179 results on '"Sullivan, Ak"'
Search Results
2. A call to action toward integrated testing and earlier care for viral hepatitis, HIV, STIs and TB
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Raben, D, Hoekstra, M, Combs, L, Sullivan, AK, Lazarus, JV, Lambert, JS, Simões, D, Streinu-Cercel, A, Rockstroh, JK, Amato-Gauci, A, Pop, CS, Oprea, C, Hedrich, D, Gökengin, D, Schatz, E, Ghita, E, Rockstroh, J, Tavochi, L, Cosmaro, L, Ursan, M, Dara, M, Dascalu, N, Dedes, N, Baptista Leite, R, Pasanen, S, Reic, T, Platteau, T, Grecu, V, Sönnerborg, A, Gazzard, B, West, B, Karpov, I, Lundgren, JD, de Wit, J, Casabona, J, Maistat, L, Matičič, M, Tsereteli, N, Pol, S, Delpech, V, Zuilhof, W, Yazdanpanah, Y, Azad, Y, Pharris, A, Noori, T, Mozalevskis, A, Vovc, E, Fenton, K, Kakalou, C, Klavs, I, Wawer, I, Hristojeva, J, Kivimets, K, Maffeo, M, Kall, M, Mommi, M, Gasbarrini, N, Wysocki, P, Koutkias, V, and Instituto de Saúde Pública da Universidade do Porto
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medicine.medical_specialty ,business.industry ,diagnosis ,Health Policy ,Human immunodeficiency virus (HIV) ,HIV ,viral hepatitis ,Hiv stis ,medicine.disease_cause ,medicine.disease ,testing ,Call to action ,Infectious Diseases ,Family medicine ,Medicine ,Pharmacology (medical) ,business ,Viral hepatitis ,sexually transmitted infections - Abstract
Objectives. The objective of the paper is to present the outcomes of the HepHIV 2019 conference, held in Bucharest under the Romanian EU Presidency and focusing on challenges of timely and integrated testing and care. Methods. The conference programme was put together by the organizing committee. It consisted of invited talks and peer-reviewed abstracts. Results. In all, 65 abstracts from 20 countries were presented during the conference, which had nearly 250 delegates, including high-profile political representation. The conference highlighted the need to shift towards further disease integration because of the epidemiological characteristics of the hepatitis B (HBV), hepatitis C (HCV), HIV, sexually transmitted infection (STIs) and tuberculosis (TB) epidemics in the WHO European region. Integration should be a priority in the response to the epidemics to better reach key populations and to ensure better testing coverage. This relates to both the integration of services in shared care models and the integration of different settings and stakeholders in national strategies. Conclusions. The conference demonstrated the need for greater political support for the policy changes required to implement integration. Testing normalization efforts are key to maximizing the impact of integration efforts. The conference call to action can help to guide developments in testing and linkage-to-care interventions across the European region. The HepHIV 2019 Bucharest Conference was co-funded with the Health Programme of the European Union and the EU Health Project Symposium; Integrated Testing and Synergies was funded by the Health Programme of the European Union. The HepHIV 2019 Bucharest Conference was funded by the HIV in Europe/EuroTEST Initiative that received sponsorship funds for this purpose from Gilead, Merck MSD, ViiV Healthcare, Abbvie, Autotest Santé (AAZ-LMB), Cepheid, InTec, OraSure and SH:24. The funders had no role in the study design, analysis, decision to publish, or preparation of the manuscript.
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- 2020
3. Psychological risk factors and early complications after bone marrow transplantation in adults
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Sullivan, AK, Szkrumelak, N, and Hoffman, LH
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- 1999
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4. Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions
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Lord, E, Stockdale, AJ, Malek, R, Rae, C, Sperle, I, Raben, D, Freedman, A, Churchill, D, Lundgren, J, Sullivan, AK, Kabel, J., Block, K., Delpech, V., Sullivan, A., Lowbury, R., Yazdanpanah, Y., Hows, J., Del Amo, J., and Rüütel, K.
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AIDS‐defining conditions ,Short Communication ,Practice Guidelines as Topic ,Short Communications ,Humans ,Mass Screening ,HIV Infections ,indicator conditions ,United Kingdom ,HIV testing - Abstract
Objectives European guidelines recommend HIV testing for individuals presenting with indicator conditions (ICs) including AIDS‐defining conditions (ADCs). The extent to which non‐HIV specialty guidelines recommend HIV testing in ICs and ADCs is unknown. Our aim was to pilot a methodology in the UK to review specialty guidelines and ascertain if HIV was discussed and testing recommended. Methods UK and European HIV testing guidelines were reviewed to produce a list of 25 ADCs and 49 ICs. UK guidelines for these conditions were identified from searches of the websites of specialist societies, the National Institute of Clinical Excellence (NICE) website, the NICE Clinical Knowledge Summaries (CKS) website, the Scottish Intercollegiate Guidance Network (SIGN) website and the British Medical Journal Best Practice database and from Google searches. Results We identified guidelines for 12 of 25 ADCs (48%) and 36 of 49 (73%) ICs. In total, 78 guidelines were reviewed (range 0–13 per condition). HIV testing was recommended in six of 17 ADC guidelines (35%) and 24 of 61 IC guidelines (39%). At least one guideline recommended HIV testing for six of 25 ADCs (24%) and 16 of 49 ICs (33%). There was no association between recommendation to test and publication year (P = 0.62). Conclusions The majority of guidelines for ICs do not recommend testing. Clinicians managing ICs may be unaware of recommendations produced by HIV societies or the prevalence of undiagnosed HIV infection among these patients. We are piloting methods to engage with guideline development groups to ensure that patients diagnosed with ICs/ADCs are tested for HIV. We then plan to apply our methodology in other European settings as part of the Optimising Testing and Linkage to Care for HIV across Europe (OptTEST) project.
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- 2016
5. Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case–control study in the UK
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Pallawela, SNS, Sullivan, AK, Macdonald, N, French, P, White, J, Dean, G, Smith, A, Winter, AJ, Mandalia, S, Alexander, S, Ison, C, Ward, H, and Medical Research Council (MRC)
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Adult ,Male ,PRIMARY SYPHILIS ,NETHERLANDS ,CLINICAL PREDICTORS ,Pain ,HIV Infections ,urologic and male genital diseases ,Proctoscopy ,Sensitivity and Specificity ,LYMPHOGRANULOMA VENEREUM ,EPIDEMIC ,1108 Medical Microbiology ,Weight Loss ,MANAGEMENT ,Humans ,Proctitis ,MSM ,Prospective Studies ,Homosexuality, Male ,SEXUALLY TRANSMITTED INFECTION ,Lymphogranuloma Venereum - a Clinical Update ,Science & Technology ,WESTERN-EUROPE ,1103 Clinical Sciences ,Middle Aged ,female genital diseases and pregnancy complications ,United Kingdom ,Infectious Diseases ,MANIFESTATIONS ,Logistic Models ,Rectal Diseases ,CHLAMYDIA-TRACHOMATIS ,1117 Public Health And Health Services ,Case-Control Studies ,Multivariate Analysis ,HOMOSEXUAL-MEN ,SEX ,Public Health ,Gastrointestinal Hemorrhage ,Life Sciences & Biomedicine ,Constipation - Abstract
Objective: Since 2003, over 2000 cases of lymphogranuloma venereum (LGV) have been diagnosed in the UK in men who have sex with men (MSM). Most cases present with proctitis, but there are limited data on how to differentiate clinically between LGV and other pathology. We analysed the clinical presentations of rectal LGV in MSM to identify clinical characteristics predictive of LGV proctitis and produced a clinical prediction model. Design: A prospective multicentre case–control study was conducted at six UK hospitals from 2008 to 2010. Cases of rectal LGV were compared with controls with rectal symptoms but without LGV. Methods: Data from 98 LGV cases and 81 controls were collected from patients and clinicians using computer-assisted self-interviews and clinical report forms. Univariate and multivariate logistic regression was used to compare symptoms and signs. Clinical prediction models for LGV were compared using receiver operating curves. Results: Tenesmus, constipation, anal discharge and weight loss were significantly more common in cases than controls. In multivariate analysis, tenesmus and constipation alone were suggestive of LGV (OR 2.98, 95% CI 0.99 to 8.98 and 2.87, 95% CI 1.01 to 8.15, respectively) and that tenesmus alone or in combination with constipation was a significant predictor of LGV (OR 6.97, 95% CI 2.71 to 17.92). The best clinical prediction was having one or more of tenesmus, constipation and exudate on proctoscopy, with a sensitivity of 77% and specificity of 65%. Conclusions: This study indicates that tenesmus alone or in combination with constipation makes a diagnosis of LGV in MSM presenting with rectal symptoms more likely.
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- 2014
6. Improved results demonstrated in the 2017 national audit of early syphilis management in the United Kingdom.
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Menon-Johansson, AS, Curtis, H, Mohammad, H, Hamlyn, E, Hughes, A, McClean, H, Pal, N, Tayal, S, Sullivan, AK, Menon-Johansson, A S, and Sullivan, A K
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SYPHILIS ,SEXUAL health ,HIV - Abstract
The revised British Association of Sexual Health and HIV UK guidelines on the management of syphilis were published in 2015 and this audit measures performance against those standards and recommendations. Although not included in the guideline recommendations, an exploratory question on clinics' HIV testing policy was also included. The audit was conducted over a two-month period in 2017 in genitourinary medicine (GUM) clinics across the UK of cases presenting in 2016. A total of 161 GUM clinics participated, and data were collected for 3017 cases. The standard for adherence to recommended treatment was met (97%, standard: 97%) and almost met for documented pre-treatment syphilis serology (95%, standard: 97%). Even though only 74% of patients had a documented action in relation to informing sexual contacts (standard: 97%), the standard for contacts seen and tested per index case within four weeks was met (0.9, standard: 0.6). Finally, those clinics with a formal policy on HIV testing after a syphilis diagnosis were twice as likely to test after the HIV window period, compared to clinics without a policy; a concurrent HIV diagnosis was made in 75 (3%) patients. More work is required to standardize documented delivery of effective partner notification and a formal policy on HIV testing appears to be effective. [ABSTRACT FROM AUTHOR]
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- 2020
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7. HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance.
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Croxford, S, Tavoschi, L, Sullivan, AK, Combs, L, Raben, D, Delpech, V, Jakobsen, SF, Amato‐Gauci, AJ, and Desai, S
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OUTPATIENT medical care ,HIV infections ,INFORMATION storage & retrieval systems ,MEDICAL databases ,MEDICAL information storage & retrieval systems ,PSYCHOLOGY information storage & retrieval systems ,MEDICAL screening ,MEDLINE ,SYSTEMATIC reviews - Abstract
Objectives: In recent years, new technologies and new approaches to scale up HIV testing have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIV testing outside of health care settings in the European Union (EU)/European Economic Area (EEA). Methods: Systematic searches to identify studies describing effective HIV testing interventions and barriers to testing were run in five databases (2010–2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014–2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results: Eighty studies on HIV testing in non‐health care settings were identified, the majority set in Northern Europe. Testing was implemented in 65 studies, with men who have sex with men the risk group most often targeted. Testing coverage and positivity/reactivity rates varied widely by setting and population group. However, testing in community and outreach settings was effective at reaching people who had never previously been tested and acceptability of HIV testing, particularly rapid testing, outside of health care settings was found to be high. Other interventions aimed to increase HIV testing identified were: campaigns (n = 8), communication technologies (n = 2), education (n = 3) and community networking (n = 1). Conclusions: This review has identified several strategies with potential to achieve high HIV testing coverage outside of health care settings. However, the geographical spread of studies was limited, and few intervention studies reported before and after data, making it difficult to evaluate the impact of interventions on test coverage. [ABSTRACT FROM AUTHOR]
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- 2020
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8. HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review.
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Desai, S, Tavoschi, L, Sullivan, AK, Combs, L, Raben, D, Delpech, V, Jakobsen, SF, Amato‐Gauci, AJ, and Croxford, S
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DIAGNOSIS ,HEALTH facilities ,HOSPITAL emergency services ,MEDICAL care use ,MEDICAL errors ,PATIENT education ,PERSONNEL management ,PRENATAL care ,PRIMARY health care ,QUALITY assurance ,SYSTEMATIC reviews ,EARLY diagnosis ,DESCRIPTIVE statistics ,AIDS serodiagnosis - Abstract
Objectives: Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA). Methods: Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010–2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014–2017). Two reviewers independently performed study selection, data extraction and critical appraisal. Results: One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9–94% in primary care compared to 3.9–66% in emergency departments. HIV test positivity was lower in emergency departments (0–1.3%) and antenatal services (0–0.05%) than in other hospital departments (e.g. inpatients: 0–5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9–72% before to 12–85% after their implementation, with most studies reporting a 10–20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77–93%). Conclusions: This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing. [ABSTRACT FROM AUTHOR]
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- 2020
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9. Cause of death among HIV patients in London in 2016.
