The demographic features and outcome indicators of the Barbados HIV Pre-exposure Prophylaxis Program, 2018-2019

Objective. To assess the demographics, risk profiles and outcome indicators of one of the few government-supported programs on pre-exposure prophylaxis (PrEP) in the English-speaking Caribbean. Methods. Chart review of all persons enrolled into the national PrEP Program from its inception on March 1st 2018 to November 30th 2019, with a descriptive summary analysis of the data extracted. Results. Of the 134 persons enrolled into the program most identified as men who have sex with men (67.9%), followed by men who have sex with men and women (14.9%); there were 20 persons, mostly men (85%), in sero-discordant relationships. PrEP uptake was 96%; however, the continuation rate (continuing for three consecutive months after initiation) was 61.5%. Continuation status for many could not be ascertained due to loss-to-follow-up. PrEP-associated toxicity prevalence was 2.3%, although side-effects occurred in 52% (mostly gastrointestinal). HIV positivity during the study period was 1.5%. Conclusions. Uptake of Barbados’ national PrEP Program is excellent but fairly low continuation rates and the HIV positivity rate indicate the need for improved pre-ART initiation education and follow-up processes. Service utilisation is mainly by men who have sex with men, and provision expansion to other civil society partners and private practitioners, as well as increased public awareness could increase access by other high-risk groups.

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Risk factors for loss to follow‐up among at‐risk HIV negative men who have sex with men participating in a research cohort with access to pre‐exposure prophylaxis in coastal Kenya

Journal of the International AIDS Society ◽

10.1002/jia2.25593 ◽

2020 ◽

Vol 23 (S6) ◽

Cited By ~ 1

Author(s):

Elizabeth W Wahome ◽

Susan M Graham ◽

Alexander N Thiong’o ◽

Khamisi Mohamed ◽

Tony Oduor ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Loss To Follow Up ◽

Coastal Kenya ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Hiv Negative

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Understanding and responding to COVID-19 in Wales: protocol for a privacy-protecting data platform for enhanced epidemiology and evaluation of interventions

BMJ Open ◽

10.1136/bmjopen-2020-043010 ◽

2020 ◽

Vol 10 (10) ◽

pp. e043010

Author(s):

Jane Lyons ◽

Ashley Akbari ◽

Fatemeh Torabi ◽

Gareth I Davies ◽

Laura North ◽

...

Keyword(s):

Policy Development ◽

Healthcare Utilisation ◽

Population Data ◽

Population Level ◽

Risk Groups ◽

Service Utilisation ◽

Natural Experiments ◽

Spread Of Infection ◽

The Impact

IntroductionThe emergence of the novel respiratory SARS-CoV-2 and subsequent COVID-19 pandemic have required rapid assimilation of population-level data to understand and control the spread of infection in the general and vulnerable populations. Rapid analyses are needed to inform policy development and target interventions to at-risk groups to prevent serious health outcomes. We aim to provide an accessible research platform to determine demographic, socioeconomic and clinical risk factors for infection, morbidity and mortality of COVID-19, to measure the impact of COVID-19 on healthcare utilisation and long-term health, and to enable the evaluation of natural experiments of policy interventions.Methods and analysisTwo privacy-protecting population-level cohorts have been created and derived from multisourced demographic and healthcare data. The C20 cohort consists of 3.2 million people in Wales on the 1 January 2020 with follow-up until 31 May 2020. The complete cohort dataset will be updated monthly with some individual datasets available daily. The C16 cohort consists of 3 million people in Wales on the 1 January 2016 with follow-up to 31 December 2019. C16 is designed as a counterfactual cohort to provide contextual comparative population data on disease, health service utilisation and mortality. Study outcomes will: (a) characterise the epidemiology of COVID-19, (b) assess socioeconomic and demographic influences on infection and outcomes, (c) measure the impact of COVID-19 on short -term and longer-term population outcomes and (d) undertake studies on the transmission and spatial spread of infection.Ethics and disseminationThe Secure Anonymised Information Linkage-independent Information Governance Review Panel has approved this study. The study findings will be presented to policy groups, public meetings, national and international conferences, and published in peer-reviewed journals.

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Loss to follow-up in a cohort of HIV-negative men who have sex with men: Project Horizonte

Revista de Saúde Pública ◽

10.1590/s1518-8787.2017051006681 ◽

2017 ◽

Vol 51 (0) ◽

Cited By ~ 1

Author(s):

Ana Paula Silva ◽

Marília Greco ◽

Maria Arlene Fausto ◽

Mariângela Carneiro

Keyword(s):

Loss To Follow Up ◽

Sex With Men ◽

Hiv Negative

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HIV and other STIs self-testing to reduce risk compensation among men who have sex with men who use oral pre-exposure prophylaxis in China: protocol for a randomised waitlist-controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-036231 ◽

2020 ◽

Vol 10 (7) ◽

pp. e036231

Author(s):

Jing Zhang ◽

Xiaojie Huang ◽

Yaokai Chen ◽

Hui Wang ◽

Yonghui Zhang ◽

...

