Search

Background: The aims of this study were to evaluate the experiences of telehealth for routine HIV care and identify preferred models of HIV routine care for the future. Methods: Anonymous, online questionnaire among people living with HIV aged 18 years or older. This survey was advertised via posters with a QR code in six sexual health clinics and one community organisation as well as on social media from November 2021 to December 2022. Results: Of 89 participants, the majority were males (80/89, 89.9%), between 36 and 55 years old (49/89, 55.1%), spoke English at home (74/89, 84.1%), had been living with HIV for >5 years (68/89, 76.4%) and reported having a telehealth consultation since the COVID-19 pandemic began (69/89, 77.5%). The top three liked aspects of telehealth were: the convenience of not leaving home or work (50/69, 72.5%); less travel time (48/69, 69.6%); and avoiding contact with other people (30/69, 43.5%). The top three dislikes of telehealth were: they could not be screened for sexually transmitted infections (STIs) or have a physical examination at the same time (29/69, 42.0%); it was an impersonal experience (20/69, 29.0%); and it was more difficult to discuss health concerns (18/69, 26.1%). Among all participants, the preference for future consultations was to have a mix between in-person and telehealth (40/89, 44.9%); however, nearly one-quarter prefer in-person consultations only (20/89, 22.5%). Conclusions: Use of telehealth during COVID-19 has been evaluated positively among people living with HIV that participated in this survey. Participants support the use of telehealth for routine care in conjunction with in-person consultations. As a consequence of COVID-19, sexual health clinics in Australia adopted the use of telehealth for the routine care of people living with HIV. Telehealth has been positively evaluated among this population. Hybrid models between in-person and telehealth conjunction were suggested for the future care model. [ABSTRACT FROM AUTHOR]

Introduction: Effective linkage to prevention and care is a crucial step following HIV testing services. This systematic review aimed to determine the proportion of individuals linked to prevention and care after HIV self‐testing (HIVST) and describe factors associated with linkage. Methods: Following PRISMA guidelines, a comprehensive search across eight databases (2010–October 2023) identified studies on linkage to care after HIVST, defined as receiving a confirmatory test or initiating antiretroviral therapy (ART) if the self‐test was reactive, and/or pre‐exposure prophylaxis (PrEP) if the self‐test was non‐reactive. A random‐effects meta‐analysis summarized the findings and meta‐regression explored study‐level covariates, such as world region, population type and service delivery model, that might explain the between‐study heterogeneity. Results: From 10,071 screened studies, 173 were included in the meta‐analysis. The majority of studies focused on key populations in Africa using unassisted, oral fluid‐based HIVST kits. Among those with reactive HIVST results, 92% (95% confidence interval [CI]: 88–95) were linked to confirmatory testing (n = 124 studies), and 89% (95% CI: 84–93) of newly diagnosed individuals initiated ART (n = 88 studies). Overall, 84% (95% CI: 74–93) of self‐testers were linked to care (n = 69 studies). However, only 9% (95% CI: 2–19) of individuals with non‐reactive HIVST results were linked to PrEP services (n = 9 studies). Assisted HIVST was associated with higher linkage rates to confirmatory testing and ART initiation compared to unassisted testing. Meta‐regression revealed that the type of delivery model for the HIVST kits influenced linkage and that individuals who obtained their HIVST kits through a social network‐based approach (SNA) were more likely to be linked to confirmatory testing (adjusted odds ratio = 1.28 [95% CI: 1.10–1.50], p = 0.001) compared to non‐SNA service delivery model. Discussion: In the context of expanding HIVST services globally, we found that linkage to confirmatory testing and ART initiation after HIVST is generally high, particularly when assisted HIVST or SNA‐based distribution is used. Conclusions: Strengthening timely linkage is vital for improving health outcomes, reducing HIV transmission and achieving the UNAIDS 95‐95‐95 goal. Ongoing research and collaboration with community‐based organizations are needed to overcoming barriers and ensuring positive outcomes for those using HIVST. PROSPERO Number: CRD42022357570. [ABSTRACT FROM AUTHOR]

