected patients. Of monoinfected patients with an initial CD4 cell count of 300-349 cells/µL, 95.6% maintained counts ≥200 cells/µL. In the coinfected group with the same initial count, this rate was lower, but 97.6% of coinfected patients with initial counts >350 cells/µL maintained counts ≥200 cells/µL.

CONCLUSIONS

From our data, it can be inferred that CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts >300 cells/µL and HIV/HCV-coinfected patients with counts >350 cells/µL.

Missed opportunities for HIV testing of patients diagnosed with an indicator condition in primary care in Catalonia, Spain

OBJECTIVE

To estimate the prevalence of HIV testing among patients diagnosed with an indicator condition (IC) for HIV, seen in primary care (PC) in Catalonia, and to estimate the prevalence of HIV infection among those patients.

DESIGN

Cross-sectional and population-based study in patients aged between 16 and 65 diagnosed with an IC within PC in Catalonia.

METHODS

Data used in this study were extracted from a large population-based public health database in Spain, the Information System for the Development of Research in Primary Care (SIDIAP). All participants registered in SIDIAP from 1 January 2010 to 31 August 2012 and with a diagnosis of an IC were screened to identify those with an HIV test within the following 4 months.

RESULTS

99 426 patients were diagnosed with an IC during the study period. In these patients, there were 102 647 episodes in which at least one IC was diagnosed. An HIV test was performed within 4 months in only 18 515 of the episodes in which an IC was diagnosed (18.5%). The prevalence of HIV infection was 1.46%. Women (OR 1.35, 95% CI 1.30 to 1.39), people aged 50 or over (OR 2.85, 95% CI 2.69 to 3.00) and patients having a single IC (OR 3.59. 95% CI 3.20 to 4.03) had the greatest odds of not having an HIV test.

CONCLUSIONS

The study highlights the persistence of missed opportunities for HIV testing within PC in Catalonia. Urgent engagement with PC professionals is required in order to increase HIV testing and prevent late HIV diagnoses.

The COBATEST network: a platform to perform monitoring and evaluation of HIV community-based testing practices in Europe and conduct operational research

The European project "HIV community-based testing practices in Europe" (HIV-COBATEST) has contributed to the establishment of a network of community-based voluntary counselling and testing services (CBVCTs) that monitors and evaluates HIV testing activity in the communities. The objective of this paper is to describe the data that have been collected during 2014 by the COBATEST network in order to provide an insight into testing activity of CBVCTs in Europe. Members of the CBVCT network share common instruments for data collection and data entry. The network has a common database that allows global data analysis and comparison between different centres. In 2014, 40 CBVCTs of 18 European countries were participating in the network, and, from those, 20 CBVCTs were using the common COBATEST data collection tools. In these 20 CBVCTs, a total of 9266 HIV screening tests were performed on 8554 people, of which 1.58% (135/8554) were reactive and 51.1% (69/135) confirmed positive. Five cases were false positives, and 84.1% (58/69) of the confirmed positive cases were linked to care. Most of the tested individuals were men (70.8%), between 21 and 35 years of age (57.6%) and natives (67.1%). A higher proportion of men who had sex with men (MSM) (38.8%; 3267/8554) were tested compared to heterosexual men (27.7%) and women (23.5%). Rapid blood test was used in 78.5% of the cases and mostly performed in CBVCT offices (88.3%). Among sex workers (SWs), the percentage of reactive screening tests was particularly high (4.0%), especially among male SWs (7.7%) as compared to other risk groups, such as MSM (3.1%). The COBATEST network contributes to the availability of standardized information about the activity and impact of CBVCT centres in Europe. This information and standardized tools can help improve these services and inform decision-makers to better contextualize these interventions within their national HIV-prevention programmes.

Level of impact on the public health of universal human immunodeficiency virus screening in an Emergency Department

INTRODUCTION

The aim of this study was to determine the prevalence of HIV and the acceptability of rapid testing in an emergency department (ED), Barcelona (6/07/2011 to 8/03/2013).

