“Facilitating HIV status adjustment: Qualitative insights from the Tambua Mapema proof-of-concept study in Kenya”

Systematic efforts are needed to prepare persons newly diagnosed with acute or chronic HIV infection to cope. We examined how patients dealt with this news, looking at how readiness to accept an HIV diagnosis impacted treatment outcomes, prevention of transmission, and HIV status disclosure. We examined vulnerability and agency over time and considered implications for policy and practice. A qualitative sub-study was embedded in the Tambua Mapema (“Discover Early”) Plus (TMP) study (NCT03508908), conducted in coastal Kenya between 2017 and 2020, which was a stepped wedge trial to evaluate an opt-out HIV-1 nucleic acid testing intervention diagnosing acute and chronic HIV infections. Diagnosed participants were offered antiretroviral therapy (ART), viral load monitoring, HIV partner notification services, and provision of pre-exposure prophylaxis (PrEP) to their uninfected partners. Data were analyzed using thematic approaches. Participants included 24 individuals who completed interviews at four time points (2 weeks and 3, 6, and 9 months after diagnosis), including 18 patients (11 women and 7 men) and 6 partners (1 woman, 5 men, of whom 4 men started PrEP). Acceptance of HIV status was often a long, individualized, and complex process, whereby participants’ coping strategies affected day-to-day issues and health over time. Relationship status strongly impacted coping. In some instances, couples supported each other, but in others, couples separated. Four main themes impacted participants’ sense of agency: acceptance of diagnosis and commitment to ART; positive feedback after attaining viral load suppression; recognition of partner supportive role and focus on sustained healthcare support whereby religious meaning was often key to successful transition. To support patients with acute or newly diagnosed chronic HIV, healthcare and social systems must be more responsive to the needs of the individual, while also improving quality of care, strengthening continuity of care across facilities, and promoting community support.

Intensified partner notification and repeat testing can improve the effectiveness of screening in reducing Chlamydia trachomatis prevalence: a mathematical modelling study

BackgroundThe Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a cluster randomised controlled trial designed to assess the effectiveness of annual chlamydia testing through general practice in Australia. The trial showed that testing rates increased among sexually active men and women aged 16–29 years, but after 3 years the estimated chlamydia prevalence did not differ between intervention and control communities. We developed a mathematical model to estimate the potential longer-term impact of chlamydia testing on prevalence in the general population.MethodsWe developed an individual-based model to simulate the transmission of Chlamydia trachomatis in a heterosexual population, calibrated to ACCEPt data. A proportion of the modelled population were tested for chlamydia and treated annually at coverage achieved in the control and intervention arms of ACCEPt. We estimated the reduction in chlamydia prevalence achieved by increasing retesting and by treating the partners of infected individuals up to 9 years after introduction of the intervention.ResultsIncreasing the testing coverage in the general Australian heterosexual population to the level achieved in the ACCEPt intervention arm resulted in reduction in the population-level prevalence of chlamydia from 4.6% to 2.7% in those aged 16–29 years old after 10 years (a relative reduction of 41%). The prevalence reduces to 2.2% if the proportion retested within 4 months of treatment is doubled from the rate achieved in the ACCEPt intervention arm (a relative reduction of 52%), and to 1.9% if the partner treatment rate is increased from 30%, as assumed in the base case, to 50% (a relative reduction of 59%).ConclusionA reduction in C. trachomatis prevalence could be achieved if the level of testing as observed in the ACCEPt intervention arm can be maintained at a population level. More substantial reductions can be achieved with intensified case management comprising retesting of those treated and treatment of partners of infected individuals.

Sexual health

This chapter covers problems that can occur with sexual health in women. It starts with the definition, assessment, diagnosis, investigations, and treatment of different sorts of vaginal discharge. It provides information about sexual health in context, including its links with other forms of disease and psychological well-being. Protocols for partner notification in the cases of diagnosis with a sexually transmitted disease are explained. The signs, symptoms, and treatment for gonorrhea, chlamydia, and Mycoplasma genitalium are all covered. It also covers the definition, causes, diagnosis, and treatment of pelvic inflammatory disease. Hepatitis B and C are described, along with anogenital warts, genital herpes, and genital lumps and ulcers. Finally HIV and new developments such as PrEP and PEP are covered.

Partner Notification Services (PNS) Among HIV Positive Key Populations: An Important Strategy Towards Achieving UNAIDS 95.95.95 Goals by the Year 2030

Key Populations are the major drivers of the HIV epidemic in most settings; thus, identifying positive KPs and their sexual partners becomes a strong strategy in the effort to achieve the first UNAID 95 goal. This study describes the level of acceptability and outcome of PNS among HIV-positive KPs using the various approaches for PNS. A descriptive study of all HIV positives KPs initiating ART in 7 One-Stop-Shop facilities that accepted PNS was conducted over 3 months. With the consent of patients who accepted PNS, their partners were reached using any of the PNS approaches. Partners who consented for HTS were tested, and positives partners were linked to ART services. Data were analyzed to describe the acceptability and outcome of PNS among KPs. Only 846/2,486 (34%) positive KPs accepted PNS. The 846 KPs elicited 941 partners, out of which 938 (99.6%) accepted HTS. 421/938 (45%) of the partners tested positive compared to PWIDF (15%), MSM (7%), FSW (4%) and PWIDM (4%). 129/421 (31%) of the positive partners were already known positives, with 61% already on ART. The commonest method of PNS accepted among KPs was the passive method (54%), followed by the contract method (22%), provider-initiated (19%), and dual method (5%). There was poor acceptance of PNS among KPs and, the HIV positivity rate was much higher among their partners than any of the KPs sub-groups. The passive approach was the most preferred method of PNS among KPs. This should be considered strongly as we scale up PNS in Nigeria. Keywords: HIV/AIDS, Key Populations in Nigeria, Partner notification services, UNAIDS 95-95-95 targets.

