2015 Participant Summaries

2018 Participant Summaries

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Study:

Patterns of sexual behaviour and sexual healthcare needs among transgender individuals in Melbourne, Australia, 2011-2014

Researchers:

Bellhouse C, Walker S, Fairley CK, Vodstrcil LA, Bradshaw CS, Chen MY, Chow EPF

Publication:

Sexually Transmitted Infections 2018; 94(3): 212-215 doi: 10.1136/sextrans-2016-052710

Summary: 
There is little Information about the healthcare needs of transgender individuals in Australia. This study looked at risk behaviours and HIV/STI positivity among transgender individuals attending Melbourne Sexual Health Centre (MSHC), between 2011 and 2014. The majority of transgender individuals were single or never married. Almost half of the individuals had at some time engaged in sex work during their lifetime. Chlamydia was seen in 7%; gonorrhoea and syphilis in 5%, and HIV in 1%. Transgender individuals were found to have low numbers of sexual partners, and regular condom use was reported to be low. A majority of individuals were using hormones for transition, and around one-fifth had undergone any type of reassignment surgery.


Study:

Associations between oral sex practices and frequent mouthwash use in men who have sex with men: implications for gonorrhoea prevention

Researchers:

Tiffany Phillips A,C, Christopher K. Fairley A,B, Sandra Walker A and Eric P. F. Chow A,B

Publication:

Sexual Health 2018; doi.org/10.1071/SH18131

Summary:

Rates of gonorrhoea continue to rise among men who have sex with men (MSM) in Australia. Oropharyngeal gonorrhoea may play a role in the spread of gonorrhoea. Mouthwash use may be an effective way to prevent the spread of gonorrhoea. This study looked at the use and frequency of using mouthwash in relation to tongue kissing, receptive fellatio with or without ejaculation, and insertive rimming among MSM by a questionnaire. Of the 918 MSM included in the final analysis, 490 men (53.4%) used mouthwash frequently either daily or weekly. The most common oral sex practice was tongue kissing, followed by receptive fellatio without ejaculation, receptive fellatio with ejaculation, then insertive rimming. Younger MSM were less likely to use mouthwash and not all MSM who engaged in oral sex practices used mouthwash frequently.



Study:

Protocol for an HIV Pre-exposure Prophylaxis (PrEP) Population Level Intervention Study in Victoria Australia: The PrEPX Study

Researchers:

Ryan K, Mak A, Stoove M, Price B, Fairley CK, Ruth S, Lal L, Asselin J, El-Hayek C, Nguyen L, Batrouney C, Wilson D, Lockwood J, Murphy D, Cornelisse VJ, Roth N, Willcox J, Chang CC, Armishaw J, Tee BK, Penn M, Forgan-Smith G, Williams C, Montgomery J, Byron K, Coelho A, Allen B, Wiggins J, Kelsall J, Vujovic O, West M, Pierce AB, Gallant D, Bell C, de Wit JBF, Hoy JF, Wesselingh SL, Grant RM and Wright EJ.


Publication:

Frontiers in Public Health 2018; 6 (151), doi.org/10.3389/fpubh.2018.00151

Summary:

Pre-exposure prophylaxis (PrEP) is the use of HIV anti-retroviral therapy to prevent the spread of HIV to people at high risk of getting HIV. PrEP is highly effective when taken either daily, or in an on-demand schedule. In Australia co-formulated tenofovir-emtricitabine is registered for daily use for PrEP, however, this co-formulation is not listed yet on the national subsidized medicines list. We describe a study protocol that aims to demonstrate giving PrEP to some 3800 individuals at risk of HIV in Victoria will reduce HIV locally by 25% generally and 30% among men who have sex with men. Generic PrEP will be delivered to 3800 individuals for up to 36 months. Participants will attend study clinics, shared care clinics, or outreach clinics for quarterly HIV/STI screening, biannual renal function tests and other clinical care as required. At each study visit participants will be invited to complete behavioral surveys and sexual risk data. This study will collect evidence on the real world impact of delivery of PrEP to 3800 individuals at risk of acquiring HIV in Victoria. This study will provide important information for the broader implementation of PrEP planning upon listing of the tenofovir-emtricitabine on the national subsidized list of medicines.