Keyword(s):

Controlled Trial ◽

Sexual Partners ◽

Risk Compensation ◽

Standard Facility ◽

Self Testing ◽

Condomless Anal Intercourse ◽

Sex With Men ◽

Exposure Prophylaxis ◽

The Impact

IntroductionPre-exposure prophylaxis (PrEP) reduces the risk of HIV infection among men who have sex with men by up to 99%. However, in real-world settings, PrEP users may exhibit risk compensation after uptake of PrEP, including more condomless anal intercourse (CAI) and increased sexually transmitted infection (STI) acquisition. HIV self-testing (HIVST) decreases CAI among men who have sex with men (MSM) by providing awareness of the HIV status of oneself and one’s sexual partners. Here, we describe the rationale and design of a randomised waitlist-controlled trial to examine the impact of HIVST on risk compensation among PrEP users.Methods and analysisThe study is a two-arm randomised waitlist-controlled trial with 1000 HIV-negative MSM in four major cities in China who will be taking oral PrEP (involving tenofovir disoproxil fumarate/emtricitabine) either daily (n=500) or in an event-driven regimen (n=500). The participants will be randomised (1:1) to either the immediate HIVST intervention arm (HIVST plus standard facility-based counselling and testing from 0 to 12 months) or the waitlist arm (standard facility-based counselling and testing from 0 to 6 months, then crossover to receive the HIVST intervention in months 7–12). Participants will provide blood samples to assess the incidence of syphilis and herpes simplex virus type 2 (HSV-2) during a follow-up. The primary outcomes will be the occurrence of CAI, number of sexual partners and incidence of syphilis and HSV-2 during a follow-up. The secondary outcomes will be the HIV and STI testing frequency and STI treatment adherence during a follow-up. The planned start and end dates for the study is 26 December 2018 and 31 December 2020.Ethics and disseminationThe Medical Science Research Ethics Committee of The First Affiliated Hospital of China Medical University has approved the study (IRB(2018)273).Trial registration numberChiCTR1800020374

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Obesity Following Antiretroviral Therapy (ART) Initiation is Common and Influenced by Both Traditional and HIV-/ART-Specific Risk Factors

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.091 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S37-S38 ◽

Cited By ~ 3

Author(s):

David Bakal ◽

Lara Coelho ◽

Paula M Luz ◽

Jesse L Clark ◽

Raquel De Boni ◽

...

Keyword(s):

Risk Factors ◽

Regression Models ◽

Cox Regression ◽

Integrase Inhibitor ◽

Incidence Rates ◽

Loss To Follow Up ◽

Female Sex ◽

Art Initiation ◽

Specific Risk

Abstract Background Weight gain commonly occurs among HIV-infected (HIV+) adults initiating modern ART regimens, and obesity is increasingly reported in this population. However, data regarding specific risk factors for obesity development after ART initiation are conflicting. Methods We retrospectively analyzed data from a cohort of HIV+ adults who initiated ART between January 1, 2000 and December 31, 2015 in Rio de Janeiro, Brazil. Body mass index (BMI) was assessed at ART initiation. Participants who were non-obese (BMI < 30kg/m2) at baseline and had ≥90 days of ART exposure were followed for development of obesity. Participants were censored at the time of obesity diagnosis or at end of follow-up (defined as death, loss to follow-up, end of study period or 2 years after their last weight measurement). Incidence rates were estimated using Poisson regression models and risk factor assessment was calculated using Cox regression models accounting for death and loss to follow-up as competing risks. Results Participants (n = 1,794) were 61.3% male, 48.3% white and had a median age of 36.3 years. At ART initiation, participants had a median BMI of 22.6kg/m2 and BMI category distribution was: underweight 14%, normal weight 56%, overweight 22% and obese 8%. Of the 1,567 non-obese participants followed after ART initiation, 76% gained weight, 44% increased their BMI category and 18% developed obesity. Median BMI at the end of follow-up was 24.7kg/m2 (0.4kg/m2 median annual change), the obesity incidence rate was 37.4 per 1000 person-years and the median time to obesity diagnosis was 1.9 years (vs. 4.7 years of follow-up for participants remaining non-obese). Factors associated with obesity after ART initiation included younger age at ART initiation, female sex, higher baseline BMI, lower baseline CD4+ T lymphocyte count, higher baseline HIV-1 RNA, having an integrase inhibitor as the most-used ART core drug and having diagnoses of hypertension and diabetes mellitus (Figure). Conclusion Obesity following ART initiation is frequent among HIV+ adults, with rates increasing in recent years. Both traditional (female sex) and HIV-specific (more advanced HIV disease, integrase inhibitor use) risk factors contribute importantly to obesity incidence following ART initiation. Disclosures All authors: No reported disclosures.