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Croxford, S, Miller, RF, Post, FA, Harding, R, Lucas, SB, Figueroa, J, Harrison, I, Delpech, VC, Dhoot, S, and Sullivan, AK
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MORTALITY prevention ,ANTIRETROVIRAL agents ,MORTALITY risk factors ,AIDS ,CAUSES of death ,PSYCHOLOGY of HIV-positive persons ,SEX distribution ,VIRAL load ,DESCRIPTIVE statistics - Abstract
Objectives: Since 2013, the London HIV Mortality Review Group has conducted annual reviews of deaths among people with HIV to reduce avoidable mortality. Methods: All London HIV care Trusts reported data on 2016 patient deaths in 2017. Deaths were submitted using a modified Causes of Death in HIV reporting form and categorized by a specialist HIV pathologist and two HIV clinicians. Results: There were 206 deaths reported; 77% were among men. Median age at death was 56 years. Cause was established for 82% of deaths, with non‐AIDS‐related malignancies and AIDS‐defining illnesses being the most common causes reported. Risk factors in the year before death included: tobacco smoking (37%), excessive alcohol consumption (19%), non‐injecting drug use (10%), injecting drug use (7%) and opioid substitution therapy (6%). Thirty‐nine per cent of patients had a history of depression, 33% chronic hypertension, 27% dyslipidaemia, 17% coinfection with hepatitis B virus and/or hepatitis C virus and 14% diabetes mellitus. At the time of death, 81% of patients were on antiretroviral therapy (ART), 61% had a CD4 count < 350 cells/μL, and 24% had a viral load ≥ 200 HIV‐1 RNA copies/mL. Thirty‐six per cent of deaths were unexpected; 61% of expected deaths were in hospital. Two‐thirds of expected deaths had a prior end‐of‐life care discussion documented. Conclusions: In 2016, most deaths were attributable to non‐AIDS‐related conditions and the majority of patients were on ART and virally suppressed. However, several potentially preventable deaths were identified and underlying risk factors were common. As London HIV patients are not representative of people with HIV in the UK, a national mortality review is warranted. [ABSTRACT FROM AUTHOR]
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- 2019
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10. Towards person‐centred care for people living with HIV: what core outcomes matter, and how might we assess them? A cross‐national multi‐centre qualitative study with key stakeholders.
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Bristowe, K, Clift, P, James, R, Josh, J, Platt, M, Whetham, J, Nixon, E, Post, FA, McQuillan, K, Ní Cheallaigh, C, Murtagh, FEM, Anderson, J, Sullivan, AK, and Harding, R
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ANXIETY ,ATTITUDE (Psychology) ,COGNITION disorders ,CONCEPTUAL structures ,MENTAL depression ,EMIGRATION & immigration ,FEAR ,GASTROINTESTINAL diseases ,HIV infections ,PSYCHOLOGY of HIV-positive persons ,INTERVIEWING ,INTIMACY (Psychology) ,MATHEMATICAL models ,RESEARCH methodology ,MEDICAL care ,MEDICAL cooperation ,MEDICAL personnel ,MEMORY disorders ,HEALTH outcome assessment ,PAIN ,RESEARCH ,SELF-efficacy ,SLEEP disorders ,QUALITATIVE research ,THEORY ,WELL-being ,THEMATIC analysis ,CROSS-sectional method ,PATIENT-centered care ,STAKEHOLDER analysis - Abstract
Objectives: People living with HIV (PLWH) have multidimensional concerns requiring person‐centred care. Routine use of patient‐reported outcome measures (PROMs) improves outcomes. No brief PROM currently reflects the breadth of concerns for PLWH. This study sought to identify priority outcomes for PLWH, model current practice, explore views on introducing PROMs into routine care, and devise a model for person‐centred care incorporating the PROM. Methods: A cross‐national multi‐centre study (London, Brighton and Dublin) was carried out. Semi‐structured qualitative interviews with adult PLWH, HIV health care professionals and HIV commissioners (responsible for planning and commissioning services) were performed. Interviews were analysed using thematic and framework analysis. Results: PLWH (n = 28), professionals (n = 21) and commissioners (n = 8) described concerns related to living with HIV across six domains: physical (e.g. pain and gastrointestinal symptoms), cognitive (e.g. memory and sleep), psychological (e.g. anxiety and depression), social (e.g. isolation and intimacy), welfare (e.g. finances and fears regarding change of immigration status), and information (e.g. long‐term outcomes) needs. Themes were highly inter‐related, impacting across domains of need (e.g. physical and cognitive problems impacting on psychological and social wellbeing). Perceived benefits of using PROMs in routine HIV care included improved person‐centredness, patient empowerment, fewer missed concerns, increased engagement with services, and informed planning of services. Potential challenges included heterogeneity of PLWH, literacy, and utility for those who struggle to engage with care. Conclusions: This study presents a novel model of person‐centred care incorporating an HIV‐specific PROM. The model reflects priorities of key stakeholders. Explicit use of PROMs in routine HIV care could afford benefits for PLWH, clinical teams and commissioners. [ABSTRACT FROM AUTHOR]
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- 2019
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11. Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions.
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Lord, E, Stockdale, AJ, Malek, R, Rae, C, Sperle, I, Raben, D, Freedman, A, Churchill, D, Lundgren, J, Sullivan, AK, Kabel, J., Block, K., Delpech, V., Sullivan, A., Lowbury, R., Yazdanpanah, Y., Hows, J., Del Amo, J., and Rüütel, K.
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DIAGNOSIS of HIV infections ,MEDICAL protocols ,AIDS ,MEDICAL screening ,DISEASE management ,AIDS serodiagnosis - Abstract
Objectives European guidelines recommend HIV testing for individuals presenting with indicator conditions ( ICs) including AIDS-defining conditions ( ADCs). The extent to which non- HIV specialty guidelines recommend HIV testing in ICs and ADCs is unknown. Our aim was to pilot a methodology in the UK to review specialty guidelines and ascertain if HIV was discussed and testing recommended. Methods UK and European HIV testing guidelines were reviewed to produce a list of 25 ADCs and 49 ICs. UK guidelines for these conditions were identified from searches of the websites of specialist societies, the National Institute of Clinical Excellence ( NICE) website, the NICE Clinical Knowledge Summaries ( CKS) website, the Scottish Intercollegiate Guidance Network ( SIGN) website and the British Medical Journal Best Practice database and from Google searches. Results We identified guidelines for 12 of 25 ADCs (48%) and 36 of 49 (73%) ICs. In total, 78 guidelines were reviewed (range 0-13 per condition). HIV testing was recommended in six of 17 ADC guidelines (35%) and 24 of 61 IC guidelines (39%). At least one guideline recommended HIV testing for six of 25 ADCs (24%) and 16 of 49 ICs (33%). There was no association between recommendation to test and publication year ( P = 0.62). Conclusions The majority of guidelines for ICs do not recommend testing. Clinicians managing ICs may be unaware of recommendations produced by HIV societies or the prevalence of undiagnosed HIV infection among these patients. We are piloting methods to engage with guideline development groups to ensure that patients diagnosed with ICs/ ADCs are tested for HIV. We then plan to apply our methodology in other European settings as part of the Optimising Testing and Linkage to Care for HIV across Europe (Opt TEST) project. [ABSTRACT FROM AUTHOR]
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- 2017
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12. Routine HIV testing in the emergency department: tough lessons in sustainability.
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Rayment, M, Rae, C, Ghooloo, F, Doku, E, Hardie, J, Finlay, S, Gidwani, S, Atkins, M, Roberts, P, and Sullivan, AK
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DIAGNOSIS of HIV infections ,HIV infection epidemiology ,CONFIDENCE intervals ,HOSPITAL emergency services ,RESEARCH funding ,DESCRIPTIVE statistics - Abstract
Objectives Routine HIV testing in nonspecialist settings has been shown to be acceptable to patients and staff in pilot studies. The question of how to embed routine HIV testing, and make it sustainable, remains to be answered. Methods We established a service of routine HIV testing in an emergency department ( ED) in London, delivered by ED staff as part of routine clinical care. All patients aged 16 to 65 years were offered an HIV test (latterly the upper age limit was removed). Meetings were held weekly and two outcome measures examined: test offer rate (coverage) and test uptake. Sustainability methodology (process mapping; plan-do-study-act ( PDSA) cycles) was applied to maximize these outcome measures. Results Over 30 months, 44 582 eligible patients attended the ED. The mean proportion offered an HIV test was 14%, varying from 6% to 54% per month over the testing period. The mean proportion accepting a test was 63% (range 33-100%). A total of 4327 HIV tests have been performed. Thirteen patients have been diagnosed with HIV infection (0.30%). PDSA cycles having the most positive and sustained effects on the outcome measures include the expansion to offer blood-based HIV tests in addition to the original oral fluid tests, and the engagement of ED nursing staff in the programme. Conclusions HIV testing can be delivered in the ED, but constant innovation and attention have been required to maintain it over 30 months. Patient uptake remains high, suggesting acceptability, but time will be required before true embedding in routine clinical practice is achieved. [ABSTRACT FROM AUTHOR]
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- 2013
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13. Automatic oral fluid-based HIV testing in HIV screening programmes: automatic for the people.
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Rayment, M, Doku, E, Thornton, A, Pearn, M, Sudhanva, M, Jones, R, Nardone, A, Roberts, P, Tenant-Flowers, M, Anderson, J, Sullivan, AK, and Atkins, M
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DIAGNOSIS of HIV infections ,HIV prevention ,HIV infection epidemiology ,SALIVA analysis ,CONFIDENCE intervals ,CLINICAL pathology ,SERODIAGNOSIS ,AIDS serodiagnosis - Abstract
Objectives UK guidelines recommend routine HIV testing in general clinical settings when the local HIV prevalence is > 0.2%. During pilot programmes evaluating the guidelines, we used laboratory-based testing of oral fluid from patients accepting tests. Samples ( n = 3721) were tested manually using the Bio- Rad Genscreen Ultra HIV Ag- Ab test ( Bio- Rad Laboratories Ltd, Hemel Hempstead, UK). This was a methodologically robust method, but handling of samples was labour intensive. We performed a validation study to ascertain whether automation of oral fluid HIV testing using the fourth-generation HIV test on the Abbott Architect ( Abbott Diagnostics, Maidenhead, UK) platform was possible. Methods Oral fluid was collected from 143 patients (56 known HIV-positive volunteers and 87 others having contemporaneous HIV serological tests) using the Oracol+ device ( Malvern Medicals, Worcester, UK). Samples were tested concurrently: manually using the Genscreen Ultra test and automatically on the Abbott Architect. Results For oral fluid, the level of agreement of results between the platforms was 100%. All results agreed with HIV serology. The use of the Oracol+ device produced high-quality samples. Subsequent field use of the test has shown a specificity of 99.97% after nearly 3000 tests. Conclusions Laboratory-based HIV testing of oral fluid requires less training of local staff, with fewer demands on clinical time and space than near-patient testing. It is acceptable to patients. The validation exercise and subsequent clinical experience support automation, with test performance preserved. Automation reduces laboratory workload and speeds up the release of results. Automated oral fluid testing is thus a viable option for large-scale HIV screening programmes. [ABSTRACT FROM AUTHOR]
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- 2013
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14. Religion and HIV diagnosis among Africans living in London.