Exploring risky practices, Opioid Substitute Therapy (OST) and disease transmission among prison inmates in India - A cross-sectional study

Background: Prison, a setting where high-risk persons including substance-use offenders are being convicted. They sometimes continue their risky behaviours which pose a risk to themselves, other prisoners and to the community. A cross-sectional study was conducted in ten correctional homes (CHs) in West Bengal to identify the substance use, sexual and hygiene practices among prison inmates inside correctional homes. Methods: In-depth interviews were conducted with 15 key informants posted inside prisons using an interview guide. Data were analysed using MS Excel 2019. Chi-Square tests were performed to ascertain the associations between variables.Results: This study confirmed the availability and use of substances within prisons, and homosexual as well as drug-injecting practices of inmates. According to key informants, many CH inmates have had infections such as contact dermatitis, scabies, UTIs, STIs, tuberculosis, HIV, and hepatitis B and C. Limited preventive and curative services such as healthy diet, isolation and treatment for HIV and TB were provided to infected inmates. The treatment completion rate in inmates who availed OST at CHs was 96.53%, while the re-addiction rate after released from prison was 98.07%. The routine screening for STIs and hepatitis, distribution of condom and needles, and treatment for hepatitis were absent in most CHs. The CHs lack mechanisms to ensure continuous drug supply, regular follow-up and treatment completion after incarceration, partner notification, hepatitis treatment, and health promotions.Conclusions: The improvements in infrastructure and uninterrupted health care delivery system can improve health outcomes of affected inmates and break the transmission to other inmates and general community.

Integrating partner notification and contact tracing services across Europe: findings from the Integrate project

Background Partner notification/contact tracing (PN/CT) is a process whereby people diagnosed with an infectious disease notify their sexual and needle-sharing partners/close contacts and invite them for testing and treatment due to exposure to the disease. PN is a necessary testing and prevention tool supported by the European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO). Traditionally, PN efforts have been siloed within disease areas, with separate pathways and systems responsible for specific diseases. The INTEGRATE project sought to improve PN/CT outcomes by sharing knowledge across diseases and countries. Methods INTEGRATE used two mapping exercises to assess the PN landscape in Europe and identify areas for integration and cross-learnings for Sexually Transmitted Infections (STIs) and Tuberculosis. Mapping exercises were surveys to 29 consortium partners and in-depth qualitative interviews at four selected pilot sites: Ireland, Greece, Romania and Italy. Results Areas for the improvement of PN/CT emerged: lack of resources and insufficient staff training, different modes of disease transmission, country-specific laws and regulations, the advent of General Data Protection Regulation (GDPR), differences in healthcare system pathways, historical concerns, and cultural differences. Activities highlighted key areas PN/CT outcomes could be improved, including PN/CT specific trainings for staff, improving knowledge on laws, regulations, guidelines and pathways and creating a country/region specific Standard Operating Procedures (SOPs) for PN/CT, incorporating information on all four disease areas. Findings were analyzed and three key areas were identified and implemented for knowledge transfer namely the creation of an online repository of European country guidelines, the transfer of SOPs and PN training in pilot sites. Conclusion A major finding of the project was challenges associated with incorporating Tuberculosis (TB) contact tracing alongside other infectious diseases. Professionals in the field, emphasized that integrating TB contact tracing with the other disease areas would be challenging and arguably unjustified, due to the different ways of transmission of TB and because well-established historical pathways for TB in public health systems already exist. However, the success of TB services presents an ideal model to draw from when strengthening PN systems for other infectious diseases.

Estimating the effects of accelerated partner therapy (APT) on reinfection of index cases with chlamydia: a mathematical modelling study

Objectives The expected effects of accelerated partner therapy (APT) on the reinfection of treated index cases by untreated partners with Chlamydia trachomatis (chlamydia) remain unclear. We analyzed data from the LUSTRUM cluster cross-over randomised controlled trial (RCT) using a mathematical model and quantified the effects of offering APT on the probability of successful partner treatment. Methods We extended a previously developed mathematical model to compute the probability of chlamydia reinfection of index cases by their untreated partners with chlamydia. We fitted the model to data from the RCT and estimated the probability of successful treatment of the partner of index cases using a Bayesian framework. Results We estimated the median probability of reinfection with chlamydia at 16.3% (50% credible interval, CrI: 12.7-20.0%) without partner treatment and 2.3% (50% CrI: 1.7-3.6%) when partner treatment is 100% successful. The observed rates of reinfection in the RCT were 6.7% (95% confidence interval, CI: 5.6-8.0%) during the control period (standard partner notification (PN)) and 4.8% (95% CI: 3.7-5.9%) during the intervention period where APT was offered in addition to standard PN. These rates correspond to a median probability of successful partner treatment of 63% (50% CrI: 47-76%) during the control period and 78% (50% CrI: 65-87%) during the intervention period. Conclusions Our study suggests that the observed reduction in reinfection with chlamydia when offering APT is consistent with a higher probability of successful partner treatment.