Frequency of HIV Testing among Gay & Bisexual Men in the UK: Implications for HIV Prevention

OBJECTIVES:

The aim of the study was to explore HIV testing frequency among UK men who have sex with men (MSM) in order to direct intervention development.

METHODS:

Cross-sectional surveys were completed by 2409 MSM in Edinburgh, Glasgow and London in 2011 and a Scotland-wide online survey was carried out in 2012/13. The frequency of HIV testing in the last 2 years was measured.

RESULTS:

Overall, 21.2% of respondents reported at least four HIV tests and 33.7% reported two or three tests in the last 2 years, so we estimate that 54.9% test annually. Men reporting at least four HIV tests were younger and less likely to be surveyed in London. They were more likely to report higher numbers of sexual and anal intercourse partners, but not "higher risk" unprotected anal intercourse (UAI) with at least two partners, casual partners and/or unknown/discordant status partners in the previous 12 months. Only 26.7% (238 of 893) of men reporting higher risk UAI reported at least four tests. Among all testers (n = 2009), 56.7% tested as part of a regular sexual health check and 35.5% tested following a risk event. Differences were observed between surveys, and those testing in response to a risk event were more likely to report higher risk UAI.

CONCLUSIONS:

Guidelines recommend that all MSM test annually and those at "higher risk" test more frequently, but our findings suggest neither recommendation is being met. Additional efforts are required to increase testing frequency and harness the opportunities provided by biomedical HIV prevention. Regional, demographic and behavioural differences and variations in the risk profiles of testers suggest that it is unlikely that a "one size fits all" approach to increasing the frequency of testing will be successful.

Full article at:   http://goo.gl/7F0D3O

By:  McDaid LM1, Aghaizu A2, Frankis J3, Riddell J1, Nardone A2, Mercey D4, Johnson AM4, Hart GJ4, Flowers P3.

• 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
• 2Public Health England, London, UK.
• 3Glasgow Caledonian University, Glasgow, UK.
• 4University College London, London, UK. 
• HIV Med. 2016 Mar 15. doi: 10.1111/hiv.12373.

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Human Papillomavirus Prevalence and Herd Immunity after Introduction of Vaccination Program, Scotland, 2009–2013

Abstract

In 2008, a national human papillomavirus (HPV) immunization program using a bivalent vaccine against HPV types 16 and 18 was implemented in Scotland along with a national surveillance program designed to determine the longitudinal effects of vaccination on HPV infection at the population level. Each year during 2009–2013, the surveillance program conducted HPV testing on a proportion of liquid-based cytology samples from women undergoing their first cervical screening test for precancerous cervical disease. By linking vaccination, cervical screening, and HPV testing data, over the study period we found a decline in HPV types 16 and 18, significant decreases in HPV types 31, 33, and 45 (suggesting cross-protection), and a nonsignificant increase in HPV 51. In addition, among nonvaccinated women, HPV types 16 and 18 infections were significantly lower in 2013 than in 2009. Our results preliminarily indicate herd immunity and sustained effectiveness of the bivalent vaccine on virologic outcomes at the population level.

Below:  Figure. Analyses for 5,715 liquid-based cytology cervical samples from vaccinated and nonvaccinated women, for which valid human papillomavirus (HPV) testing results were available, Scotland, 2009–2013. A) Proportion and 95% CIs for samples with positive results for each HPV type. B) Difference in the proportion positive and associated 95% CIs for the difference between vaccinated and nonvaccinated women, by HPV type. Other than HPV types 16 and 18, the 95% CIs of the difference were corrected for multiple testing using by using the Bonferroni correction. *Significant change.

  

Full article at:  http://goo.gl/AW79p3

By:   Ross L. Cameron, Kimberley Kavanagh, Jiafeng Pan, John Love, Kate Cuschieri, Chris Robertson, Syed Ahmed, Timothy Palmer, and Kevin G.J. Pollock

Author affiliations: Health Protection Scotland, Glasgow, Scotland, UK (R.L. Cameron, J. Love, S. Ahmed, K.G.J. Pollock); University of Strathclyde, Glasgow (K. Kavanagh, J. Pan, C. Robertson); Scottish Human Papillomavirus Reference Laboratory, Edinburgh, Scotland, UK (K. Cuschieri); University of Edinburgh, Edinburgh (T. Palmer)

  

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Asymptomatic Lymphogranuloma Venereum in Men who Have Sex with Men, United Kingdom

Abstract

We investigated prevalence of lymphogranuloma venereum (LGV) among men who have sex with men who were tested for chlamydia at 12 clinics in the United Kingdom during 10 weeks in 2012. Of 713 men positive for Chlamydia trachomatis, 66 (9%) had LGV serovars; 15 (27%) of 55 for whom data were available were asymptomatic.

Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by the L1, L2, and L3 serovars of Chlamydia trachomatis (CT). An LGV outbreak among men who have sex with men (MSM) first reported in the Netherlands in 2003 has since spread across other industrialized countries (1). Cases are typically seen among white, HIV-positive MSM who report unprotected anal intercourse, other high-risk behaviors, and STI co-infection and who commonly have symptoms of proctitis (i.e., rectal pain, rectal discharge, bloody stools, constipation, and tenesmus) (2).

The United Kingdom now has the largest documented outbreak of LGV among MSM worldwide (3,4). Infection control in England has relied on CT DNA typing and treatment of symptomatic MSM who have CT-positive rectal infections and their contacts, as well as health promotion. These measures were supported by a large prospective study in the United Kingdom during 2006–2007 that reported <6% of LGV CT infections were asymptomatic (5). However, studies in the Netherlands and Germany, and a smaller UK study, have reported higher proportions (17%–53%) of asymptomatic infection (6–8). We reinvestigated the prevalence of asymptomatic LGV CT infection among MSM in the United Kingdom to assess whether it may be sustaining the current epidemic.

Below:  Figure. Data analysis flowchart for univariable and multivariable analyses of symptomatic lymphogranuloma venereum (LGV) versus non-LGV Chlamydia trachomatis (CT) infection (Table 1) and asymptomatic LGV versus non-LGV CTinfection (Table 2) in men who have sex with men, United Kingdom*Patients from Glasgow were excluded from risk factor analyses because they do not routinely report to the Genitourinary Medicine Clinic Activity Dataset.

Full article at:   http://goo.gl/NJEfPA

By:   Cara Saxon, Gwenda Hughes, Catherine Ison, and for the UK LGV Case-Finding Group

Author affiliations: Author affiliation: Public Health England, London, UK

  

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Mortality & Cause Of Death in a Cohort of People Who Had Ever Injected Drugs in Glasgow: 1982-2012

To describe all-cause and cause-specific mortality in a cohort of people who had ever injected drugs (PWID) with a low prevalence of HIV over 20-30 years.

Using a retrospective study design, identifying data from a cohort of PWID recruited between 1982 and 1993 through in-patient drug treatment services were linked to National Records for Scotland deaths data using probabilistic record linkage. We report all-cause and cause-specific mortality rates; standardized mortality ratios (SMR) across time, gender and age were estimated.

• Among 456 PWID, 139 (30.5%) died over 9024 person-years (PY) of follow-up. 
• Mortality within the cohort was almost nine times higher than the general population, and remained elevated across all age groups. 
• The greatest excess mortality rate was in the youngest age group, who were 15-24 years of age. 
• Drug-related deaths declined over time and mortality was significantly higher among HIV positive participants. 
• Although SMRs declined with follow-up, the SMR of the oldest age group (45-60) was 4.5. 
• There were no significant differences in all-cause mortality rates between participants who were 25 years and older at cohort entry compared to younger participants.

Mortality rates remained higher than the general population across all age groups. Screening services that identify a history of injecting drug use may be an opportunity to address risk factors faced by an ageing population of PWID and potentially have implications for future health care planning.

Via:  http://ht.ly/SJ3xG Purchase full article at:  http://ht.ly/SJ3zk 

By: Nambiar D1, Weir A2, Aspinall EJ2, Stoové M3, Hutchinson S2, Dietze P3, Waugh L4, Goldberg DJ2.

• 1Centre for Population Health, Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: dhanya@burnet.edu.au.
• 2School of Health and Life Sciences, Glasgow Caledonian University, Scotland, UK; Health Protection Scotland, Glasgow, UK.
• 3Centre for Population Health, Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
• 4Information Services Division, Glasgow, UK.

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