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Fakoya, I, Johnson, Am, Fenton, Ka, Anderson, J, Nwokolo, N, Sullivan, Ak, Munday, P, and Burns, Fm
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DIAGNOSIS of HIV infections ,RACE ,RELIGION ,SURVEYS ,CD4 lymphocyte count - Abstract
Objectives The aim of the paper was to describe the association of religion with HIV outcomes in newly diagnosed Africans living in London. Methods A survey of newly diagnosed HIV-positive Africans attending 15 HIV treatment centres across London was carried out between April 2004 and February 2006. Confidential self-completed questionnaires were used, linked to clinical records. Bivariate analyses were conducted to ascertain whether religious beliefs were associated with late diagnosis, antiretroviral therapy, and immunological and virological outcome 6 months post diagnosis. Results A total of 246 Black Africans were eligible and included in the analysis: 62.6% were women, and the median age was 34 years. The median CD4 count at diagnosis was 194 cells/ μL (range 0-1334 cells/ μL) and 75.6% presented late, as defined as a CD4 count < 350 cells/ μL. Most participants were religious: non- Roman Catholic Christians (55.7%), Roman Catholics (35.2%) and Muslims (6.1%). Only 1.2% stated that they did not have a religion. Participants who attended religious services at least monthly were more likely to believe that 'faith alone can cure HIV' than those who attended less frequently (37.7% vs. 15.0%; P = 0.002). A small proportion (5.2%) believed that taking antiretroviral therapy implied a lack of faith in God. Bivariate analysis found no relationship between religiousness (as measured using frequency of attendance at religious services and religious attitudes or beliefs) and late diagnosis, changes in CD4 count/viral load 6 months post diagnosis, or initiation of antiretroviral therapy. Conclusions Strong religious beliefs about faith and healing are unlikely to act as a barrier to accessing HIV testing or antiretroviral treatment for Black Africans living in London. [ABSTRACT FROM AUTHOR]
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- 2012
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15. eTriage--a novel, web-based triage and booking service: enabling timely access to sexual health clinics.
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Jones R, Menon-Johansson A, Waters AM, Sullivan AK, Jones, R, Menon-Johansson, A, Waters, A M, and Sullivan, A K
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In recent years, the sexual health of the nation has risen in profile. We face increasing demands and targets, in particular the 48-hour waiting time directive, and as a result clinic access has become a priority. eTriage is a novel, secure, web-based service designed specifically to increase access to our clinics. It has proved a popular booking method, providing access to 10% of all appointments across the Directorate within six months of introduction. KC60 analyses revealed that the majority of users (58%) underwent asymptomatic screening with the remainder having some degree of pathology. There was a greater percentage prevalence of human papilloma virus, chlamydia, non-specific urethritis, gonorrhoea, herpes and trichomonas in the eTriage population when compared with the general clinic population. A notes review illustrated a high degree of concordance between data entered on eTriage registration and clinical review (97%). A patient survey revealed high levels of patient satisfaction with the service. As an adjunct to our existing booking services, eTriage has served to increase patient choice and has proved itself to be a safe, efficient and effective means of improving patient access. [ABSTRACT FROM AUTHOR]
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- 2010
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16. Oligoclonal CD4+ T cells in the lungs of patients with severe emphysema.
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Sullivan AK, Simonian PL, Falta MT, Mitchell JD, Cosgrove GP, Brown KB, Kotzin BL, Voelkel NF, Fontenot AP, Sullivan, Andrew K, Simonian, Philip L, Falta, Michael T, Mitchell, John D, Cosgrove, Gregory P, Brown, Kevin K, Kotzin, Brian L, Voelkel, Norbert F, and Fontenot, Andrew P
- Abstract
Rationale: Within the lungs of patients with severe emphysema, inflammation continues despite smoking cessation. Foci of T lymphocytes in the small airways of patients with emphysema have been associated with disease severity. Whether these T cells play an important role in this continued inflammatory response is unknown.Objective: The aim of this study was to determine if T cells recruited to the lungs of subjects with severe emphysema contain oligoclonal T-cell populations, suggesting their accumulation in response to antigenic stimuli.Methods: Lung T-cell receptor (TCR) Vbeta repertoire from eight patients with severe emphysema and six control subjects was evaluated at the time of tissue procurement (ex vivo) and after 2 weeks of culture with interleukin 2 (in vitro). Junctional region nucleotide sequencing of expanded TCR-Vbeta subsets was performed.Results: No significantly expanded TCR-Vbeta subsets were identified in ex vivo samples. However, T cells grew from all emphysema (n = 8) but from only one of the control lung samples (n = 6) when exposed to interleukin 2 (p = 0.0013). Within the cultured cells, seven major CD4-expressing TCR-Vbeta subset expansions were identified from five of the patients with emphysema. These expansions were composed of oligoclonal populations of T cells that had already been expanded in vivo.Conclusion: Severe emphysema is associated with inflammation involving T lymphocytes that are composed of oligoclonal CD4+ T cells. These T cells are accumulating in the lung secondary to conventional antigenic stimulation and are likely involved in the persistent pulmonary inflammation characteristic of severe emphysema. [ABSTRACT FROM AUTHOR]- Published
- 2005
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17. 024 Mortality in the HAART era.
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Sullivan, Ak, Mazhude, C, Nelson, M, Fisher, M, Chard, S, and Gazzard, B
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HIV infections , *HIV-positive persons , *MORTALITY - Abstract
Objective: To determine retrospectively whether patients seen by GPs and hospital doctors in South London with symptoms and signs compatible with acute HIV infection remain undiagnosed. Methods: All request cards sent to the virology laboratory at St Thomas's Hospital between 5/1998 and 5/1999 were reviewed. Patients with symptoms and signs compatible with acute HIV infection were entered into the study (314). Trust databases were cross-referenced and those with other diagnoses (28), recent HW tests (two) and insufficient serum for testing (16) were excluded. After anonymization, samples were pooled into batches of 10 and each pool HIV antibody tested (microparticle enzyme immunoassay (MEIA), Abbott Axsym system). Samples in HIV antibody pools were re-tested individually and Western blots performed on those testing antibody positive. HIV antibody negative serum was pooled into batches of 10 and each pool tested for HIV RNA using nucleic acid sequence based amplification (NASBA, Organon-Teknika). Results: 8/268 (3%) of patients were HIV antibody positive; 2/268 (0.8%) had Western blot profiles compatible with acute HIV infection. None of the HIV antibody negative serum samples tested NASBA positive. Conclusion: Patients with acure HIV infection, seen by GPs and hospital doctors, remain undiagnosed. This study emphasizes the need for more risk assessment and HIV testing if patients are to be diagnosed early and potentially benefit from better treatment available now and in the future. [ABSTRACT FROM AUTHOR]
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- 2000
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18. P42 Discordant CD4 response on HAART.
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Sullivan, Ak, Vlahakis, E, Mandalia, S, Nelson, M, and Gazzard, B
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HIV infections , *THERAPEUTICS , *CD antigens - Abstract
Introduction: PI-associated lipodystrophy and dyslipidaemia have well documented. Some authors suggest a change to an NNRTIbased regimen to ameliorate or even reverse these events. Results: Three patients treated at our centre were switched from a PI-containing regimen to an EFV-containing regimen to manage lipodystrophy/dyslipidaemia but showed a significant worsening of their status. Patient 3 had gross stigmata of lipodystrophy: these reduced only slightly on changing to EFV. Mean change in maximum total cholesterol (chol) on EFV-containing regimen compared to PI-containing regimen was +4.03 mmol/1; mean change in triglycerides (TG) was 29.3 mmol/1. Time from change to EFV to maximum increase in lipids was approximately 12 weeks. Max chol Max IG Max chol Max TG on PI on PI on EFV on EFV Outcome Pt 1 10.2 13.3 19.5 53.00 Treatment with fenofibrate Pt 2 12.0 16.2 14.8 67.6 Switched to NVP+ fenofibrate; lipids return to baseline Pt 3 7.7 8.1 7.7 4.9 Death due to MI Conclusion: As the exact mechanism for ARV-induced lipodystrophy/dyslipidaemia is unknown, close monitoring of lipids and glucose is strongly advised in patients changing from PIs to EFVcontaining regimens. [ABSTRACT FROM AUTHOR]
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- 2000
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19. P43 Immune responses in patients changing from PI to NNRTI-based HAART.
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Sullivan, Ak, Nelson, M, Moyle, G, Mandalia, S, Gotch, Fm, Gazzard, B, and Imami, N
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- *
HIV infections , *THERAPEUTICS , *LYMPHOPROLIFERATIVE disorders - Abstract
Objective: To describe the lymphoproliferative responses (LPR) following therapy change from PI- to NNRTI-based HAART. Methods: Patients switching from PI- to NNRTI-based regimens were identitied. CD4 cell counts, viral loads (VL) and LPR to recall antigens, mitogens and HIV-1 recombinant antigens were performed at baseline (BL) and at 12 and 24 weeks (12W, 24W). Results: Six patients were identitied (five drug intolerance, one virological failure). CD4 count (cells/µL) Virai load (copies/mL) Patient BL 12W 24W BL 12W 24W 1 41 205 287 1116 BLD BLD 2 418 622 665 6794 753 394 3 243 214 267 55068 BLD BLD 4 503 449 373 BLD BLD BLD 5 256 190 306 BLD BLD BLD 6 185 269 283 BLD BLD BLD Following therapy switch, a 67% proportional increase in mitogen response (95% confidence interval (CI) 45-88%) and a 52% increase (CI 35-70%) in response to recall antigens was seen. The latter was more likely in patients with a detectable VL at BL. All patients were more likely to respond to low-dose IL-2 stimulation (83%, CI 54-100%). Three patients showed increased HIV-specific responses, two had detectable virus at BL. Condusion: NNRTI substitution for a PI appears to result in an improvement in LPR. [ABSTRACT FROM AUTHOR]
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- 2000
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20. P44 Assessment of b-chemokines in HIV-1-infected individuals: impact of protease inhibitor (PI) vs. non-nucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral therapy (HAART).
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Burton, Ct, Davis, L, Hardy, G, Sullivan, Ak, Nelson, M, Gazzard, B, Gotch, Fm, and Imami, N
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HIV infections ,THERAPEUTICS ,CHEMOKINES ,PROTEASE inhibitors - Abstract
Objective: To describe the lymphoproliferative responses (LPR) following therapy change from PI- to NNRTI-based HAART. Methods: Patients switching from PI- to NNRTI-based regimens were identitied. CD4 cell counts, viral loads (VL) and LPR to recall antigens, mitogens and HIV-1 recombinant antigens were performed at baseline (BL) and at 12 and 24 weeks (12W, 24W). Results: Six patients were identitied (five drug intolerance, one virological failure). CD4 count (cells/µL) Virai load (copies/mL) Patient BL 12W 24W BL 12W 24W 1 41 205 287 1116 BLD BLD 2 418 622 665 6794 753 394 3 243 214 267 55068 BLD BLD 4 503 449 373 BLD BLD BLD 5 256 190 306 BLD BLD BLD 6 185 269 283 BLD BLD BLD Following therapy switch, a 67% proportional increase in mitogen response (95% confidence interval (CI) 45-88%) and a 52% increase (CI 35-70%) in response to recall antigens was seen. The latter was more likely in patients with a detectable VL at BL. All patients were more likely to respond to low-dose IL-2 stimulation (83%, CI 54-100%). Three patients showed increased HIV-specific responses, two had detectable virus at BL. Conclusion: NNRTI substitution for a PI appears to result in an improvement in LPR. [ABSTRACT FROM AUTHOR]
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- 2000
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21. Improved sexual history taking in the 2012 BASHH asymptomatic screening re-audit.
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Menon-Johansson, AS, McClean, H, Carne, CA, Estreich, S, Knapper, C, Sethi, G, Smith, A, and Sullivan, AK
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HIV-positive persons ,SEXUALLY transmitted diseases ,LIVER diseases ,INFECTION ,HEPATITIS B - Abstract
Effective asymptomatic screening for sexually transmitted infections is an important public health service because a significant proportion of sexually transmitted infections do not present with symptoms. In 2009, the National Audit Group of the British Association of Sexual Health and HIV (BASHH) audited the management of asymptomatic patients and recommended increased documentation about oral and anal sex, regional strategies for nucleic acid amplification test (NAAT) use for gonorrhoea, improved screening for hepatitis B in men who have sex with men and an increase in screening for HIV. The 2012 audit used web-based forms to collect submissions from 180 consultant-led centres (65% response rate) that included episodes of care from 6669 asymptomatic patients. An improvement was demonstrated for all the areas measured during the 2009 audit. A doubling of gonorrhoea testing using NAATs was seen and yet 10% of asymptomatic patients continued to have microscopy despite these tests not being recommended by BASHH guidelines. This audit recommends universal adoption of gonorrhoea NAATs across the United Kingdom. [ABSTRACT FROM AUTHOR]
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- 2014
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22. The HepHIV 2023 Madrid conference: A call to action for political leadership in reaching the sustainable development goals on earlier testing and linkage to care for HIV, viral hepatitis, and sexually transmitted infections.
