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This review critically appraises the major considerations associated with oral pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) within the Australian context, and suggests implications for future research. Daily oral PrEP, tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) has demonstrated efficacy in preventing human immunodeficiency virus (HIV) transmission in MSM with an estimated risk reduction between 44.0 - 86.7% and even up to 99%, with consistent daily adherence. However, uptake has been slow, driven by high costs, limited availability, poor acceptance, and low concept awareness. Implementation of PrEP will rely heavily on primary care providers, who are at the forefront of health care services, in identifying high-risk patients, providing education, assessing readiness, and prescribing antiretroviral medication. Clinician scepticism and reluctance to prescribe PrEP can significantly impair access to this effective preventative strategy. Future research is essential to inform the best strategies in developing programs to support PrEP uptake, utilisation, and adherence in Australia. This will require collaboration and coordination between community health organisations, the health sector, and the general public. Open label and implementation research modelling real world effects, is urgently needed to respond to this gap in knowledge and is pivotal in driving the introduction of this effective primary prevention modality in Australia. [ABSTRACT FROM AUTHOR]

Background: In May 2005, the Western Australian Department of Health (WA Health) developed a communication strategy to improve the awareness and appropriate use of non-occupational post-exposure prophylaxis (nPEP) in WA. The communication strategy included the development of an nPEP information pamphlet, the establishment of a 24 hour nPEP phone line and the distribution of the WA Health nPEP guidelines to health professionals. The communication strategy was aimed at gay men, people in sero-discordant relationships, people living with HIV, injecting drug users and health care providers with patients from these populations. This evaluation aimed to assess the awareness and appropriate use of nPEP in WA before and after the commencement of the nPEP communication strategy. Methods: A program logic method was used to identify the immediate (short-term) and ultimate (long-term) outcomes of the communication strategy. The achievement of these outcomes was evaluated using data from website statistics, a survey of 'sexuality sensitive' doctors, statistics published in Perth Gay Community Periodic Surveys (PGCPS) and data from the WA nPEP database. A χ2 test for trend was conducted to identify any significant changes in the ultimate outcome indicators pre- and post-strategy. Results: nPEP awareness among gay men in the PGCPS initially increased from 17.2% in 2002 to 54.9% in 2008, then decreased to 39.9% in 2010. After the commencement of the communication strategy, the proportion of nPEP prescriptions meeting the eligibility criteria for nPEP significantly increased (61.2% in 2002-2005 to 90.0% in 2008-2010 (p < .001)). The proportion of nPEP recipients who completed the prescribed course of nPEP (46.6% in 2002-2005 to 66.9% in 2008-2010 (p = .003)) and the proportion who received a post-nPEP HIV test three to four months after the first visit for nPEP (38.8% in 2002-2005 to 51.9% in 2008-2010 (p = .023)) also increased. Conclusions: Since the introduction of the nPEP communication strategy, the delivery and appropriate use of nPEP have significantly improved in WA. In the 2008-2010 period, an improvement in HIV testing of nPEP recipients at three month follow-up was reported for the first time in WA. However, there is a need for ongoing activities to raise nPEP awareness among gay men. [ABSTRACT FROM AUTHOR]

The latest guidelines from the American Heart Association (AHA) 2007, the Journal of the American Dental Association (JADA) 2008, the Australian Prevention of Endocarditis Guidelines 2008, the British Society for Antimicrobial Chemotherapy (BSAC) 2006, and the National Institute for Clinical Excellence (NICE) 2008 were reviewed for this article. As a result of recent literature reviews by the AHA and NICE committees, both groups made recommendations regarding antibiotic prophylaxis for dental treatment. While both agree that the benefit of prophylaxis for dental treatment is unproven, the NICE committee has recommended no antibiotic cover for any patients previously classified as 'at risk' of infective endocarditis (IE), while the AHA has recommended cover only for patients deemed to be at high risk of developing IE and with the poorest outcome in the event of IE development. The BSAC guidelines and the recently published Australian Therapeutic Guidelines on Prevention of Endocarditis 2008 fall broadly into line with the AHA guidelines. This paper will review all the separate guidelines and advocate a regimen for treating at-risk patients. [ABSTRACT FROM AUTHOR]

The use of MTX for GVHD prophylaxis may be associated with significant toxicity, including hepatotoxicity, graft failure and mucositis. Folinic acid may be involved in the amelioration of MTX toxicity. There is, however, no consensus regarding its use. A survey was conducted in Australian and New Zealand transplant centres (n=22) regarding the use of folinic acid following MTX in the transplant setting. Of 18 participating transplant centres, 12 (66%) used folinic acid following MTX—8 (44%) routinely and 4 (22%) only in the presence of significant mucositis. Those centres that did not use routine dosing of folinic acid post transplant chose not to do so on the grounds that they believed that it was not efficacious or may increase the risk of GVHD. Grading of mucositis was inconsistently done. There is wide variation in the use of folinic acid following HSCT. Folinic acid is infrequently used in the adult transplant setting or is used after mucositis is already apparent, practices that appear to run counter to available clinical evidence and to pharmacological data. Further research is required to conclusively determine whether folinic acid has any benefit in the post-BMT setting.Bone Marrow Transplantation (2008) 42, 547–550; doi:10.1038/bmt.2008.197; published online 14 July 2008 [ABSTRACT FROM AUTHOR]

This study compared the oral health status 600 6 16-yr-old young persons: 297 from Heidelberg, Victoria, Australia (an area of recent water fluoridation and a predominantly market place delivery system and 303 from Dunedin, New Zealand (an area with established water fluoridation and a long-standing school based public delivery system). A greater proportion of Heidelberg subjects, in each of three age groups, Were caries free. Level of dental plaque varied both with study area and with age group. Dundin subjects in the younger age groups had lower mean levels of plaque than their Heidelberg peers. The New Zealand dental service delivery System was consistently closer, in each age group, to meeting defined dental needs than the Australian system. The similarities and contrasts between this study and the WHO-IGS illustrate the importance for planners to consider carefully differences in local conditions which may affect service and morbidity projections. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the efficacy of oral nystatin when used as prophylaxis in cases of neonatal invasive fungal infections (IFI) during 1993-2006 in Australia and New Zealand. Data were gathered during 1993-2006, wherein some hospitals changed policies with respect to the use of oral nystatin. According to the study, among institutions that used oral nystatin prophylaxis and those that did not, the incidence of IFI per 100 babies were 0.54 and 1.23, respectively.

The maintenance of 172 patients who were treated and then attended a periodontal practice in Sydney, Australia for periods of at least 10 years has been surveyed. The results, expressed as loss of teeth over the maintenance period, have been compared with a 1978 study. Results of the two surveys have been compared for total tooth loss over the maintenance period, loss of individual tooth types, loss of teeth with furca lesions, and tooth loss relative to surgical experience. The comparative analysis is limited by the difference in total number of patients and by the duration of the studies. The proportionate division of patients into three groups according to tooth retention (well maintained, downhill, and extreme downhill) was statistically similar in both surveys. There were very few statistically valid differences in numbers of individual teeth lost between the two studies. Despite these comparable end results of long-term maintenance, the surgical experience was quite different, with the patients in our practice undergoing much more surgical treatment than those in the earlier report. The results appear to support the hypothesis that long-term maintenance is attainable for most periodontal patients, and is consistent with a variety of treatment approaches.