METHOD

A convenience sample was used, depending on nurse availability in the ED. Participants signed an informed consent. Results were confirmed by conventional methods.

RESULT

A total of 2,140 individuals were offered testing, and 5% rejected taking part (107/2,140). Three subjects (3/2,033 [0.15%]) had confirmed reactive test. Individuals with a higher education were more likely to perform a rapid HIV test in ED (P<.005).

CONCLUSION

A low prevalence of new HIV diagnoses was found among participants, although there was a high acceptability rate to perform rapid testing in the ED.

Corticosteroids as adjunctive treatment in community-acquired pneumonia

Community-acquired Pneumonia (CAP) is the first leading infectious cause of death in developed countries. The mortality rate in severe CAP is very high and has not changed in recent years, despite advances in antimicrobial therapy and supportive measures. Several studies have identified an excessive host inflammatory response as a marker of poor prognosis in CAP. Corticosteroids are anti-inflammatory and immunosupressive agents widely used in modern medicine. Chronic use of corticosteroids has been related to immunosuppression and higher incidence of pneumonia due to opportunistic and high resistant bacteria. However, the use of corticosteroids as adjunctive therapy in CAP may be beneficial due to their anti-inflammatory effect. Experimental pneumonia studies showed that corticosteroid administration was associated with a reduction in circulating and pulmonary cytokine levels, an improvement in histopathological severity scores and a decreased bacterial burden. Several randomized controlled trials (RCT) testing the usefulness of corticosteroids in CAP have been performed in the recent years with conflicting results. However, two recent meta-analyses found improved mortality in the subgroup with severe CAP and/or receiving >5 days of glucocorticoid treatment. Dosage, duration of treatment and side effects are two important aspects not well determined yet. This review discusses the association of corticosteroids as adjunctive therapy and its association with clinical outcomes and side effects in patients with CAP.

Pulmonary complications in hematopoietic SCT: a prospective study

Pulmonary complications are common and often lethal in hematopoietic SCT recipients. The objective of this prospective interventional study was to evaluate the etiology, diagnostic procedures, risk factors and outcome of pulmonary complications in a cohort of hematopoietic SCT recipients followed up for 1 year. For patients suffering from a pulmonary complication, a diagnostic algorithm that included non-invasive and bronchoscopic procedures was performed. We identified 73 pulmonary complications in 169 patients: 50 (68%) were pneumonias; 21 (29%) were non-infectious complications and 2 (3%) were undiagnosed. Viruses (particularly Rhinovirus) and bacteria (particularly P. aeruginosa) (28 and 26%, respectively) were the most common causes of pneumonia. A specific diagnosis was obtained in 83% of the cases. A non-invasive test gave a specific diagnosis in 59% of the episodes. The diagnostic yield of bronchoscopy was 67 and 78% in pulmonary infections. Early bronchoscopy (⩽5 days) had higher diagnostic yield than late bronchoscopy (78 vs 23%; P=0.02) for pulmonary infections. Overall mortality was 22 and 32% of all fatalities were due to pulmonary complications. Pulmonary complications are common and constitute an independent risk factor for mortality, stressing the importance of an appropriate clinical management.

Attitudes to rapid HIV testing among Spanish General Practitioners

OBJECTIVES

The objectives of this study were to investigate the acceptability of rapid HIV testing among general practitioners in Spain and to identify perceived barriers and needs in order to implement rapid testing in primary care settings.

METHODS

An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15th June and 31st October 2010.

RESULTS

Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were General Practitioners (GP). Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the results obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively).

CONCLUSIONS

This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

Acceptability of rapid HIV diagnosis technology among primary healthcare practitioners in Spain

This study investigated the acceptability of rapid HIV testing among general practitioners (GP) and aimed to identify perceived barriers and needs in order to implement rapid testing in primary care settings. An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15 June 2012 and 31 October 2010. Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were GP. Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the result obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

[Assessment of effectiveness of a plan against tobacco in a universitary hospital]

AIMS

Assessment of effectiveness of a plan entitled «Smoke-free hospitals», specifically the reduction in the number of smoking staff and an increase in smoke-free areas.