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Simões D, Raben D, Moran AB, Imaz A, Stengaard AR, Raahauge A, Sullivan AK, Vaughan E, Brännström J, De Baetselier I, Platteau T, Casabona J, and Del Amo J
- Abstract
Introduction and Objectives: The HepHIV 2023 Conference, held in Madrid in November 2023, highlighted how Europe is not on track to meet the United Nations (UN) sustainable development goals and Joint UN Programme on HIV/AIDS (UNAIDS) targets. This article presents the outcomes of the conference, which focus on ways to improve testing and linkage to care for HIV, viral hepatitis, and other sexually transmitted infections. HIV-related stigma and discrimination, a major barrier to progress, was a key concept of the conference and on the agenda of the Spanish Presidency of the European Union., Methods: The HepHIV 2023 organizing committee, alongside the Spanish Ministry of Health, oversaw the conference organization and prepared the scientific programme based on abstract rankings. Key outcomes are derived from conference presentations and discussions., Results: Conference presentations covered the obstacles that HIV-related stigma and discrimination continue to pose to access to services, models for data collection to better monitor progress in the future, and examples of legislative action that can be taken at national levels. Diversification of testing approaches was also highlighted, to reach key populations, (e.g. migrant populations), to increase testing offered in healthcare settings (e.g. emergency departments), and to account for different stages of epidemics across the region., Conclusion: With a strong call for intensified action to address the impact of HIV-related stigma and discrimination on testing uptake, the conference concluded that strengthened collaboration is required between governments and implementers around testing and linkage to care. There is also an ongoing need to ensure sustainable political commitment and appropriate resource allocation to address gaps and inequalities in access for key populations and to focus on the implementation of integrated responses to HIV, viral hepatitis, and sexually transmitted infections., (© 2024 The Author(s). HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)
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- 2024
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23. Recommendations for defining preventable HIV-related mortality for public health monitoring in the era of Getting to Zero: an expert consensus.
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Croxford SE, Martin V, Lucas SB, Miller RF, Post FA, Anderson J, Apea VJ, Asboe D, Brough G, Chadwick DR, Collins S, Corkin H, Dean G, Delpech VC, Gogia M, Gold D, Kafkalias A, Korkodilos M, Kowalska JD, Lindo J, Lundgren JD, Lynch L, Martinez E, McDougall N, North S, Rockstroh JK, Sabin C, Vidal-Read M, Waters LJ, and Sullivan AK
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- Humans, Consensus, Public Health, Health Personnel, HIV Infections
- Abstract
Getting to Zero is a commonly cited strategic aim to reduce mortality due to both HIV and avoidable deaths among people with HIV. However, no clear definitions are attached to these aims with regard to what constitutes HIV-related or preventable mortality, and their ambition is limited. This Position Paper presents consensus recommendations to define preventable HIV-related mortality for a pragmatic approach to public health monitoring by use of national HIV surveillance data. These recommendations were informed by a comprehensive literature review and agreed by 42 international experts, including clinicians, public health professionals, researchers, commissioners, and community representatives. By applying the recommendations to 2019 national HIV surveillance data from the UK, we show that 30% of deaths among people with HIV were HIV-related or possibly HIV-related, and at least 63% of these deaths were preventable or potentially preventable. The application of these recommendations by health authorities will ensure consistent monitoring of HIV elimination targets and allow for the identification of inequalities and areas for intervention., Competing Interests: Declaration of interests SEC reports consultancy fees from the Centre of Excellence for Health, Immunity and Infections, Rigshospitalet and University of Copenhagen outside of the submitted work. FAP reports honoraria and research grants to King's College Hospital from Gilead Sciences, ViiV Healthcare, and Merck Sharp & Dohme (MSD); and conference attendance paid by ViiV Healthcare, all outside of the submitted work. CS reports receipt of funding from ViiV Healthcare and Janssen-Cilag for participation in advisory boards and data safety and monitoring boards; and payment from Gilead Sciences and ViiV Healthcare for preparation of educational materials and lectures, all outside of the submitted work. JA reports consultancy and speaker fees from Gilead Sciences, ViiV Healthcare, and MSD; support to attend meetings and travel by Gilead Sciences; royalties from Elsevier for contributions to a clinical medicine textbook; and payment from the Pharmacokinetic and Clinical Observations in People Over Fifty study team to support hospital participation, all outside the submitted work. JA also reports being a board member of the RIO study, Chair of the National AIDS Trust (unpaid), a medical college Trustee for St Bartholomew's Hospital Trust (unpaid), and a past Master of the Worshipful Society of Apothecaries (unpaid), all outside of the submitted work. LJW reports advisory and speaker fees from Gilead Sciences, ViiV Healthcare, MSD, Janssen-Cilag, Theratechnologies, Mylan, and Cipla, outside of the submitted work. JKR reports consulting fees from Abivax, Boehringer Ingelheim, and Galapagos; and honoraria from Gilead Sciences, Janssen-Cilag, Merck, Theratechnologies, and ViiV Healthcare, all outside of the submitted work. JKR also reports participation on a data safety monitoring board for Abivax and Galapagos, outside of the submitted work, and was the past President of EACS (unpaid). EM reports grants and consultancy fees from MSD, Gilead Sciences, Janssen-Cilag, Theratechnologies, and ViiV Healthcare; honoraria from Gilead Sciences, Janssen-Cilag, MSD, and ViiV Healthcare; support for attending meetings from Gilead Sciences and MSD; and participation on a data safety, monitoring, and advisory board for Gilead Sciences, Janssen-Cilag, MSD, Theratechnologies, and ViiV Healthcare, all outside of the submitted work. VJA reports honoraria and speaker fees from ViiV Healthcare, Gilead Sciences, Janssen-Cilag, and MSD and support for attending meetings from ViiV Healthcare, outside of the submitted work. VJA is the Medical Director of NAZ (some elements paid) and is the Chair of the British Association for Sexual Health and HIV National Audit Group (unpaid), outside of the submitted work. VJA also declares grants from the National Institute of Health and Care Research and Barts Charity. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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24. Assessing the impact of online postal self-sampling for sexually transmitted infections on health inequalities, access to care and clinical outcomes in the UK: protocol for ASSIST, a realist evaluation.
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Gibbs J, Howarth AR, Sheringham J, Jackson LJ, Wong G, Copas A, Crundwell DJ, Mercer CH, Mohammed H, Ross J, Sullivan AK, Murray E, and Burns FM
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- Humans, Health Personnel, Health Services Accessibility, United Kingdom, Research Design, Sexually Transmitted Diseases diagnosis
- Abstract
Introduction: The past decade has seen a rapid increase in the volume and proportion of testing for sexually transmitted infections that are accessed via online postal self-sampling services in the UK. ASSIST (Assessing the impact of online postal self-sampling for sexually transmitted infections on health inequalities, access to care and clinical outcomes in the UK) aims to assess the impact of these services on health inequalities, access to care, and clinical and economic outcomes, and to identify the factors that influence the implementation and sustainability of these services., Methods and Analysis: ASSIST is a mixed-methods, realist evaluated, national study with an in-depth focus of three case study areas (Birmingham, London and Sheffield). An impact evaluation, economic evaluation and implementation evaluation will be conducted. Findings from these evaluations will be analysed together to develop programme theories that explain the outcomes. Data collection includes quantitative data (using national, clinic based and online datasets); qualitative interviews with service users, healthcare professionals and key stakeholders; contextual observations and documentary analysis. STATA 17 and NVivo will be used to conduct the quantitative and qualitative analysis, respectively., Ethics and Dissemination: This study has been approved by South Central - Berkshire Research Ethics Committee (ref: 21/SC/0223). All quantitative data accessed and collected will be anonymous. Participants involved with qualitative interviews will be asked for informed consent, and data collected will be anonymised.Our dissemination strategy has been developed to access and engage key audiences in a timely manner and findings will be disseminated via the study website, social media, in peer-reviewed scientific journals, at research conferences, local meetings and seminars and at a concluding dissemination and networking event for stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
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- 2022
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25. National medical specialty guidelines of HIV indicator conditions in Europe lack adequate HIV testing recommendations: a systematic guideline review.
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Jordans CCE, Vasylyev M, Rae C, Jakobsen ML, Vassilenko A, Dauby N, Grevsen AL, Jakobsen SF, Raahauge A, Champenois K, Papot E, Malin JJ, Boender TS, Behrens GMN, Gruell H, Neumann A, Spinner CD, Valbert F, Akinosoglou K, Kostaki EG, Nozza S, Giacomelli A, Lapadula G, Mazzitelli M, Torti C, Matulionyte R, Matulyte E, Van Welzen BJ, Hensley KS, Thompson M, Ankiersztejn-Bartczak M, Skrzat-Klapaczyńska A, Săndulescu O, Streinu-Cercel A, Streinu-Cercel A, Miron VD, Pokrovskaya A, Hachfeld A, Dorokhina A, Sukach M, Lord E, Sullivan AK, and Rokx C
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- Female, Pregnancy, Humans, Europe epidemiology, Europe, Eastern, HIV Testing, HIV Infections diagnosis, HIV Infections epidemiology, Medicine
- Abstract
BackgroundAdequate identification and testing of people at risk for HIV is fundamental for the HIV care continuum. A key strategy to improve timely testing is HIV indicator condition (IC) guided testing.AimTo evaluate the uptake of HIV testing recommendations in HIV IC-specific guidelines in European countries.MethodsBetween 2019 and 2021, European HIV experts reviewed guideline databases to identify all national guidelines of 62 HIV ICs. The proportion of HIV IC guidelines recommending HIV testing was reported, stratified by subgroup (HIV IC, country, eastern/western Europe, achievement of 90-90-90 goals and medical specialty).ResultsOf 30 invited European countries, 15 participated. A total of 791 HIV IC guidelines were identified: median 47 (IQR: 38-68) per country. Association with HIV was reported in 69% (545/791) of the guidelines, and 46% (366/791) recommended HIV testing, while 42% (101/242) of the AIDS-defining conditions recommended HIV testing. HIV testing recommendations were observed more frequently in guidelines in eastern (53%) than western (42%) European countries and in countries yet to achieve the 90-90-90 goals (52%) compared to those that had (38%). The medical specialties internal medicine, neurology/neurosurgery, ophthalmology, pulmonology and gynaecology/obstetrics had an HIV testing recommendation uptake below the 46% average. None of the 62 HIV ICs, countries or medical specialties had 100% accurate testing recommendation coverage in all their available HIV IC guidelines.ConclusionFewer than half the HIV IC guidelines recommended HIV testing. This signals an insufficient adoption of this recommendation in non-HIV specialty guidelines across Europe.
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- 2022
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26. Late diagnosis of HIV: An updated consensus definition.
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Croxford S, Stengaard AR, Brännström J, Combs L, Dedes N, Girardi E, Grabar S, Kirk O, Kuchukhidze G, Lazarus JV, Noori T, Pharris A, Raben D, Rockstroh JK, Simões D, Sullivan AK, Van Beckhoven D, and Delpech VC
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- Humans, Delayed Diagnosis, Consensus, CD4 Lymphocyte Count, Risk Factors, Acquired Immunodeficiency Syndrome diagnosis, HIV Infections
- Abstract
Introduction: In recent years, HIV testing frequency has increased, resulting in more people being diagnosed during seroconversion with a temporarily low CD4 count. Using the current consensus definition of late HIV presentation ('presenting for care with a CD4 count < 350 cells/μL or an AIDS-defining event, regardless of CD4 count') these individuals would be incorrectly assigned as being diagnosed late., Methods: In spring 2022, a European expert group convened to revise the current late HIV presentation consensus definition. A survey on data availability to apply this revised definition was sent to nominated European focal points responsible for HIV surveillance (n = 53)., Results: Experts agreed that the updated definition should refer to late HIV diagnosis rather than presentation and include the following addition: People with evidence of recent infection should be reclassified as 'not late', with evidence of recent infection considered hierarchically. The individual must have: (i) laboratory evidence of recent infection; (ii) a last negative HIV test within 12 months of diagnosis; or (iii) clinical evidence of acute infection. People with evidence of being previously diagnosed abroad should be excluded. A total of 18 countries responded to the survey; 83% reported capturing CD4 count and/or AIDS at diagnosis through national surveillance, 67% captured last negative test and/or previous HIV diagnosis, 61% captured seroconversion illness at diagnosis and 28% captured incident antibody results., Conclusions: Accurate data on late diagnosis are important to describe the effects of testing programmes. Reclassification of individuals with recent infection will help to better identify populations most at risk of poor HIV outcomes and areas for intervention., (© 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)
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- 2022
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27. Impact of Artificial Intelligence Assistance on Chest CT Interpretation Times: A Prospective Randomized Study.