In response to the COVID?19 pandemic, Australia went into a nationwide lockdown that began on 22 March 2020 with stage one restrictions. These initial restrictions included closing non?essential businesses as [...], : Objective: Examine the changes in service delivery Australian public sexual health clinics made to remain open during lockdown. Methods: A cross?sectional survey designed and delivered on Qualtrics was emailed to 21 directors of public sexual health clinics across Australia from July?August 2020 and asked about a variety of changes to service delivery. Descriptive statistics were calculated. Results: Twenty clinics participated, all remained open and reported service changes, including suspension of walk?in services in eight clinics. Some clinics stopped offering asymptomatic screening for varying patient populations. Most clinics transitioned to a mix of telehealth and face?to?face consultations. Nineteen clinics reported delays in testing and 13 reported limitations in testing. Most clinics changed to phone consultations for HIV medication refills (n=15) and eleven clinics prescribed longer repeat prescriptions. Fourteen clinics had staff redeployed to assist the COVID?19 response. Conclusion: Public sexual health clinics pivoted service delivery to reduce risk of COVID?19 transmission in clinical settings, managed staffing reductions and delays in molecular testing, and maintained a focus on urgent and symptomatic STI presentations and those at higher risk of HIV/STI acquisition. Implications for public health: Further research is warranted to understand what impact reduced asymptomatic screening may have had on community STI transmission.

Background. The patterns of sexually transmitted infections (STIs) in populations may be influenced by the sexual mixing within the population. We aimed to investigate the assortative sexual mixing pattern by bisexuality in male-male partnerships. Methods. This was a retrospective repeated crosssectional study of men with mostly regular male partners attending the Melbourne Sexual Health Centre between 2011 and 2019. Data on sexual practices, including their sexual practices, presence of other male/female sex partners and the gender of sexual partners in the previous 3 and 12 months, were collected using computer-assisted self-interview. We calculated the proportion of male partnerships where at least one man in the partnership reported a female sex partner. Results. A total of 2056 male-male partnerships (i.e. 4112 individuals) with a median age of 29 years (IQR 25 to 35) were included. Overall, in 94.4% (1941/2056) of male-male partnerships both men had male partners only; however, in 5.5% (113/2056) of partnerships, one man had both male and female partners, and in 0.1% (2/2056) partnerships, both men had both male and female partners. No assortative relationship was found on the sexual mixing by bisexuality in male-male partnerships due to the low assortativity coefficient (r = 0.006, 95% CI: -0.004 to 0.016). Conclusion. One in 20male-male partnerships had at least one man who had both male and female partners within the preceding year. Individuals were not selective by bisexuality, suggesting that partnerships of bisexual individuals are mixed proportionately to the distribution of their characteristics. Still, these sexual mixing practices may affect STI transmission dynamics. [ABSTRACT FROM AUTHOR]

This Virtual Special Issue explores emerging topics in reproductive health in the Australian and New Zealand context. The included manuscripts cover pregnancy and termination of pregnancy, priority populations for sexual and reproductive health, digital technology and its impact on reproductive health, and perspectives from clinicians. [ABSTRACT FROM AUTHOR]

