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Background: Attaining a good quality of life (QOL) is a priority for people living with HIV (PLHIV). We explored the interaction between QOL and the associated demographic, behavioural and clinical factors for PLHIV attending an outer-metropolitan clinical setting in Western Sydney, Australia. The clinic's cohort of PLHIV is characterised by relatively high proportions of women, heterosexual men, and patients from culturally and linguistically diverse (CALD) communities. Methods: We assessed QOL using the PozQol tool that is specifically designed for PLHIV. QOL scores and de-identified socio-demographic and clinical data were extracted from the electronic and paper medical records of PLHIV who completed a PozQol tool (September 2020–March 2022). We performed descriptive analyses and logistic regression to identify associations. Results: Among 188 patients, there were 77.7% men, 21.3% women, 1.1% transwomen; 67.0% were born overseas, 85.1% spoke English, 84.4% were Medicare-eligible, 85.9% were employed, 58.5% were diagnosed with HIV 6–20 years ago, and 33.0% within the past 5 years. Overall, 58.0% had a high or very high QOL. A low score in any domain was associated with Medicare-ineligibility. Low QOL scores in specific domains were associated with the following factors: health (being born overseas, having partners of both sexes), psychological (unemployment, having a mental health condition, having a viral load >20 copies/mL), social (unemployment), and functional (Medicare-eligibility, unemployment, having a viral load >20 copies/mL). Conclusions: The PozQol tool has enhanced understanding of factors impacting on QOL for PLHIV attending our service in Western Sydney. Identifying patients with low QOL scores allows targeted clinical interventions to improve QOL, and re-alignment of clinical services to better support PLHIV. Quality of life (QOL) is an important priority for people living with HIV (PLHIV). Using a patient-reported outcome measure (PozQol tool), we found that 58% of PLHIV reported a high or very high QOL, and socio-demographic factors such as Medicare-ineligibility and unemployment were associated with lower QOL scores. PozQol may assist services by enhancing understanding of QOL among PLHIV, guide local and national policy, health service provision, and promote empowerment of individuals to better understand their own QOL. [ABSTRACT FROM AUTHOR]

The introduction of HIV pre-exposure prophylaxis (PrEP) has the potential to impact the attitudes gay and bisexual men (GBM) who consequently choose to take PrEP have towards treatment as prevention (TasP), and the extent to which they are willing to have condomless anal intercourse (CLAI) with an HIV-positive sexual partner who has an undetectable viral load (UVL). Using a cross-sectional sample from an observational cohort study conducted from August 2018 to March 2020, we examined the extent to which PrEP-experienced GBM are willing to have CLAI with a partner who has a UVL. Simple and multiple logistic regression models were used to identify associated variables. Of the 1386 participants included in the analyses, 79.0% believed in the effectiveness of TasP, and 55.3% were willing to have CLAI with a partner who has a UVL. Wiling participants were less worried about getting HIV when taking PrEP and more likely to believe in TasP. Further research is needed to better understand the gap between belief in TasP and willingness to have CLAI with a partner who has a UVL among PrEP-experienced GBM., (© 2023. The Author(s).)

Background: Most human immunodeficiency virus (HIV) seroconversions in people who have initiated preexposure prophylaxis (PrEP) occur in the context of insufficient adherence. We describe participants who seroconverted after being dispensed PrEP in a large PrEP implementation study in Australia., Methods: Expanded PrEP Implementation in Communities in New South Wales was an implementation study of daily oral PrEP in individuals aged ≥18 years at high risk for acquiring HIV. HIV seroconversions were defined as a positive HIV test by either antigen, antibody, or detectable HIV viral load after enrollment. Insufficient adherence, measured by dispensing logs or participant self-report, was defined as <4 PrEP doses per week., Results: A total of 9596 participants were enrolled and dispensed PrEP between 1 March 2016 and 30 April 2018; 30 were diagnosed with HIV by 31 March 2019. The median (interquartile range [IQR]) age was 31 (25-38) years, all identified as male, 29 (97%) identified as gay or homosexual, and 20 (69%) lived in a postcode with a low concentration of gay male residents. The median (IQR) days from first PrEP dispensing to diagnosis was 409 (347-656). There was no evidence that participants who seroconverted had been sufficiently adherent to PrEP. Nineteen (63%) participants who seroconverted were diagnosed with chlamydia, gonorrhoea, syphilis, or new hepatitis C infection. One participant had resistance to emtricitabine (M184V mutation) at diagnosis., Conclusions: Participants who seroconverted were insufficiently adherent to PrEP despite being at high risk for acquiring HIV. Understanding the reasons for poor PrEP adherence in individuals who subsequently acquire HIV is critical to improving PrEP effectiveness., Competing