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Yacoub B, Varga-Szemes A, Schoepf UJ, Kabakus IM, Baruah D, Burt JR, Aquino GJ, Sullivan AK, Doherty JO, Hoelzer P, Sperl J, and Emrich T
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- Male, Humans, Female, Middle Aged, Aged, Prospective Studies, Radiologists, Neural Networks, Computer, Retrospective Studies, Artificial Intelligence, Tomography, X-Ray Computed methods
- Abstract
BACKGROUND. Deep learning-based convolutional neural networks have enabled major advances in development of artificial intelligence (AI) software applications. Modern AI applications offer comprehensive multiorgan evaluation. OBJECTIVE. The purpose of this article was to evaluate the impact of an automated AI platform integrated into clinical workflow for chest CT interpretation on radiologists' interpretation times when evaluated in a real-world clinical setting. METHODS. In this prospective single-center study, a commercial AI software solution was integrated into clinical workflow for chest CT interpretation. The software provided automated analysis of cardiac, pulmonary, and musculoskeletal findings, including labeling, segmenting, and measuring normal structures as well as detecting, labeling, and measuring abnormalities. AI-annotated images and autogenerated summary results were stored in the PACS and available to interpreting radiologists. A total of 390 patients (204 women, 186 men; mean age, 62.8 ± 13.3 [SD] years) who underwent out-patient chest CT between January 19, 2021, and January 28, 2021, were included. Scans were randomized using 1:1 allocation between AI-assisted and non-AI-assisted arms and were clinically interpreted by one of three cardiothoracic radiologists (65 scans per arm per radiologist; total of 195 scans per arm) who recorded interpretation times using a stopwatch. Findings were categorized according to review of report impressions. Interpretation times were compared between arms. RESULTS. Mean interpretation times were significantly shorter in the AI-assisted than in the non-AI-assisted arm for all three readers (289 ± 89 vs 344 ± 129 seconds, p < .001; 449 ± 110 vs 649 ± 82 seconds, p < .001; 281 ± 114 vs 348 ± 93 seconds, p = .01) and for readers combined (328 ± 122 vs 421 ± 175 seconds, p < .001). For readers combined, the mean difference was 93 seconds (95% CI, 63-123 seconds), corresponding with a 22.1% reduction in the AI-assisted arm. Mean interpretation time was also shorter in the AI-assisted arm compared with the non-AI-assisted arm for contrast-enhanced scans (83 seconds), noncontrast scans (104 seconds), negative scans (84 seconds), positive scans without significant new findings (117 seconds), and positive scans with significant new findings (92 seconds). CONCLUSION. Cardiothoracic radiologists exhibited a 22.1% reduction in chest CT interpretations times when they had access to results from an automated AI support platform during real-world clinical practice. CLINICAL IMPACT. Integration of the AI support platform into clinical workflow improved radiologist efficiency.
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- 2022
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28. COVID-19 mortality among people with diagnosed HIV compared to those without during the first wave of the COVID-19 pandemic in England.
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Brown AE, Croxford SE, Nash S, Khawam J, Kirwan P, Kall M, Bradshaw D, Sabin C, Miller RF, Post FA, Harding R, Collins S, Waters L, Asboe D, Chadwick DR, Delpech V, and Sullivan AK
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- Adolescent, Adult, England epidemiology, Female, Humans, Male, Middle Aged, Young Adult, COVID-19 mortality, HIV Infections diagnosis, HIV Infections epidemiology, Pandemics
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Objectives: We describe COVID-19 mortality among people with and without HIV during the first wave of the pandemic in England., Methods: National surveillance data on adults (aged ≥ 15 years) with diagnosed HIV resident in England were linked to national COVID-19 mortality surveillance data (2 March 2020-16 June 2020); HIV clinicians verified linked cases and provided information on the circumstances of death. We present COVID-19 mortality rates by HIV status, using negative binomial regression to assess the association between HIV and mortality, adjusting for gender, age and ethnicity., Results: Overall, 99 people with HIV, including 61 of black ethnicity, died of/with COVID-19 (107/100 000) compared with 49 483 people without HIV (109/100 000). Compared to people without HIV, higher COVID-19 mortality rates were observed in people with HIV of black (188 vs. 122/100 000) and Asian (131 vs. 77.0/100 000) ethnicity, and in both younger (15-59 years: 58.3 vs. 10.2/100 000) and older (≥ 60 years: 434 vs. 355/100 000) people. After adjustment for demographic factors, people with HIV had a higher COVID-19 mortality risk than those without (2.18; 95% CI: 1.76-2.70). Most people with HIV who died of/with COVID-19 had suppressed HIV viraemia (91%) and at least one comorbidity reported to be associated with poor COVID-19 outcomes (87%)., Conclusions: In the first wave of the pandemic in England, COVID-19 mortality among people with HIV was low, but was higher than in those without HIV, after controlling for demographic factors. This supports the strategy of prioritizing COVID-19 vaccination for people with HIV and strongly encouraging its uptake, especially in those of black and Asian ethnicity., (2021 Crown copyright. HIV Medicine © 2021 British HIV Association. This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.)
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- 2022
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29. HIV seroprevalence in five key populations in Europe: a systematic literature review, 2009 to 2019.
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Stengaard AR, Combs L, Supervie V, Croxford S, Desai S, Sullivan AK, Jakobsen SF, Santos Q, Simões D, Casabona J, Lazarus JV, de Wit JBF, Amort FM, Pharris A, Nerlander L, and Raben D
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- Europe epidemiology, Female, Gender Identity, HIV Seroprevalence, Homosexuality, Male, Humans, Male, Population Groups, Prevalence, Seroepidemiologic Studies, HIV Infections diagnosis, HIV Infections epidemiology, Sex Workers, Sexual and Gender Minorities
- Abstract
BackgroundIn Europe, HIV disproportionately affects men who have sex with men (MSM), people who inject drugs (PWID), prisoners, sex workers, and transgender people. Epidemiological data are primarily available from national HIV case surveillance systems that rarely capture information on sex work, gender identity or imprisonment. Surveillance of HIV prevalence in key populations often occurs as independent studies with no established mechanism for collating such information at the European level.AimWe assessed HIV prevalence in MSM, PWID, prisoners, sex workers, and transgender people in the 30 European Union/European Economic Area countries and the United Kingdom.MethodsWe conducted a systematic literature review of peer-reviewed studies published during 2009-19, by searching PubMed, Embase and the Cochrane Library. Data are presented in forest plots by country, as simple prevalence or pooled across multiple studies.ResultsEighty-seven country- and population-specific studies were identified from 23 countries. The highest number of studies, and the largest variation in HIV prevalence, were identified for MSM, ranging from 2.4-29.0% (19 countries) and PWID, from 0.0-59.5% (13 countries). Prevalence ranged from 0.0-15.6% in prisoners (nine countries), 1.1-8.5% in sex workers (five countries) and was 10.9% in transgender people (one country). Individuals belonging to several key population groups had higher prevalence.ConclusionThis review demonstrates that HIV prevalence is highly diverse across population groups and countries. People belonging to multiple key population groups are particularly vulnerable; however, more studies are needed, particularly for sex workers, transgender people and people with multiple risks.
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- 2021
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30. Increased integrated testing for HIV, hepatitis C and sexually transmitted infections in health care facilities: results from the INTEGRATE Joint Action pilots in Lithuania, Romania and Spain.
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Matulionytė R, Jakobsen ML, Grecu VI, Grigaitiene J, Raudonis T, Stoniene L, Olteanu M, de la Mora L, Raben D, and Sullivan AK
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- Ambulatory Care Facilities, Delivery of Health Care, Humans, Lithuania, Retrospective Studies, Romania, Spain, HIV Infections diagnosis, HIV Infections epidemiology, Hepatitis C diagnosis, Hepatitis C epidemiology, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases epidemiology
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Background: Indicator condition guided HIV testing is a proven effective strategy for increasing HIV diagnosis in health care facilities. As part of the INTEGRATE Joint Action, we conducted four pilot studies, aiming to increase integrated testing for HIV/HCV/HBV and sexually transmitted infections, by introducing and expanding existing indicator condition guided HIV testing methods., Methods: Pilot interventions included combined HIV/HCV testing in a dermatovenerology clinic and a clinic for addictive disorders in Lithuania; Increasing HIV testing rates in a tuberculosis clinic in Romania by introducing a patient information leaflet and offering testing for HIV/HCV/sexually transmitted infections to chemsex-users in Barcelona. Methods for implementing indicator condition guided HIV testing were adapted to include integrated testing. Testing data were collected retrospectively and prospectively. Staff were trained in all settings, Plan-do-study-act cycles frequently performed and barriers to implementation reported., Results: In established indicator conditions, HIV absolute testing rates increased from 10.6 to 71% in the dermatovenerology clinic over an 18 months period. HIV testing rates improved from 67.4% at baseline to 94% in the tuberculosis clinic. HCV testing was added to all individuals in the dermatovenerology clinic, eight patients of 1701 tested positive (0.47%). HBV testing was added to individuals with sexually transmitted infections with a 0.44% positivity rate (2/452 tested positive). The Indicator condition guided HIV testing strategy was expanded to offer HIV/HCV testing to people with alcohol dependency and chemsex-users. 52% of chemsex-users tested positive for ≥ 1 sexually transmitted infection and among people with alcohol dependency 0.3 and 3.7% tested positive for HIV and HCV respectively., Conclusions: The four pilot studies successfully increased integrated testing in health care settings, by introducing testing for HBV/HCV and sexually transmitted infections along with HIV testing for established indicator conditions and expanding the strategy to include new indicators; alcohol dependency and chemsex. HCV testing of individuals with alcohol abuse showed high positivity rates and calls for further implementation studies. Methods used for implementing indicator condition guided HIV Testing have proven transferable to implementation of integrated testing., (© 2021. The Author(s).)
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- 2021
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31. The development and cognitive testing of the positive outcomes HIV PROM: a brief novel patient-reported outcome measure for adults living with HIV.
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Bristowe K, Murtagh FEM, Clift P, James R, Josh J, Platt M, Whetham J, Nixon E, Post FA, McQuillan K, Cheallaigh CN, Kall M, Anderson J, Sullivan AK, and Harding R
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- Adult, Female, Humans, Male, Middle Aged, Psychometrics methods, Qualitative Research, Reproducibility of Results, Anti-HIV Agents therapeutic use, Cognition drug effects, HIV Infections drug therapy, Outcome Assessment, Health Care statistics & numerical data, Patient Reported Outcome Measures, Patient-Centered Care methods, Quality of Life psychology
- Abstract
Background: People living with HIV experience burdensome multidimensional symptoms and concerns requiring person-centred care. Routine use of patient reported outcome measures can improve outcomes. There is no brief patient reported outcome measure (PROM) that currently reflects the breadth of concerns for people living with HIV. This study aimed to develop and cognitively test a brief novel patient reported outcome measure for use within routine adult HIV care- the "Positive Outcomes" HIV PROM., Methods: Development followed the COSMIN taxonomy and guidance for relevance and comprehensiveness, and Rothrock guidance on development of valid patient reported outcome measures. The Positive Outcomes HIV PROM was developed by a steering group (people living with HIV, HIV professionals and health services researchers) using findings from a previously reported qualitative study of priority outcomes for people living with HIV. The prototype measure was cognitively tested with a purposive sample of people living with HIV., Results: The Positive Outcomes HIV PROM consists of 23 questions (22 structured, and one open question) informed by the priorities of key stakeholders (n = 28 people living with HIV, n = 21 HIV professionals and n = 8 HIV commissioners) to ensure face and content validity, and refined through cognitive testing (n = 6 people living with HIV). Cognitive testing demonstrated high levels of acceptability and accessibility., Conclusions: The Positive Outcomes HIV PROM is the first brief patient reported outcome measure reflecting the diverse needs of people living with HIV designed specifically for use in the clinical setting to support patient assessment and care, and drive service quality improvement. It is derived from primary data on the priority outcomes for people living with HIV and is comprehensive and acceptable. Further psychometric testing is required to ensure reliability and responsiveness.
- Published
- 2020
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32. Response letter to BASHH National Syphilis Audit 2017: Quality Improvement Report.
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Pammi M, Curtis H, and Sullivan AK
- Subjects
- Guidelines as Topic, HIV Infections diagnosis, Humans, Syphilis diagnosis, Syphilis Serodiagnosis, Contact Tracing, Guideline Adherence, Medical Audit, Quality Improvement standards
- Published
- 2020
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33. Agricultural development addresses food loss and waste while reducing greenhouse gas emissions.
