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Background: It is estimated that approximately half of new HIV diagnoses among heterosexual migrants in Victoria, Australia, were acquired post-migration. We investigated the characteristics of phylogenetic clusters in notified cases of HIV among heterosexual migrants., Methods: Partial HIV pol sequences obtained from routine clinical genotype tests were linked to Victorian HIV notifications with the following exposures listed on the notification form: heterosexual sexual contact, injecting drug use, bisexual sexual contact, male-to male sexual contact or heterosexual sexual contact in combination with injecting drug use, unknown exposure. Those with heterosexual sexual contact as the only exposure were the focus of this study, with the other exposures included to better understand transmission networks. Additional reference sequences were extracted from the Los Alamos database. Maximum likelihood methods were used to infer the phylogeny and the robustness of the resulting tree was assessed using bootstrap analysis. Phylogenetic clusters were defined on the basis of bootstrap and genetic distance., Results: HIV pol sequences were available for 332 of 445 HIV notifications attributed to only heterosexual sexual contact in Victoria from 2005-2014. Forty-three phylogenetic clusters containing at least one heterosexual migrant were detected, 30 (70%) of which were pairs. The characteristics of these phylogenetic clusters varied considerably by cluster size. Pairs were more likely to be composed of people living with HIV from a single country of birth (p = 0.032). Larger clusters (n≥3) were more likely to contain people born in Australian/New Zealand (p = 0.002), migrants from more than one country of birth (p = 0.013) and viral subtype-B, the most common subtype in Australia (p = 0.006). Pairs were significantly more likely to contain females (p = 0.037) and less likely to include HIV diagnoses with male-to-male sexual contact reported as a possible exposure (p<0.001) compared to larger clusters (n≥3)., Conclusion: Migrants appear to be at elevated risk of HIV acquisition, in part due to intimate relationships between migrants from the same country of origin, and in part due to risks associated with the broader Australian HIV epidemic. However, there was no evidence of large transmission clusters driven by heterosexual transmission between migrants. A multipronged approach to prevention of HIV among migrants is warranted., Competing Interests: MH and MS has received investigator initiated funding from Gilead Sciences, AbbVie and Bristol Myers Squibb for research unrelated to this work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: The integration of maternal and child health services (MCH) with routine immunization is an important global health strategy, particularly in low- and middle-income countries (LMICs). However, evidence is lacking regarding the best practices for service integration and the effect of integration on immunization and linked health service outcomes. Methods: We searched publication databases and gray literature for articles published between 2011 and 2020 that include approaches to integrating MCH services with immunizations during the first two years of life in LMICs. Abstracts and full-text articles were screened for eligibility. For the included articles, data extraction and analysis examined the descriptive characteristics of studies, outcomes, and implementation considerations. Results: Among the 16,578 articles screened, 44 met the criteria for inclusion, representing 34 studies, of which 29 were from Africa. The commonly linked MCH services were family planning (24%), human immunodeficiency virus (HIV) diagnosis or care (21%), and malaria prevention or control (21%). Multiple integration strategies were typically used; the co-location of linked services (65%), the provision of extra services by immunization staff (41%), and/or the provision of extra information by immunization staff (41%) were the most common. In general, integration improved MCH service outcomes (76%) and was either beneficial (55%) or neutral for immunization (35%), with some examples in family planning, malaria, and HIV where integrated services were not beneficial. Important implementation considerations included the careful matching of target populations in service re-design, ensuring support from policy, logistics, and information systems, the provision of adequate training and support of staff to avoid overload, clear client communication regarding service integration, and the need to address community concerns. Conclusions: Integrating MCH services with routine immunization can expand linked services and improve immunization coverage. This study has identified key implementation considerations relevant to both childhood and adult vaccination programs. More research is needed regarding costs and client preferences. [ABSTRACT FROM AUTHOR]

Background Following a HIV outbreak among Aboriginal people in a culturally diverse inner-city suburb of Melbourne, a blood-borne virus (BBV) screening program was conducted to inform public health interventions to prevent transmission and facilitate timely diagnosis and linkage to care.Methods: In August-September 2014, community health workers recruited people who inject drugs (PWID) from a local needle and syringe program. Participants were tested for hepatitis C virus (HCV), hepatitis B virus (HBV), HIV and syphilis and completed a bio-behavioural questionnaire.Results: In total, 128 PWID participated in the study. Serological evidence of exposure to HCV and HBV was detected among 118 (93%) and 57 participants (45%) respectively. Five participants were HIV positive. Independent risk factors for needle sharing were Aboriginality (AOR=6.21, P<0.001), attending health care for mental health problems (AOR=2.79, P=0.023) and inability to access drug treatment in the previous 6 months (AOR=4.34, P=0.023).Conclusions: BBV prevalence in this sample was much higher than reported in other recent Australian studies. This local population is at high risk of further BBV transmission, particularly Aboriginal PWID. Individual and service-related factors associated with risk in the context of a dynamic urban drug culture and HIV outbreak suggest an urgent need for tailored harm-reduction measures. [ABSTRACT FROM AUTHOR]