Interests: Potential conflicts of interest. N. J. D. has received research support through the Gilead Australia Fellowship for an unrelated project (paid to institution). A. C. has received research funding from Gilead Sciences, MSD, and ViiV Healthcare (paid to institution); consulting fees, lecture and travel sponsorships from Gilead Sciences, MSD. and ViiV Healthcare (paid to author); and has served on advisory boards for Gilead Sciences, MSD. and ViiV Healthcare (paid to author). I. Z. has received previous research support from Gilead Sciences for research unrelated to the current work and is a member of the Australian Nation PrEP Guideline Writing Group. P. R. has received research funding from Gilead Sciences, and honoraria for speaking from Gilead Sciences, MSD, and ViiV. B. B. reports grants from Gilead Sciences (Unrestricted research grant, 2021-22) and ViiV Healthcare (Unrestricted research grant, 2022-23), honorarium from Gilead Sciences (speakers fee, 2020), and support from ViiV Healthcare (Travel to Melbourne for meeting, 2022). A. E. G. reports royalties or licenses from ViiV, implementation research on injectable PrEP (paid to institution), support from ViiV for attending a meeting on injectable treatment (2022) and is a member of the Governing council of the International AIDS society. R. G. is an investigator on a project that receives funding from Gilead (unrelated to this project). J. H. is an executive member for the board at NSW Gender Centre inc. S. J. M. reports support from Gilead to attend local education evenings (does not include national or international meetings; unpaid participation, local restaurant dinner and talk). B. Y. reports support from Mylan Pty Ltd (travelled to Canberra, Australian Capital Territory to present EPIC-NSW study at a clinical care meeting at Canberra Hospital on 28 August 2019). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The use of preexposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) has raised concerns of increased sexual risk behaviors. These behaviors may be associated with increased incidence of sexually acquired hepatitis C virus (HCV) among gay and bisexual men., Methods: The Expanded PrEP Implementation in Communities-New South Wales (EPIC-NSW) study was a cohort study of daily coformulated tenofovir disoproxil fumarate and emtricitabine for HIV prevention. We recruited 9596 people at high risk of HIV acquisition from 31 clinics across New South Wales and the Australia Capital Territory in Australia. We report prior exposure to HCV and incidence in this cohort between 2016 and 2019., Results: At least 1 HCV test result was available for 8658 (90.2%) participants. These individuals had a median age of 34 years (interquartile range, 28-43), most of whom were male (8530, 98.5%), identified as gay (7944, 91.8%), and were born in Australia (51.8%). Prior exposure to HCV was detected among 81 participants at baseline (0.9%; 95% confidence interval [CI]: .71.2). Twenty of 8577 participants were diagnosed with incident infection (rate 0.2/100 person-years [95% CI: .1-.3/100 person-years]). They were significantly older (median age 41 years vs 34 years, P = .044), and more likely to report methamphetamine use at baseline (incidence rate ratio, 2.7 [95% CI: 1.00-7.2]) than those without incident infection., Conclusions: In this population of PrEP users, HCV prior exposure and incidence were low. With high levels of HCV and HIV testing and treatment, the dual goals of HIV and HCV elimination could be achieved in this population. Clinical Trials Registration: number NCT02870790., Competing Interests: Potential conflicts of interest. A. G. receives grant funding from Viiv for study of injectable preexposure prophylaxis and Seqirus for genital warts surveillance; membership of global forum on adult HPV from MSD; member of Governing Council 2020 from International AIDS Society; and in kind support for a trial of a gonorrhea vaccine (Bexsero vaccine) from GSK. B. B. receives unrestricted grant funding from ViiV and Gilead Sciences for studies unrelated to the submitted work, 2021–2022; travel honorarium in 2019 from Gilead Sciences; honorarium in 2020 from Gilead Sciences and honorarium in 2021 from Virology Education; and Board Director of HIV communication organization in NSW Australia from ACON Health. G. M, receives grant funding from Gilead Sciences and AbbVie and reports payment or honoraria from Janssen. N. D. received research support paid to her institution (UNSW Sydney) through a Gilead Australia Fellowship for an unrelated project. P. R. receives from funding from Gilead Sciences and personal speaker fees from Gilead Sciences and AbbVie. D. J. T. has received payment for providing expert reports for the NSW justice system on the significance of STIs in cases of suspected child sexual abuse. He has not received payment for expert testimony relevant to any aspect of this manuscript on PrEP more generally. D. A. B. reports trial funding from Viiv Healthcare and MSD; participation on an Advisory Board for Gilead Sciences and AbbVie; and a leadership or fiduciary role as an advisor to Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). No other investigators reported any other relevant funding or conflicts of interest., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)