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Galford GL, Peña O, Sullivan AK, Nash J, Gurwick N, Pirolli G, Richards M, White J, and Wollenberg E
- Abstract
Food loss and waste (FLW) reduce food available for consumption and increase the environmental burden of production. Reducing FLW increases agricultural and value-chain productivity and may reduce greenhouse gas emissions associated with feeding the global population. Although studies of interventions that reduce FLW exist, almost no research systematically investigates FLW interventions across multiple value chains or countries, most likely due to challenges in collecting and synthesizing data and estimates, let alone estimating greenhouse gas emissions. Our research team investigated changes in FLW in projects supported by the United States Agency for International Development's (USAID) global hunger and food security initiative, Feed the Future. This was a unique opportunity to conduct ex-ante estimates of the impacts of FLW interventions across 20 value chains in 12 countries, based on project documents and interviews with USAID and project staff. This paper describes specific interventions in each value chain and country context, providing insight to interventions that decrease FLW at multiple points along food value chains, from upstream producer-dominated stages to downstream consumer-dominated stages. Amongst the sub-sectors studied, FLW interventions directed at extensive dairy systems could decrease FLW by 4-10%, providing meaningful greenhouse gas mitigation, since these systems are both emission-intensive and experience high FLW. More modest emissions reductions were found for other key agricultural products, including maize, rice, vegetables, fruits and market goods., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2020
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34. Prevalence and correlates of depressive symptoms among gay, bisexual and other men who have sex with men in the PROUD randomised clinical trial of HIV pre-exposure prophylaxis.
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Miltz A, Lampe F, McCormack S, Dunn D, White E, Rodger A, Phillips A, Sherr L, Sullivan AK, Reeves I, Clarke A, and Gafos M
- Subjects
- Adult, Correlation of Data, Cross-Sectional Studies, England epidemiology, HIV Infections prevention & control, Humans, Male, Middle Aged, Pre-Exposure Prophylaxis, Prevalence, Randomized Controlled Trials as Topic, Socioeconomic Factors, Young Adult, Bisexuality psychology, Depression epidemiology, Homosexuality, Male psychology, Sexual and Gender Minorities psychology
- Abstract
Objectives: The aim of this analysis is to: (i) assess the prevalence of clinically significant depressive symptoms at baseline and follow-up for participants in the PROUD trial of HIV pre-exposure prophylaxis (PrEP), examining changes in prevalence over time and (ii) investigate the association of socioeconomic and psychosocial factors with depression., Methods: PROUD was an open label randomised trial evaluating the benefit of PrEP for 544 HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in England. Enrolment was between 2012 and 2014, with at least 2 years follow-up. Prevalence of depression (score ≥10 on Patient Health Questionnaire-9) was assessed and compared across time-points (using McNemar's χ
2 tests) and between trial arms (using χ2 tests). Cross-sectional associations with socioeconomic and psychosocial factors were examined using baseline data in modified Poisson regression models and combined 12 and 24 month follow-up data in generalised estimating equations (GEEs). Prevalence ratios (PRs) were presented as unadjusted PR and adjusted PR (aPR) for age, UK birth, sexual identity, university education, London study clinic site and calendar time (and follow-up time-point in GEEs)., Results: Depression increased significantly from baseline (9.1%; 49/540) to the 12 month (14.4%; 59/410) and 24 month (14.4%; 48/333) follow-ups, possibly explained by underreporting at baseline. The prevalence of depression did not differ by study trial arm, at any time-point. In the baseline analysis, younger age, unemployment and crystal methamphetamine use, was associated with depression. In combined analysis of 12 and 24 month data, measures of intimate partner violence (IPV) (lifetime IPV victimisation aPR 2.57 (95% CI: 1.71 to 3.86)), internalised homophobia (aPR 1.91 (95% CI: 1.29 to 2.83)) and concealment of sexual identity (aPR 1.75 (95% CI: 1.16 to 2.65)), were strongly associated with depression., Conclusions: There is a high concomitant burden of psychosocial factors with depression among GBMSM., Trial Registration Number: ISRCTN (ISRCTN94465371) and ClinicalTrials.gov (NCT02065986)., Competing Interests: Competing interests: The PROUD study was provided drug free of charge by Gilead Sciences plc which also distributed it to participating clinics and provided funds for additional diagnostic tests for HCV and drug levels. AP has received payments for presentations made at meetings sponsored by Gilead in spring 2015. EW has had tuition fees and a stipend paid by Gilead. AC received advisory board fees from Gilead Sciences plc and GSK/ViiV; speaker fees from Gilead and conferences bursaries from Gilead & Janssen. SM reports grants from the European Union H2020 scheme, EDCTP 2, the National Institute of Health Research and Gilead Sciences; other support from Gilead Sciences, and the Population Council Microbicide Advisory Board and is Chair of the Project Advisory Committee for USAID grant awarded to CONRAD to develop tenofovir-based products for use by women (non-financial)., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)- Published
- 2019
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35. Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants.
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O'Halloran C, Rice B, White E, Desai M, Dunn DT, McCormack S, Sullivan AK, White D, McOwan A, and Gafos M
- Subjects
- Adolescent, Adult, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination administration & dosage, Female, Follow-Up Studies, Humans, Male, Middle Aged, Self Report, Sexual Behavior, Sexual and Gender Minorities, Young Adult, Anti-HIV Agents administration & dosage, HIV Infections prevention & control, Medication Adherence statistics & numerical data, Pre-Exposure Prophylaxis methods, Substance-Related Disorders epidemiology
- Abstract
Background: Pre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants., Methods: The PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of Truvada
Ⓡ -PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI)., Results: 1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90-1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline., Conclusions: These analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2019
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36. Predictive factors for HIV infection among men who have sex with men and who are seeking PrEP: a secondary analysis of the PROUD trial.
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White E, Dunn DT, Desai M, Gafos M, Kirwan P, Sullivan AK, Clarke A, and McCormack S
- Subjects
- Adolescent, Adult, Anti-HIV Agents, England epidemiology, HIV Infections epidemiology, HIV Infections psychology, Homosexuality, Male psychology, Humans, Male, Middle Aged, Pre-Exposure Prophylaxis, Sexual Behavior, Young Adult, HIV Infections prevention & control, Homosexuality, Male statistics & numerical data
- Abstract
Objectives: Pre-exposure prophylaxis (PrEP) is a highly effective method of HIV prevention for men who have sex with men (MSM). However, uncertainty remains around the optimal eligibility criteria for PrEP, specifically whether there are subgroups at low risk of HIV for whom PrEP might not be warranted., Methods: PROUD was an open-label waitlist trial design that randomised MSM attending participating sexual health centres in England to receive PrEP immediately (IMM) or after a deferral period of 1 year (DEF). This analysis is based on participants who were randomised to the deferred arm, when they did not have access to PrEP. HIV incidence was compared between subgroups defined by baseline characteristics., Results: Overall, 21 participants acquired HIV infection over 239.3 person-years (PY) follow-up, yielding an incidence rate of 8.8/100 PY (95% CI 5.4 to 13.4). Two highly significant predictors for HIV acquisition were identified. Men with a self-reported diagnosis of syphilis, rectal chlamydia (CT) or rectal gonorrhoea (GC) in the previous 12 months had an incidence of 17.2/100 PY (95% CI 9.7 to 28.5); those reporting receptive anal intercourse without a condom (ncRAI) with two or more partners in the previous 3 months had an incidence of 13.6/100 PY (95% CI 7.9 to 21.7). The incidence rate among participants lacking both of these risk factors was 1.1/100 PY (1/87.6, 95% CI 0.03 to 6.4)., Conclusions: The high HIV incidence in PROUD suggests that most participants appropriately judged their need for PrEP. Eligibility criteria for a PrEP programme can therefore be broad, as in the current guidelines. However, a recent history of syphilis or rectal CT/GC, or multiple ncRAI partners indicates a high imminent risk of HIV infection. MSM with any of these characteristics should be offered PrEP as a matter of urgency., Competing Interests: Competing interests: The PROUD study was provided drug free of charge by Gilead Sciences which also distributed it to participating clinics and provided funds for additional diagnostic tests for HCV and drug levels. EW's university fees and stipend were funded by Gilead Sciences. DTD has received fees for participation on advisory boards and educational workshops from ViiV Healthcare and Gilead Sciences. PK was part funded by Gilead Sciences during 2017/2018. AC received advisory board fees from Gilead Sciences and GSK/ViiV; speaker fees from Gilead and conferences bursaries from Gilead & Janssen. SM reports grants from the European Union H2020 scheme, EDCTP 2, the National Institute of Health Research and Gilead Sciences; other support from Gilead Sciences, and the Population Council Microbicide Advisory Board; and is Chair of the Project Advisory Committee for USAID grant awarded to CONRAD to develop tenofovir-based products for use by women (non-financial)., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2019
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37. Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II Study - 2012 - 2015.
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Raben D, Sullivan AK, Mocroft A, Kutsyna G, Hadžiosmanović V, Vassilenko A, Chkhartisvili N, Mitsura V, Pedersen C, Anderson J, Begovac J, Bak Dragsted U, Bertisch B, Grzeszczuk A, Minton J, Necsoi VC, Kitchen M, Ajana F, Sokhan A, Comi L, Farazmand P, Pesut D, De Wit S, Gatell JM, Gazzard B, d'Arminio Monforte A, Rockstroh JK, Yazdanpanah Y, Champenois K, Jakobsen ML, and Lundgren JD
- Subjects
- Adolescent, Adult, Aged, Europe, Eastern epidemiology, Female, HIV Infections epidemiology, HIV Infections virology, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Prevalence, Young Adult, Early Diagnosis, HIV isolation & purification, HIV Infections diagnosis, Mass Screening, Serologic Tests methods
- Abstract
Background: It is cost-effective to perform an HIV test in people with specific indicator conditions (IC) with an undiagnosed HIV prevalence of at least 0.1%. Our aim was to determine the HIV prevalence for 14 different conditions across 20 European countries., Methods: Individuals aged 18-65 years presenting for care with one of 14 ICs between January 2012 and June 2014 were included and routinely offered an HIV test. Logistic regression assessed factors associated with testing HIV positive. Patients presenting with infectious mononucleosis-like syndrome (IMS) were recruited up until September 2015., Results: Of 10,877 patients presenting with an IC and included in the analysis, 303 tested positive (2.8%; 95% CI 2.5-3.1%). People presenting with an IC in Southern and Eastern Europe were more likely to test HIV positive as were people presenting with IMS, lymphadenopathy and leukocytopenia/ thrombocytopenia. One third of people diagnosed with HIV after presenting with IMS reported a negative HIV test in the preceding 12 months. Of patients newly diagnosed with HIV where data was available, 92.6% were promptly linked to care; of these 10.4% were reported lost to follow up or dead 12 months after diagnosis., Conclusion: The study showed that 10 conditions had HIV prevalences > 0.1%. These 10 ICs should be adopted into HIV testing and IC specialty guidelines. As IMS presentation can mimic acute HIV sero-conversion and has the highest positivity rate, this IC in particular affords opportunities for earlier diagnosis and public health benefit., Competing Interests: The HIDES study was funded by the HIV in Europe initiative which has received unrestricted funding from Gilead Sciences, ViiV Healthcare, Merck, Tibotec, Pfizer, Schering-Plough, Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline. This does not alter our adherence to PLOS ONE policies on sharing data and materials. AM has received honoraria and consultancy fee from Gilead Sciences and ViiV Healthcare. JG has received honoraria and grants from ViiV Healthcare, MSD, Gilead Sciences and Janssen and is by 1 May 2018 employed by ViiV Healthcare. JR has received honoraria and consultancy fee from ViiV Healthcare, Merck/MSD, Gilead Sciences, Abbott, Abbvie, Abivax, Janssen. YY has received speaker and consultancy fee from Abbott, BMS, Gilead Sciences, MSD, Roche, Tibotec and ViiV Healthcare. KC has received consultancy and speaker fee from Gilead. All other authors declare no conflict of interest.
- Published
- 2019
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38. Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates.