Study:

Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation

Researchers:

Read TRH, Fairley CK, Murray GL, Jensen JS, Danielewski J, Worthington K, Doyle M, Mokany E, Tan L, Chow EPF, Garland SM, Bradshaw CS

Publication:

Clinical Infectious Diseases 2018; doi.org/10.1093/cid/ciy477

Summary:

New approaches to treating Mycoplasma genitalium are needed because of rising multi resistance to antibiotics. In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. All patients with positive M. genitalium tests were also tested for resistant M. genitalium to azithromycin and other antibiotics. After doxycycline treatment, those patients who had no resistant M. genitalium to azithromycin were given azithromycin (1 g, then 500 mg daily for 3 days). The patients with resistant M. genitalium were given sitafloxacin (100 mg twice daily for 7 days). Test of cure and reinfection occurred 14–90 days after the second antibiotic. This study showed that >92% of anogenital M. genitalium infections could be cured in a population where resistance to azithromycin-like antibiotics is common. The increased dose of azithromycin was well tolerated.



Study:

Evaluation of PrEP eligibility criteria using sexually transmissible infections as HIV risk markers at baseline in PrEPX, a large Australian HIV pre-exposure prophylaxis trial


Researchers:

Cornelisse VJ, Fairley CK, Stoove M, Asselin J, Chow EPF, Price B, Roth NJ, Willcox J, Tee BK, Penn M, Chang CC, Armishaw J, Forgan-Smith G, Wright EJ.

Publication:

Clinical Infectious Diseases 2018; 67(12):1847-1852

doi: 10.1093/cid/ciy370

Summary:

The Australian preexposure prophylaxis (PreEPX) trial used 6 pointers to estimate risk of HIV to participants. We included 1774 participants, of whom 10% tested positive for STIs. These pointers included having an HIV-positive regular partner with a detectable viral load, having condomless anal intercourse with casual partners, having previously been diagnosed with an STI, and using methamphetamines. Syphilis and anorectal STIs are known markers of potential HIV risk. These results suggest that using these PrEPX 6 pointers accurately selected participants at high risk of HIV. Participants who were enrolled without any of the 6 pointers were found to have syphilis and anorectal STIs at enrollment (7.1%), suggesting that they were at substantial risk of HIV. These findings highlight that a person who requests PrEP is likely to be at risk of HIV and supports the recommendation that clinicians should have the discretion to prescribe PrEP for individuals who do not meet formal eligibility criteria, as is permitted by the 2017 Australian PrEP guidelines



Study:

Molecular test for chlamydia and gonorrhoea used at point-of-care in remote primary health care settings: a diagnostic test evaluation

Researchers:

Causer L, Guy R, Tabrizi S, Whiley D, Speers D, Ward J, Tangey A, Badman S, Hengel B, Natoli L, Anderson D, Wand H, Wilson D, Regan D, Shephard M, Donovan B, Fairley CK, Kaldor JM

Publication:

SexTransm Infection 2018; 94:340-345, doi:10.1136/sextrans-2017-053443

Summary:

A new molecular onsite at clinic test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) (GeneXpert CT/NG) has been demonstrated to be as accurate as in use laboratory based nucleic acid amplification tests (NAAT). Performance has not been evaluated in routine primary care, performed at the point of care by clinicians. At 12 health services, training was provided to 99 clinicians in the use of the assay who tested specimens from all patients undergoing STI screening. Specimens were also sent in parallel for in use laboratory-based NAATs and the results were compared. Clinicians conducted 2486 tests: CT comparison was 99.4% NG comparison was 99.9%.  In this first study reporting routine point-of-care use of GeneXpert CT/NG by primary care clinicians, we found excellent results when compared to in use laboratory NAATs. The use of the GeneXpert CT/ NG at the point of care could potentially transform management and control of these infections in many endemic settings, including low/middle-income countries



Study:

Incorporating digital ano-rectal examinations for anal cancer screening into routine HIV care for men who have sex with men living with HIV: a prospective cohort study

Researchers:

Ong JJ, Walker S, Grulich A, Hoy J, Read T, Bradshaw C, Chen M, Garland S, Hillman R, Templeton D, Hocking J, Eu B, Tee BK, Chow EPF, Fairley CK

Publication:

Journal of International AIDS Society 2018; 21:c25192
doi: org/10.1002/jia2.25192

Summary:

Men who have sex with men (MSM) living with HIV have a high risk of anal cancer, which is often detected at late stages. Using digital anorectal examination in routine HIV care for MSM living with HIV, from the perspective of patients, physicians and the health service was evaluated. In 2014, we recruited 327 MSM over the age of 35 years living with HIV in Melbourne, Australia. Men were followed up for two years and digital anorectal examination was recommended at first visit, year 1 and year 2. Data were collected regarding patient and physician experience, and health service use. Of 862 examinations performed, 33 (3.8%) examinations resulted in a referral to a colorectal surgeon. One Stage 1 anal cancer was detected. Including an early anal cancer detection programme into routine HIV clinical care for MSM living with HIV showed high patient acceptability, uncommon adverse outcomes and specialist referral patterns similar to other cancer screening programmes.


Study:

Non-consensual condom removal in a sexually transmitted infection clinic population

Researchers:

Latimer RL, Read TRH, Vodstrcil LA, Fairley CK, Cornelisse VJ, Chow EPF, Bradshaw CS

Publication:

PLOS ONE 2018;13(12): e0209779. doi:10.1371/journal.pone.0209779

Summary:

Non-consensual removal of condoms, colloquially referred to as ‘stealthing’, is the removal of a condom during sex by a sexual partner when consent has only been given for sex with a condom. We conducted a cross-sectional survey to determine how commonly women and men who have sex with men (MSM) attending Melbourne Sexual Health Centre had experienced stealthing. Thirty-two percent of women and 19% of MSM reported having ever experienced stealthing. Women who had been stealthed were more likely to be a current sex worker. MSM who had experienced stealthing were more likely to report anxiety or depression. Both female and male participants who had experienced stealthing were three times less likely to consider it to be sexual assault than participants who had not experienced stealthing. A high proportion of women and MSM attending a sexual health service reported having experienced stealthing.


Study:

The frequency of kissing as part of sexual activity differs depending on how men meet their male casual sexual partners.

Researchers:

Cornelisse VJ, Priest D, Fairley CK, Walker S, Bradshaw CS, Phillips T, Chow EPF

Publication:

International Journal of STD & AIDS 2018, 29(6): 598 - 602 doi: 10.1177/0956462417748717

Summary:

This was a questionnaire-based study of men who have sex with men (MSM) attending Melbourne Sexual Health Centre, Australia, between March and September 2015. We measured differences in kissing practices among MSM who use different methods to find male casual sexual partners. We surveyed 753 MSM around the age of 29 years. Most of the men (80%) had used apps in the last 3 months to find casual sex partners. Users of apps had a higher number of casual sex partners than non-users and also kissed more casual partners than non-users. We are also investigating whether kissing is an important way of spreading gonorrhoea infection.


Study:

Risk factors for oropharyngeal gonorrhoea in men who have sex with men: an age-matched case–control study

Researchers:

Vincent J Cornelisse, Sandra Walker, Tiffany Phillips, Jane S Hocking, Catriona S Bradshaw, David A Lewis, Garrett Paul Prestage, Andrew E Grulich, Christopher K Fairley, Eric P F Chow

Publication:

Sex Transm Infect Published Online First: 22 January 2018 2018 doi: 10.1136/sextrans-2017-053381

Summary:

In 2015, we compared MSM of similar age who attended the Melbourne Sexual Health Centre and had either tested positive or negative for throat gonorrhoea. We looked at which oral sex practices were important risk factors for spreading throat gonorrhoea including tongue kissing, receptive oro-penile sex (fellatio) or insertive oro-anal sex (rimming), and whether the use of mouthwash every day and recent antibiotics would protect against getting infection. The highest risk factor for gonorrhoea throat infection was the number of casual sex partners. Throat gonorrhoea was not associated with insertive oro-anal sex or mouthwash use. The finding that throat gonorrhoea was associated with a higher number of sexual partners but not specific sexual practices highlights the need for further research in the area of how gonorrhoea is transmitted.