METHOD

Interventional, non-controlled, populational study. A baseline study was conducted in 2004 to find out the situation as regards the prevalence of smokers in our hospital and the support of health workers for the smoke-free hospital plan. We used the questionnaire validated for the European smoke free hospital network in a sample of 483 workers randomly selected and stratified by gender, age and establishment. In 2007 we repeated the study with the same methodology to ascertain the progress of the project, in this case a sample of 425 workers was collected.

RESULTS

The number of smoking workers had decreased from 35.2% to 27.4 (P<.05). This reduction was seen in virtually all sectors, but was less so in nursing staff. In 2007 we had achieved that people only smoke in smoking areas (P<.0001). The plan was supported by smokers and non-smokers.

CONCLUSIONS

The «Smoke-free hospital» plan has achieved the objectives proposed. The actions carried out helped to enforce the law and respect that hospital areas should not be for smoking, together with strong support to help workers who want to quit smoking are shown to be effective.

E-cadherin controls beta-catenin and NF-kappaB transcriptional activity in mesenchymal gene expression

E-cadherin and its transcriptional repressor Snail1 (Snai1) are two factors that control epithelial phenotype. Expression of Snail1 promotes the conversion of epithelial cells to mesenchymal cells, and occurs concomitantly with the downregulation of E-cadherin and the upregulation of expression of mesenchymal genes such as those encoding fibronectin and LEF1. We studied the molecular mechanism controlling the expression of these genes in mesenchymal cells. Forced expression of E-cadherin strongly downregulated fibronectin and LEF1 RNA levels, indicating that E-cadherin-sensitive factors are involved in the transcription of these genes. E-cadherin overexpression decreased the transcriptional activity of the fibronectin promoter and reduced the interaction of beta-catenin and NF-kappaB with this promoter. Similar to beta-catenin, NF-kappaB was found, by co-immunoprecipitation and pull-down assays, to be associated with E-cadherin and other cell-adhesion components. Interaction of the NF-kappaB p65 subunit with E-cadherin or beta-catenin was reduced when adherens junctions were disrupted by K-ras overexpression or by E-cadherin depletion using siRNA. These conditions did not affect the association of p65 with the NF-kappaB inhibitor IkappaBalpha. The functional significance of these results was stressed by the stimulation of NF-kappaB transcriptional activity, both basal and TNF-alpha-stimulated, induced by an E-cadherin siRNA. Therefore, these results demonstrate that E-cadherin not only controls the transcriptional activity of beta-catenin but also that of NF-kappaB. They indicate too that binding of this latter factor to the adherens junctional complex prevents the transcription of mesenchymal genes.

Corticosteroids in severe pneumonia

The mortality rate in severe community- or hospital-acquired pneumonia is very high, ranging 20-50%. Despite advances in antimicrobial therapy and supportive measures, this rate has not changed in recent years, suggesting that other factors are also responsible for the poor outcome. An abnormal increase in the local and systemic inflammatory response is associated with poor outcome, and this occurs despite adequate antibiotic therapy. There is evidence that acute administration of corticosteroids decreases the inflammatory response and might decrease mortality in severe pneumonia. This has been shown in one small randomised controlled study, terminated prematurely due to 0% mortality in the intervention arm. In addition, an experimental study showed that glucocorticosteroids decrease lung inflammatory response and lung bacterial burden, confirming the results obtained through in vitro investigations. Although these results are promising and suggest a novel role of glucocorticosteroids in pneumonia, the inherent risks and potential side-effects of these drugs require further controlled clinical trials in order to better define the target population before their general use in clinical practice. Specifically, dosage, period of administration, titration, tapering and side-effects are some of the key questions that need to be investigated.