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Martínez Sanz J, Pérez Elías MJ, Muriel A, Gómez Ayerbe C, Vivancos Gallego MJ, Sánchez Conde M, Herrero Delgado M, Pérez Elías P, Polo Benito L, de la Fuente Cortés Y, Barea R, Sullivan AK, Fuster Ruiz de Apodaca MJ, Galindo MJ, and Moreno S
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Delayed Diagnosis prevention & control, Education, Continuing, HIV Infections diagnosis, HIV Infections epidemiology, HIV Infections therapy, Health Personnel education, Mass Screening, Primary Health Care
- Abstract
Background: Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed., Methods: A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer., Results: A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01-1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77-0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17-0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01-5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04-2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02-1.42; p = 0.036)., Conclusions: This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes., Competing Interests: J.M.S. has received travel grants from ViiV Healthcare and Gilead Sciences. M.J.P.E. has received research grants or honoraria for lectures or for participation in advisory boards from Abbott, Bristol-Myers Squibb,Boehringer Ingelheim, Gilead Sciences, ViiF-Healthcare previously GlaxoSmithKline, Roche and Janssen, and unrestricted grants from Abbott, ViiF Healthcare previously GlaxoSmithKline, Gilead Sciences and Janssen. M.J.V.G has received honoraria (grants and personal fees) as a speaker in educational programs sponsored by ViiV, and Gilead; and has received support (registration, travel assistance) for expert courses and congresses by MSD and ViiV. M.S.C. has received honoraria for collaborations with Gilead Sciences, Merck Sharp & Dohme and ViiV Healthcare. M.J.G. has worked as a consultant in the laboratories Abbott Laboratoires, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and AbbVie; he has received scholarships for clinical research from Abbott Laboratories, Boehringer Ingelheim, Glaxo, Janssen and has received financial compensation for talks by Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and Roche; he has collaborated in the elaboration of educational materials for Janssen, Pfizer, ViiV, Glaxo and AbbVie. S.M. has been involved in speaking activities and has received grants for research from Abbott, Boehringer&Ingelheim, Bristol-Myers Squibb, Gilead, Glaxo Smith Kline, Janssen Cilag, Merck Sharp&Dohme, Pfizer, Roche, and Schering Plough. M.J. F. R. A. has provided consultancy services to ViiV, Gilead, and Janssen; her institution has received grants from MSD, ViiV, Janssen, and Gilead and payments for lectures or educational presentations from MSD, Gilead, and ViiV. All other authors have nothing to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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- 2019
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39. The British Association for Sexual Health and HIV 2016 UK national audit and survey of clinic policies in relation to risk assessment, HIV testing and follow-up.
- Author
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Bhaduri S, Curtis H, McClean H, and Sullivan AK
- Subjects
- Ambulatory Care Facilities, Guideline Adherence, Humans, Male, Reproductive Health, Risk Assessment, Sexual Health, United Kingdom, Clinical Audit, HIV Infections diagnosis, HIV Infections prevention & control, Health Policy, Homosexuality, Male, Illicit Drugs adverse effects, Practice Guidelines as Topic
- Abstract
This national audit of 142 clinics demonstrated that the majority of clinics surveyed had policies and agreed clinical practice for alcohol and recreational drug enquiry, as well as documentation of HIV test refusal, although this was not the case in 24% of clinics as regards alcohol usage, 21% of clinics as regards recreational drugs use and 43% of clinics as regards chemsex usage. Regarding management of HIV test refusal, there was no policy or agreed practice in 13% of clinics with respect to men having sex with men (MSM) attenders, and in 18% of clinics for heterosexual attenders. Seventy percent of clinics had HIV point of care tests (POCT) available. Recommendations include: all clinics should have a policy of routine enquiry about alcohol, recreational drugs and chemsex, all clinics should record reasons for HIV test refusal and all clinics should provide testing alternatives to improve uptake, e.g. point of care testing or home sampling.
- Published
- 2018
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40. BASHH 2016 UK national audit and survey of HIV testing, risk assessment and follow-up: case note audit.
- Author
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Bhaduri S, Curtis H, McClean H, and Sullivan AK
- Subjects
- Humans, Male, Risk Assessment, Sexual Behavior, United Kingdom, AIDS Serodiagnosis statistics & numerical data, Clinical Audit, Guideline Adherence, Homosexuality, Male, Illicit Drugs, Mass Screening statistics & numerical data, Practice Guidelines as Topic, Substance-Related Disorders complications
- Abstract
This national audit demonstrated discrepancies between actual practice and that indicated by clinic policies following enquiry about alcohol, recreational drugs and chemsex use. Clinics were more likely to enquire about risk behaviour if this was clinic policy or routine practice. Previous testing was the most common reason for refusing HIV testing, although 33% of men who have sex with men had a prior test of more than three months ago. Of the group declining due to recent exposure in the window period, 21/119 cases had an exposure within the four weeks prior to presentation, but had a previous risk not covered by previous testing. Recommendations include provision of risk assessments for alcohol, recreational drug use and chemsex, documenting reasons for HIV test refusal, provision of HIV point-of-care testing, follow-up for cases at higher risk of HIV and advice about community testing or self-sampling/testing.
- Published
- 2018
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41. HIV testing in Europe: Evaluating the impact, added value, relevance and usability of the European Centre for Disease Prevention and Control (ECDC)'s 2010 HIV testing guidance.
- Author
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Sullivan AK, Sperle I, Raben D, Amato-Gauci AJ, Lundgren JD, Yazdanpanah Y, Jakobsen SF, and Tavoschi L
- Subjects
- Europe, European Union, HIV Infections prevention & control, Health Policy, Humans, AIDS Serodiagnosis, Guideline Adherence, HIV Infections diagnosis, Mass Screening methods, Practice Guidelines as Topic
- Abstract
Background: An evaluation of the 2010 ECDC guidance on HIV testing, conducted in October 2015-January 2016, assessed its impact, added value, relevance and usability and the need for updated guidance., Methods: Data sources were two surveys: one for the primary target audience (health policymakers and decision makers, national programme managers and ECDC official contact points in the European Union/European Economic Area (EU/EEA) countries and one for a broader target audience (clinicians, civil society organisations and international public health agencies); two moderated focus group discussions (17 participants each); webpage access data; a literature citation review; and an expert consultation (18 participants) to discuss the evaluation findings., Results: Twenty-three of 28 primary target audience and 31 of 51 broader target audience respondents indicated the guidance was the most relevant when compared with other international guidance. Primary target audience respondents in 11 of 23 countries reported that they had used the guidance in development, monitoring and/or evaluation of their national HIV testing policy, guidelines, programme and/or strategy, and 29 of 51 of the broader target audience respondents reported having used the guidance in their work. Both the primary and broader target audience considered it important or very important to have an EU/EEA-level HIV testing guidance (23/28 and 46/51, respectively)., Conclusion: The guidance has been widely used to develop policies, guidelines, programmes and strategies in the EU/EEA and should be regularly updated due to continuous developments in the field in order to continue to serve as an important reference guidance in the region.
- Published
- 2017
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42. Enrichment of HLA Types and Single-Nucleotide Polymorphism Associated With Non-progression in a Strictly Defined Cohort of HIV-1 Controllers.
- Author
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Westrop SJ, Cocker ATH, Boasso A, Sullivan AK, Nelson MR, and Imami N
- Abstract
HIV-1 controllers (HIC) are extremely rare patients with the ability to control viral replication, maintain unchanging CD4 T-cell count, and evade disease progression for extensive periods of time, in the absence of antiretroviral therapy. In order to establish the representation of key genetic correlates of atypical disease progression within a cohort of HIV-1
+ individuals who control viral replication, we examine four-digit resolution HLA type and single-nucleotide polymorphisms (SNP) previously identified to be correlated to non-progressive infection, in strictly defined HIC. Clinical histories were examined to identify patients exhibiting HIC status. Genomic DNA was extracted, and high definition HLA typing and genome-wide SNP analysis was performed. Data were compared with frequencies of SNP in European long-term non-progressors (LTNP) and primary infection cohorts. HLA-B alleles associated with atypical disease progression were at very high frequencies in the group of five HIC studied. All four HIC of European ancestry were HLA-B*57+ and half were also HLA-B*27+ . All HIC, including one of self-reported African ethnicity, had the HLA-Cw*0602 allele, and the HLA-DQ9 allele was present only in HIC of European ancestry. A median 95% of the top 19 SNP known to be associated with LTNP status was observed in European HIC (range 78-100%); 17/19 of the SNP considered mapped to chromosome 6 in the HLA region, whereas 2/19 mapped to chromosome 8. The HIC investigated here demonstrated high enrichment of HLA types and SNP previously associated with long-term non-progression. These findings suggest that the extreme non-progressive phenotype considered here is associated with a genetic signature characterized by a single-genetic unit centered around the HLA-B*57 haplotype and the possible additive effect of HLA-B*27.- Published
- 2017
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43. An effective strategy to diagnose HIV infection: findings from a national audit of HIV partner notification outcomes in sexual health and infectious disease clinics in the UK.
- Author
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Rayment M, Curtis H, Carne C, McClean H, Bell G, Estcourt C, Roberts J, Wilkins E, Estreich S, Morris G, Phattey J, and Sullivan AK
- Subjects
- Adult, Female, HIV Infections epidemiology, Health Policy, Humans, Male, Middle Aged, Patient Outcome Assessment, Retrospective Studies, United Kingdom, Young Adult, Clinical Audit, Contact Tracing statistics & numerical data, HIV Infections diagnosis, Sexual Behavior statistics & numerical data, Sexual Partners
- Abstract
Objectives: Partner notification (PN) is a key public health intervention in the control of STIs. Data regarding its clinical effectiveness in the context of HIV are lacking. We sought to audit HIV PN outcomes across the UK., Methods: All UK sexual health and HIV services were invited to participate. Clinical audit consisted of retrospective case-note review for up to 40 individuals diagnosed with HIV per site during 2011 (index cases) and a review of PN outcomes for up to five contacts elicited by PN per index case., Results: 169/221 (76%) clinical services participated (93% sexual health/HIV services, 7% infectious diseases/HIV units). Most (97%) delivered PN for HIV. Data were received regarding 2964 index cases (67% male; 50% heterosexual, 52% white). PN was attempted for 88% of index cases, and outcomes for 3211 contacts were audited (from an estimated total of 6400): 519 (16%) were found not to be at risk of undiagnosed HIV infection, 1399 (44%) were informed of their risk and had an HIV test, 310 (10%) were informed of the risk but not known to have tested and 983 (30%) were not informed of their risk of HIV infection. Of 1399 contacts tested through PN, 293 (21%) were newly diagnosed with HIV infection. Regular partners were most likely to test positive (p<0.001)., Conclusions: HIV PN is a highly effective diagnostic strategy. Non-completion of PN thus represents a missed opportunity to diagnose HIV in at-risk populations. Vigorous efforts should be made to pursue PN to identify people living with, and at risk of, HIV infection., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
- Published
- 2017
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44. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort.
- Author
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Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, Burns F, Copas A, Brown AE, Sullivan AK, and Delpech V
- Subjects
- Adolescent, Adult, Aged, Antiretroviral Therapy, Highly Active, Case-Control Studies, Cause of Death, Cohort Studies, Female, HIV Infections drug therapy, Humans, Male, Middle Aged, United Kingdom epidemiology, Young Adult, HIV Infections diagnosis, HIV Infections mortality
- Abstract
Background: Deaths in HIV-positive people have decreased since the introduction of highly active antiretroviral therapy (HAART) in 1996. Fewer AIDS-related deaths and an ageing cohort have resulted in an increase in the proportion of HIV patients dying from non-AIDS-related disorders. Here we describe mortality and causes of death in people diagnosed with HIV in the HAART era compared with the general population., Methods: In this observational analysis, we linked cohort data collected by Public Health England (PHE) for individuals aged 15 years and older, diagnosed with HIV in England and Wales from 1997 to 2012, to the Office for National Statistics (ONS) national mortality register. Cohort inclusion began at diagnosis with follow-up clinical information collected every year from all 220 National Health Service (NHS) HIV outpatient clinics nationwide. To classify causes of death we used a modified Coding Causes of Death in HIV (CoDe) protocol, which uses death certificate data and clinical markers. We applied Kaplan-Meier analysis for survival curves and mortality rate estimation and Cox regression to establish independent predictors of all-cause mortality, adjusting for sex, infection route, age at diagnosis, region of birth, year of diagnosis, late diagnosis, and history of HAART. We used standardised mortality ratios (SMRs) to make comparisons with the general population., Findings: Between 1997 and 2012, 88 994 people were diagnosed with HIV, contributing 448 839 person-years of follow up. By the end of 2012, 5302 (6%) patients had died (all-cause mortality 118 per 10 000 person-years, 95% CI 115-121). In multivariable analysis, late diagnosis was a strong predictor of death (hazard ratio [HR] 3·50, 95% CI 3·13-3·92). People diagnosed more recently had a lower risk of death (2003-07: HR 0·66, 95% CI 0·62-0·70; 2008-12: HR 0·65, 95% CI 0·60-0·71). Cause of death was determinable for 4808 (91%) of 5302 patients; most deaths (2791 [58%] of 4808) were attributable to AIDS-defining illnesses. Cohort mortality was significantly higher than the general population for all causes (SMR 5·7, 95% CI 5·5-5·8), particularly non-AIDS infections (10·8, 9·8-12·0) and liver disease (3·7, 3·3-4·2). All-cause mortality was highest in the year after diagnosis (SMR 24·3, 95% CI 23·4-25·2)., Interpretation: Despite the availability of free treatment and care in the UK, AIDS continues to account for the majority of deaths in HIV-positive people, and mortality remains higher in HIV-positive people than in the general population. These findings highlight the importance of prompt diagnosis, care engagement, and optimum management of comorbidities in reducing mortality in people with HIV., Funding: Public Health England., (Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2017
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45. Screening for asymptomatic lymphogranuloma venereum co-infection in men who have sex with men newly diagnosed with HIV, hepatitis C or syphilis.