Background: The incidence of sexual assault continues to rise in Australia. This study aimed to describe the nature of assault, HIV/STI positivity, and its management at a sexual health clinic. Methods: We performed a chart review of 516 sexual assault cases presenting to Melbourne Sexual Health Centre between 2012 and 2021, collecting data on victim demographics, details of assault, HIV/STI testing and positivity, police involvement, and offer of counselling. Results: We included 516 cases: 124 males (24.0%); 384 females (74.4%); and eight transgender (1.6%) victims. The proportion of assault cases presenting to Melbourne Sexual Health Centre increased from 0.1% (37/37,070) in 2012 to 0.2% (56/36,514) in 2021 (P trend = 0.006). HIV post-exposure prophylaxis was prescribed for 64.5% (80/124) of males and 12.5% (48/384) of females. Among victims, 69.4% (358/516) were tested for HIV and no one tested positive, while 71.9% (371/516) were tested for syphilis, with 1.6% (6/371) positive. Gonorrhoea and chlamydia were tested at the oropharynx (44.8% [231/516] vs 28.7% [148/516]), genitals (83.7% [432/516] vs 92.4% [477/516]) and anorectum (35.3% [182/516] vs 35.3% [182/516]). Positivity for gonorrhoea and chlamydia were: 2.6% (6/231) vs 2.0% (3/148) at oropharynx, 1.4% (6/432) vs 2.9% (14/477) at genitals, and 5.5% (10/182) vs 7.1% (13/182) at anorectum. According to clinical records, 25.2% (130/516) of victims sought police involvement, and 71.7% (370/516) were offered counselling. Conclusions: Sexual assault was an uncommon presentation at Melbourne Sexual Health Centre, with diverse circumstances surrounding assault; however, clinical documentation varied, indicating a need for a standard primary care protocol for clients presenting with acute sexual assault. The incidence of sexual assault continues to rise in Australia. However, there is a paucity of literature examining the nature of assault and subsequent management for victims of all genders. The findings of this large, retrospective clinical audit determined that the nature of assault differs between male and female victims, with varying detail of clinical documentation. There is need for a standard primary care protocol for clients presenting with acute sexual assault. [ABSTRACT FROM AUTHOR]

Background: Despite the increase in the proportion of HIV notifications attributed to heterosexuals in Australia, little is known about their HIV testing behaviours. We investigated the trends and factors associated with HIV testing behaviours among heterosexuals. Methods: We analysed the trend and proportion of heterosexuals attending the centre for the first time between 2011 and 2020, who had ever tested and tested for HIV in the past 12 months and the median number of months since their last HIV test. We identified factors associated with HIV testing behaviours using univariable and multivariable logistic regressions. Results: Of the 78 652 heterosexuals included, 53.1% were men and 46.9% were women. Overall, the proportion of heterosexuals who had ever tested for HIV was 40.8%, with a declining testing trend from 40.2% in 2011 to 36.5% in 2020 (P trend < 0.001). Overall, the proportion of heterosexuals tested for HIV in the past 12 months was 15.7%, with no significant change from 15.3% in 2011 to 14.7% in 2020 (P trend = 0.489). The median number of months since the last HIV test decreased from 18.0 (IQR 6.9–37.3) in 2011 to 15.0 (IQR 6.4–32.5) in 2020 (P trend < 0.001). Individuals who had condomless sex with casual partners (aOR 0.92, 95% CI 0.88–0.96) and who were diagnosed with a sexually transmitted infection (aOR 0.88, 95% CI 0.84–0.93) were less likely to have ever tested for HIV. Conclusions: HIV testing was low among heterosexuals, and individuals who engaged in condomless sex and had another sexually transmitted infection were less likely to be tested. To reduce HIV transmission, strategies to improve HIV testing among heterosexuals are needed. Despite the increase in the proportion of HIV notifications attributed to heterosexuals in Australia, little is known about their HIV testing practices. Among heterosexuals attending the Melbourne Sexual Health Centre for the first time between 2011 and 2020, the odds of ever HIV testing werelow (40.8%), and individuals who engaged in condomless sex and had another STI were less likely to be tested. To reduce HIV transmission, strategies to improve HIV testing among heterosexuals are needed. [ABSTRACT FROM AUTHOR]