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The first 30 months of the MindSpot Clinic: Evaluation of a national e-mental health service against project objectives

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867416671598 ◽

2016 ◽

Vol 51 (12) ◽

pp. 1227-1239 ◽

Cited By ~ 52

Author(s):

Nickolai Titov ◽

Blake F Dear ◽

Lauren G Staples ◽

James Bennett-Levy ◽

Britt Klein ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Public Awareness ◽

Treatment Options ◽

Service Utilisation ◽

Clinical Effects ◽

Post Traumatic Stress ◽

Project Objectives

Objective: The MindSpot Clinic provides online mental health services to Australian adults with anxiety and depression. This paper describes users of MindSpot between January 2013 and June 2015. Outcomes are considered against three key objectives: improving access to mental health services, improving public awareness of how to access services and providing evidence-based treatments. Method: Website traffic data were examined to determine patterns of use. Demographic characteristics, past service utilisation and reasons for contacting MindSpot were analysed. Outcomes for patients enrolled in a MindSpot treatment course were also analysed. Primary outcomes were scores on the 9-Item Patient Health Questionnaire, Generalised Anxiety Disorder 7-Item, Yale–Brown Obsessive Compulsive Scale and Post-Traumatic Stress Disorder Checklist–Civilian Version, administered at assessment, post-treatment and 3-month follow-up. Results: The website was visited by almost 500,000 Australians, of which 33,990 adults started assessments, and 25,469 people completed assessment and were eligible for analysis. Mean age was 36.4 years (standard deviation = 13.3 years; range = 18–94 years), and 72% were female. The proportion living in rural or remote regions and who identified as Aboriginal and Torres Strait Islander closely matched national statistics. The majority (82%) reported that they were not currently in contact with mental health services. Most patients sought an assessment, information about treatment options, or referral to another service, and only 24% of those completing an assessment commenced a MindSpot treatment course. Of these, large clinical effects ( d: 0.7–2.4; average symptom reductions: 25.5% to 61.6%) were found from assessment to follow-up on all outcome measures. Deterioration ranged from 1.0% to 4.3%. Conclusion: Based on the number of website visits, completed assessments and treatment outcomes, MindSpot achieved its three programme objectives. This model of service provision has considerable value as a complement to existing services, and is proving particularly important for improving access for people not using existing services.

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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

BMJ Open ◽

10.1136/bmjopen-2019-031085 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031085 ◽

Cited By ~ 1

Author(s):

Ada Miltz ◽

Fiona Lampe ◽

Sheena McCormack ◽

David Dunn ◽

Ellen White ◽

...

Keyword(s):

Depressive Symptoms ◽

Sexual Identity ◽

Psychosocial Factors ◽

University Education ◽

Link Type ◽

Prevalence Of Depression ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Time Point

ObjectivesThe 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.MethodsPROUD 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 χ2tests) and between trial arms (using χ2tests). 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).ResultsDepression 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.ConclusionsThere is a high concomitant burden of psychosocial factors with depression among GBMSM.Trial registration numberISRCTN (ISRCTN94465371) and ClinicalTrials.gov (NCT02065986).

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Audit of patient retention in pre-exposure prophylaxis (PrEP) services in an integrated sexual reproductive health service setting

International Journal of STD & AIDS ◽

10.1177/0956462419879618 ◽

2019 ◽

Vol 30 (14) ◽

pp. 1432-1435

Author(s):

Eleanor Cochrane ◽

Carys Knapper

Keyword(s):

Reproductive Health ◽

Health Service ◽

Perceived Risk ◽

Reproductive Health Service ◽

Health Board ◽

Sexual Reproductive Health ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Lost To Follow Up

Pre-exposure prophylaxis (PrEP) for HIV in Wales was launched in July 2017. We set up a PrEP service delivered via our integrated sexual reproductive health service in Aneurin Bevan University Health Board (ABUHB), south east Wales. Public Health Wales (PHW) data show a 22% ‘lost to follow-up’ rate amongst Welsh PrEP patients. Over 18 months, 278 patients booked into ABUHB PrEP clinics. Of these, 275 were men who have sex with men (MSM). One hundred and ninety-three patients commenced PrEP, 5 were diagnosed with HIV at baseline, 42 did not attend their first appointment. The remainder declined PrEP. Of those commenced on PrEP, 51.7% had reduced clinic attendances; all were MSM. Patients with reduced attendances were more likely to be younger (mean age 33 vs. 37 years), reside outside ABUHB catchment area (56.4% vs. 49.6%) and have mental health issues (28.6% vs. 18.8%), but were less likely to disclose substance misuse (24.2% vs. 27.1%) than those attending in line with operational guidance. Of the 63 patients who stopped attending the PrEP clinic, 32.3% (21) had documented reasons, the most common being reduced self-perceived risk. This is the first evaluation of reasons why patients stop attending as well as risk factors associated with those lost to follow-up in PrEP services in Wales.

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