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Pallawela S, Bradshaw D, Hodson L, Rehill K, Wong F, Rockwood N, Gedela K, Hardie J, Price H, Alexander S, McLean K, Dean G, Smith A, and Sullivan AK
- Subjects
- Adult, Chlamydia trachomatis isolation & purification, HIV Infections epidemiology, Hepatitis C epidemiology, Humans, Incidence, Lymphogranuloma Venereum epidemiology, Lymphogranuloma Venereum microbiology, Male, Mass Screening, Prevalence, Risk Factors, Syphilis epidemiology, United Kingdom epidemiology, Asymptomatic Infections epidemiology, Coinfection epidemiology, HIV Infections diagnosis, Hepatitis C diagnosis, Homosexuality, Male, Lymphogranuloma Venereum diagnosis, Syphilis diagnosis
- Abstract
Patients diagnosed with lymphogranuloma venereum have high rates of co-infection with HIV, syphilis and hepatitis C. The aim of this enhanced surveillance was to screen all men who have sex with men (MSM) newly diagnosed with HIV, syphilis or hepatitis C for co-infection with asymptomatic lymphogranuloma venereum as part of the recommended sexual health screen. Of the 145 patients screened, 21 patients were diagnosed with rectal Chlamydia trachomatis, one with both rectal and urethral chlamydia and six with urethral chlamydia. One rectal chlamydia-positive sample, when tested, was equivocal for lymphogranuloma venereum. Our data suggested that there was not a pool of asymptomatic lymphogranuloma venereum infection in MSM recently diagnosed with HIV, hepatitis C and syphilis. However, there have been recent reports of an increased incidence of asymptomatic lymphogranuloma venereum, raising the question whether lymphogranuloma venereum should be screened for in high risk asymptomatic MSM. The prevalence of asymptomatic rectal chlamydia infections was 19%., (© The Author(s) 2015.)
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- 2016
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46. United Kingdom National Guideline on the Management of the viral hepatitides A, B and C 2015.
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Brook G, Bhagani S, Kulasegaram R, Torkington A, Mutimer D, Hodges E, Hesketh L, Farnworth S, Sullivan V, Gore C, Devitt E, and Sullivan AK
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- Adult, Child, Female, Humans, Male, Pregnancy, United Kingdom, Hepatitis, Viral, Human diagnosis, Hepatitis, Viral, Human therapy, Practice Guidelines as Topic
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- 2016
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47. UK national guidelines on the management of syphilis 2015.
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Kingston M, French P, Higgins S, McQuillan O, Sukthankar A, Stott C, McBrien B, Tipple C, Turner A, Sullivan AK, Radcliffe K, Cousins D, FitzGerald M, Fisher M, Grover D, Higgins S, Kingston M, Rayment M, and Sullivan A
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- Disease Management, Humans, Treponema pallidum immunology, United Kingdom, Practice Guidelines as Topic, Syphilis diagnosis, Syphilis drug therapy, Syphilis Serodiagnosis
- Abstract
These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline., (© The Author(s) 2016.)
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- 2016
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48. An analysis of baseline data from the PROUD study: an open-label randomised trial of pre-exposure prophylaxis.
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Dolling DI, Desai M, McOwan A, Gilson R, Clarke A, Fisher M, Schembri G, Sullivan AK, Mackie N, Reeves I, Portman M, Saunders J, Fox J, Bayley J, Brady M, Bowman C, Lacey CJ, Taylor S, White D, Antonucci S, Gafos M, McCormack S, Gill ON, Dunn DT, and Nardone A
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- Adolescent, Adult, Anti-HIV Agents adverse effects, Drug Administration Schedule, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination adverse effects, England epidemiology, HIV Infections epidemiology, HIV Infections transmission, HIV Infections virology, Humans, Incidence, Male, Middle Aged, Pilot Projects, Reverse Transcriptase Inhibitors adverse effects, Risk Assessment, Risk Factors, Socioeconomic Factors, Surveys and Questionnaires, Time Factors, Treatment Outcome, Young Adult, Anti-HIV Agents administration & dosage, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination administration & dosage, HIV Infections prevention & control, Homosexuality, Male, Primary Prevention methods, Reverse Transcriptase Inhibitors administration & dosage, Unsafe Sex prevention & control
- Abstract
Background: Pre-exposure prophylaxis (PrEP) has proven biological efficacy to reduce the sexual acquisition of the human immunodeficiency virus (HIV). The PROUD study found that PrEP conferred higher protection than in placebo-controlled trials, reducing HIV incidence by 86 % in a population with seven-fold higher HIV incidence than expected. We present the baseline characteristics of the PROUD study population and place the findings in the context of national sexual health clinic data., Methods: The PROUD study was designed to explore the real-world effectiveness of PrEP (tenofovir-emtricitabine) by randomising HIV-negative gay and other men who have sex with men (GMSM) to receive open-label PrEP immediately or after a deferral period of 12 months. At enrolment, participants self-completed two baseline questionnaires collecting information on demographics, sexual behaviour and lifestyle in the last 30 and 90 days. These data were compared to data from HIV-negative GMSM attending sexual health clinics in 2013, collated by Public Health England using the genitourinary medicine clinic activity database (GUMCAD)., Results: The median age of participants was 35 (IQR: 29-43). Typically participants were white (81 %), educated at a university level (61 %) and in full-time employment (72 %). Of all participants, 217 (40 %) were born outside the UK. A sexually transmitted infection (STI) was reported to have been diagnosed in the previous 12 months in 330/515 (64 %) and 473/544 (87 %) participants reported ever having being diagnosed with an STI. At enrolment, 47/280 (17 %) participants were diagnosed with an STI. Participants reported a median (IQR) of 10 (5-20) partners in the last 90 days, a median (IQR) of 2 (1-5) were condomless sex acts where the participant was receptive and 2 (1-6) were condomless where the participant was insertive. Post-exposure prophylaxis had been prescribed to 184 (34 %) participants in the past 12 months. The number of STI diagnoses was high compared to those reported in GUMCAD attendees., Conclusions: The PROUD study population are at substantially higher risk of acquiring HIV infection sexually than the overall population of GMSM attending sexual health clinics in England. These findings contribute to explaining the extraordinary HIV incidence rate during follow-up and demonstrate that, despite broad eligibility criteria, the population interested in PrEP was highly selective., Trial Registration: Current Controlled Trials ISRCTN94465371 . Date of registration: 28 February 2013.
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- 2016
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49. Effect of nondisclosure of HIV status in sexual health clinics on unlinked anonymous HIV prevalence estimates in England, 2005-2009.
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Savage EJ, Lowndes CM, Sullivan AK, Back DJ, Else LJ, Murphy G, and Gill ON
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- Adult, England epidemiology, Female, HIV Infections diagnosis, Humans, Male, Middle Aged, Prevalence, Surveys and Questionnaires, Young Adult, Ambulatory Care, Anti-Retroviral Agents blood, HIV Infections drug therapy, HIV Infections epidemiology
- Abstract
Objectives: To assess the extent of nondisclosure of known HIV status among sexual health clinic attendees and to quantify the impact of nondisclosure on estimates of undiagnosed HIV prevalence and of the proportion of patients remaining undiagnosed on leaving the clinic., Methods: Serum samples from the unlinked anonymous survey of clinic attendees' archive were tested for antiretrovirals. Estimates of undiagnosed HIV were adjusted using the findings., Results: Antiretrovirals were detected in 27% of samples taken from 'previously undiagnosed' attendees, who did not have an HIV test but were HIV positive as detected by unlinked anonymous testing, indicating nondisclosure; 24% of such samples from MSM had antiretrovirals present compared with 32% of heterosexual men and women. Antiretrovirals were detected in 33% of samples from London clinics and in 21% from non-London clinics. Following adjustment, the estimated prevalence of undiagnosed HIV decreased nonsignificantly from 3.04% (95% confidence interval 2.71-3.41) to 2.66% (2.35-3.01) among men who have sex with men (MSM), 0.31% (0.26-0.37) to 0.30% (0.25-0.36) in heterosexual men and 0.40% (0.35-0.46) to 0.37% (0.32-0.43) in women; 7% of MSM who do not have an HIV test at a clinic visit will be infected with HIV and remain unaware of their infection., Conclusion: Nondisclosure of HIV status to healthcare professionals occurs among clinic attendees. Adjustment for nondisclosure results in a small, nonsignificant decrease in the prevalence of undiagnosed HIV estimated from the unlinked anonymous survey in sexual health clinics. Testing the population of MSM not having an HIV test remains a priority as levels of undiagnosed HIV are high.
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- 2016
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50. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial.
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McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, Sullivan AK, Clarke A, Reeves I, Schembri G, Mackie N, Bowman C, Lacey CJ, Apea V, Brady M, Fox J, Taylor S, Antonucci S, Khoo SH, Rooney J, Nardone A, Fisher M, McOwan A, Phillips AN, Johnson AM, Gazzard B, and Gill ON
- Subjects
- Adult, Bisexuality, Condoms statistics & numerical data, England, HIV Infections virology, HIV-1, Homosexuality, Male, Humans, Male, Pilot Projects, Treatment Outcome, Anti-HIV Agents therapeutic use, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination therapeutic use, HIV Infections prevention & control, Pre-Exposure Prophylaxis methods, Unsafe Sex
- Abstract
Background: Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect., Methods: PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex with men who had had anal intercourse without a condom in the previous 90 days. Participants were randomly assigned (1:1) to receive daily combined tenofovir disoproxil fumarate (245 mg) and emtricitabine (200 mg) either immediately or after a deferral period of 1 year. Randomisation was done via web-based access to a central computer-generated list with variable block sizes (stratified by clinical site). Follow-up was quarterly. The primary outcomes for the pilot phase were time to accrue 500 participants and retention; secondary outcomes included incident HIV infection during the deferral period, safety, adherence, and risk compensation. The trial is registered with ISRCTN (number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986)., Findings: We enrolled 544 participants (275 in the immediate group, 269 in the deferred group) between Nov 29, 2012, and April 30, 2014. Based on early evidence of effectiveness, the trial steering committee recommended on Oct 13, 2014, that all deferred participants be offered PrEP. Follow-up for HIV incidence was complete for 243 (94%) of 259 patient-years in the immediate group versus 222 (90%) of 245 patient-years in the deferred group. Three HIV infections occurred in the immediate group (1·2/100 person-years) versus 20 in the deferred group (9·0/100 person-years) despite 174 prescriptions of post-exposure prophylaxis in the deferred group (relative reduction 86%, 90% CI 64-96, p=0·0001; absolute difference 7·8/100 person-years, 90% CI 4·3-11·3). 13 men (90% CI 9-23) in a similar population would need access to 1 year of PrEP to avert one HIV infection. We recorded no serious adverse drug reactions; 28 adverse events, most commonly nausea, headache, and arthralgia, resulted in interruption of PrEp. We detected no difference in the occurrence of sexually transmitted infections, including rectal gonorrhoea and chlamydia, between groups, despite a suggestion of risk compensation among some PrEP recipients., Interpretation: In this high incidence population, daily tenofovir-emtricitabine conferred even higher protection against HIV than in placebo-controlled trials, refuting concerns that effectiveness would be less in a real-world setting. There was no evidence of an increase in other sexually transmitted infections. Our findings strongly support the addition of PrEP to the standard of prevention for men who have sex with men at risk of HIV infection., Funding: MRC Clinical Trials Unit at UCL, Public Health England, and Gilead Sciences., (Copyright © 2016 McCormack et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.)
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- 2016
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