Purpose: The social determinants of health (SDOH) include factors such as poverty, lack of access to health care, educational barriers, stigma, and racism which can contribute to health disparities and inequities. Minorities, rural communities, and underserved populations are disproportionately affected by SDOH. Nursing students must become aware of the SDOH in order to provide high-quality, holistic, patient-centered care to patients and their families. The purpose of this study was to determine the impact of a case-based workshop on undergraduate and graduate nursing students' knowledge and attitudes about the social determinants of health. Sample: Bachelor of Science in Nursing (BSN), Family Nurse Practitioner (FNP), and Psychiatric Mental Health Nurse Practitioner (PMHNP) students from a public, liberal arts university in the rural, southeastern United States participated in the project. Method: Demographic information and survey data were obtained from participating undergraduate and graduate nursing students to assess the impact of a case-based SDOH workshop on their knowledge and attitudes about the SDOH. Findings: Five of the nine scored survey items had statistically significant differences in pre- and post-survey ranked scores. Increased student response scores were noted on items about SDOH knowledge and attitudes, including awareness of SDOH and vulnerable populations, knowledge of how social determinants and economic factors influence health, and confidence with working with vulnerable populations in the future. Four themes were apparent from analysis of the three open-ended questions: Awareness of Resources, Social Worker Perspective, Awareness of Social Determinants of Health, and Importance of Empathy. Conclusions: It is important for nurses in rural areas to understand the influence of social determinants on population and individual health when caring for and treating vulnerable patients so that they can provide more holistic care to patients and can address health disparities. [ABSTRACT FROM AUTHOR]

Background: Few studies investigate group sex among heterosexuals. The aim of this study was to provide an exploration of characteristics and practices among heterosexual men and women who engage in group sex.Method: We conducted a cross-sectional survey between May 2019 and March 2020 among heterosexual men and women attending a sexual health clinic in Melbourne, Australia. Participants were asked whether they had participated in group sex (sex involving more than two participants) in the past 3months, the size of the most recent event, sexual activities in which they engaged, and condom use.Results: Of 3277 heterosexuals surveyed (1509 women and 1768 men), the mean age was 29.9years (s.d. 8.8) and more than half (56.0%, n=1834) were born outside Australia. One in 20 participants (5.4%) had engaged in group sex in the past 3months with the number of events ranging 1-10times. Kissing was the most common activity in group sex, and women were significantly more likely to kiss a same-sex partner than men. Overall, of 165 participants who engaged in vaginal sex, 57 (34.5%) reported always using condoms and changing condoms between consecutive partners. Of the 100 men and women who had condomless vaginal sex, 79 (79.0%) received or performed fellatio after condomless vaginal sex.Conclusion: About two-thirds of heterosexuals who engaged in group sex neither used condoms nor changed condoms between partners in the most recent group sex event. Safe sex messages on changing condoms between partners and between sexual activities should be reinforced for sexually transmitted infections prevention. [ABSTRACT FROM AUTHOR]

Background We aimed to examine the incidence of syphilis in men who have sex with men (MSM) and identify subgroups of MSM at a higher risk of syphilis infection. Methods We conducted a retrospective cohort study of MSM attending a sexual health clinic in Australia, during 2013–2019, who had at least 2 syphilis serological tests during the study period. The incidence of syphilis was expressed as per 100 person-years. A cox regression analysis was conducted to identify risk factors for syphilis. Results A total of 24 391 individual MSM (75 086 consultations) were included. A total of 1404 new syphilis cases were diagnosed with an incidence of 3.7/100 person-years (95% confidence interval, 3.5–3.9). Syphilis incidence was higher in MSM with human immunodeficiency virus ([HIV] 9.3/100 person-years) than in MSM taking HIV pre-exposure prophylaxis (PrEP) (6.9/100 person-years) or HIV-negative MSM not taking PrEP (2.2/100 person-years). Risk factors associated with high incidence of syphilis included the following: MSM with HIV (adjusted hazard ratio [aHR] 2.7), MSM taking HIV PrEP (aHR 2.1), past history of syphilis infection (aHR 2.4), injecting drug use (aHR 2.7), condomless anal sex (aHR 1.7), >4 sexual partners in the last 12 months (aHR 1.2), and concurrent sexually transmitted infection (chlamydia and gonorrhoea) (aHR 1.6). Conclusions The incidence of syphilis remains high among MSM, particularly in subgroups with associated risk factors for syphilis infections. These data highlight the need for biomedical and behavioral interventions to be targeted to subgroups of MSM at the highest risk of syphilis infection. [ABSTRACT FROM AUTHOR]