Study:

Evaluation of the implementation of a new nurse-led express ‘Test-And-Go’ HIV/STI testing service for men who have with men at a sexual health centre in Melbourne, Australia

Researchers:

Chow EPF, Fortune R, Dobinson S, Wakefield T, Read TRH, Chen MY, Bradshaw CS, Fehler G, Fairley CK

Publication:

Sexually Transmitted Diseases 2018, 45 (6): 429-433

Summary:

In August 2015, a new by appointment nurse-led express HIV/STI testing service “Test-And-Go” (TAG) for asymptomatic men who have sex with men (MSM) was introduced at Melbourne Sexual Health Centre in response to the increase in demand for services. We compared asymptomatic MSM who attended the TAG service to MSM who attended the clinic and received the standard walk-in consultation service. Consultation and waiting times for both services were calculated. The average waiting time for the TAG service (8 minutes) was 45 minutes less than the routine walk-in service (53 minutes). The consultation time in the TAG service (9 minutes) was less than the routine walk-in service (18 minutes). The TAG service required less waiting and consultation time and created additional clinical capacity at the general clinic to see clients at higher risk.


 


Study:

Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: tolerability, acceptability and impact on the genital microbiota of couples

Researchers:

Plummer EL, Vodstrcil LA, Danielewski JA, Murray GL, Fairley CK, Garland SM, Hocking JS, Tabrizi SN, Bradshaw CS

Publication:

PLOS ONE 2018, 13(1): e0190199 doi:10.1371/journal.pone.0190199

Summary:

We report that treatment of the male partner of women with bacterial vaginosis (BV) is acceptable and treatment was tolerable. Current treatments for BV are associated with unacceptably high recurrence rates. We observed low recurrence of BV in a group of women with a past history of BV who were having unprotected sex with a regular partner following treatment and treatment of their partner. This study supports the need for larger studies with longer follow up to assess the impact on BV recurrence.



Study:
Associations between anorectal chlamydia and oro-anal sex or saliva use as a lubricant for anal sex: A cross-sectional survey

Researchers: 
Cornelisse V, Fairley CK, Read TRH, Lee D, Walker S, Hocking JS, Chen MY, Bradshaw CS, Chow EPF

Publication:
Sexually Transmitted Diseases January 2018 doi: 10.1097/OLQ.0000000000000800

Summary:
Questions on receptive rimming, receptive fingering or penis “dipping”, and the use of a partner’s saliva as anal lubricant were completed by men who have sex with men (MSM) who were tested for anorectal chlamydia. The use of a partner’s saliva during receptive anal sex practices such as rimming, fingering or penis dipping were weak risk factors for getting anorectal chlamydia in MSM. This is different to our previously reported findings that the use of saliva as anal lubricant is more strongly associated with anorectal gonorrhoea



Study:
‘It Opened My Eyes’ – examining the impact of a multifaceted chlamydia testing intervention on general practitioners using Normalization Process Theory

Researchers:
Yeung A, Hocking J, Guy R, Fairley CK, Smith K, Vaisey A, Donovan B, Imrie J, Gunn J, Temple-Smith M

Publication:
Family Practice March 2018 doi:10.1093/fampra/cmy011

Summary:
Chlamydia is the most common notifiable sexually transmissible infection in Australia. Left untreated, it can develop into pelvic inflammatory disease and infertility. The majority of notifications come from general practice and it is ideally situated to test young Australians. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a multifaceted intervention that aimed to reduce chlamydia prevalence by increasing testing in 16- to 29-year-olds attending general practice. GPs were interviewed to describe the effectiveness of the ACCEPt intervention in integrating chlamydia testing into routine practice using Normalization Process Theory (NPT). The theory has four elements: understanding of the intervention by clinic staff, commitment and engagement to the intervention, work carried out to make the intervention function and evaluation of the intervention. GPs were purposively selected based on age, gender, geographic location and size of practice at baseline and midpoint. Interview data were analysed regarding the intervention components and results were interpreted using NPT. A total of 44 GPs at baseline and 24 at midpoint were interviewed. Most GPs reported offering a test based on age at midpoint versus offering a test based on symptoms or patient request at baseline. Quarterly feedback was the most significant ACCEPt component for facilitating a chlamydia test. The ACCEPt intervention has been able to moderately normalize chlamydia testing among GPs, although the components had varying levels of effectiveness. NPT can demonstrate the effective implementation of an intervention in general practice and has been valuable in understanding which components are essential and which components can be improved upon.