ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

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Presented by Dr Ayden Scheim, Division of Global Public Health, University of California, San Diego, USA 

Overview

1.       Trans populations are incredibly diverse

2.       Trans women disproportionately impacted by HIV globally

3.       A “global” picture obscures context & knowledge gaps

4.       Trans people face multi-level HIV /STI vulnerabilities and protective factors

5.       We must make trans people visible in HIV & sexual health

6.       A trans sexual health agenda is needed

Trans populations are diverse

Trans and gender diverse identities

-          Trans women/ trans feminine & trans men / trans masculine

-          Non- binary

-          Two Spirit

-          Sistergirl/ Brotherboy

0.6 % of US adults (~ 1 in 160) are trans gender compared 1.2 % of NZ high school students

Gender Identity

Non Binary people counted 35 %, while 33 % of Transgender women and 29 % of Transgender men with the least proportion is Crossdressers, only 3 %

Medical Transition (hormones and / or surgeries)

Almost a quarter already had completed transition and next quarter is still in process. Other half include; Planning but not begun, not planning to and not sure group as well as concept does not apply group

Ø  Trans women face a disproportionate HIV burden globally

-          Based on paper from Baral et al, Lancet Infectious Disease 2013, the pool HIV prevalence was 19.1 % in 11066 transgender women worldwide.

Trans men

Qualitative data is very limited and Lab confirmed HIV + varies from 0 - 4 % while self reported presented from 0 – 10 %

Choosing the right denominator

-          2/3 of trans men identify as gay, bi, queer but only 1/3 of those had sex with cis men

Trans MSM seem a lot like other MSM; however countervailing risk & protective factors shown as below are unavoidable

-          Sexual abuse, stimulant use, depression, syndemics predict risk behaviour

-          But are distinct in consequential ways

-          Exclusion from gay communities

-          Less anal intercourse

-          Changes to genital mucosa

Therefore, Trans people are not MSM….. except for when they are

-          Include trans MSM alongside other MSM

-          Who will be accountable to trans women ?

Summary

A trans sexual health agenda based in access to gender affirming care including hormones and surgery, reproductive care, HIV / STI prevention, screening and treatment in a context of gender recognition and rights protection

Background

·         Gay and bisexual men’s sexual practices have evolved throughout the HIV Epidemic

·         Protective strategies (e.g. condoms) have often been community led/ generated

·         Every technological innovation in HIV testing, treatment and prevention has prompted shifts in practice

·         Australian GBM’s practices have been monitored by the Gay Community Periodic Surveys since 1996

·         What follows is a review of trends in selected practices since 2000

( national;unadjusted;7 states / territories, > 6000 participants per year; only NSW & VIC in 2017 )

Findings

Overall, partner numbers have declined over time, except in 2016 – 2017

Majority of men in relationship have condomless sex with their regular partners. This became more common after 2010 which is around 60 % in 2017 

Regarding HIV status, 30- 40 % of HIV Negative partners with similar status while both partners positive observed just under 10 %

HIV negative relationship more common after 2010

Condom use was primary prevention strategy, with casual partners and Anal sex has become gradually more common with casual partners.

 

 

Risk reducing strategies frequently used during condomless sex with casual partners

-          HIV positive men who had CAIC  ( Condomless Anal Intercourse ); 2011 – 2017 counted Undectable viral load 80 % whose partners are on PrEP around 40 %

-          HIV Negative men who had CAIC represented around 50 % whose partners on PrEP approx. 40 %

 

Summary

·         Up until recently, Gay / Bi men were reporting fewer male sex partners over time

·         Since 2000, condomless sex has become more common

-          First emphasising serosorting ( matching HIV status )

-          Now harnessing PrEP and treatment as prevention

·         In the last 5 years,

-          HIV positive men have switched from serosorting to undetectable viral load as their primary strategy during condomless sex with casual partners

-          HIV negative men have rapidly embraced PrEP and many continue to serosort

·         The vast majority of GBM continue to minimise HIV transmission risk, using an increased range of strategies

 

The speakers presented a range of sessions around PrEP uptake and use in Gay and MSM.

Most use has been in the well connected, educated, white clients.  Why are some gay and bisexual men eligible for PrEP but not taking it suggested that many see others at more risk than themselves.  The flux cohort research suggested that there is increasing use of Meth and Viagra, adding Truvada into the mix for HIV protection, MTV. 

Other risk reduction strategies include serosorting, strategic positioning and negotiating safety.  A lot of PrEP users have decreased or stopped using condoms but there is an increasing awareness of the importance of undetectable viral loads.  The final session discussed the lack of Indigenous health promotion material and lack of uptake/knowledge of, in this priority group. 

If they were using it was probably in those "well integrated with the main stream MSM communities". Big positives for prep were that it is promoting disclosure and discussion with the Gay MSM community.

 

Posted by on in Public Health and Prevention

Presenters:  Dr Llloyd Einsiedel, Shane Schinke, Professor Damian Purcell, Dr Genoveffa Franchini, Professor Graham Taylor, Dr Fabiola Martin

 

A truly amazing and well rounded session on a disease which has been around since the 1980’s.  Although it’s endemic to many parts of the world, including a high prevalence area in Central Australia, causing high burdens of morbidity with progressive and irreversible neurologic, pulmonary, inflammatory and immune diseases, there are no targeted therapies and it is not widely known in Australian health sectors.

 

All the speakers had considerable knowledge in identification, treatment and research of HTLV-1.  We were truly fortunate to hear from Shane Schinke, a long serving remote area nurse, who shared his own story of HTLV-1 associated HAMS/TSP which currently has him wheelchair bound. 

 

Key Points:

·      Endemic in central Australia (HTLV-1c subtype), and many tropical regions of the world

·      Causes adult T-cell lymphoma, pulmonary, neurological changes

·      If suspecting: Diagnose with a Western blot and request HTLV-1 pro viral load

 

·      More awareness and research is vital

Continuing the theme of acknowledging our own societal disadvantages and the urgent need for equity, the Sexual Health Opening Plenary featured Professor Christopher Fairley discussing his own encouraging and inclusive professional ethos. 

Key Point:  ‘Be nice, but not soft’

 

 

Next, Professor Gracelyn Smallwood from Central Queensland University, an Indigenous clinical nurse, midwife, activist, world traveller and ceaseless advocate shared her story.  I can’t be the only one there who wished she was my ‘Auntie Grace’, as she unravelled the burden of history currently contributing to growing inequity in our Indigenous, regional and remote communities. 

Key Points:

·      The disproportionate health burdens existing in ATSI communities are a result of societal breakdown

·      Equity will not be achieved until social determinants of health – employment, education, housing – are addressed collaboratively at a policy level, informed by grass roots knowledge

 

·      We must reconcile with historical truth

 

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ASHM CONFERENCE 2017

Undetectable Viral Load Prevents HIV Transmission in Male Serodiscordant Couples in Australia, Thailand and Brazil.

Benjamin Bavington

Monday 6th

One of the first presentations in the 2017 ASHM conference was the talk that was initially given to the Paris IAS conference in July this year on the final outcomes of the Opposites Attract Study.  This research was unique as its focus was on HIV transmission in HIV discordant male gay couples.  This study showed no linked transmissions between discordant couples where the positive partner had an undetectable viral load.  The researchers took phylogenic ‘finger-prints’ of the positive partners virus at the beginning of the study so if the other person became positive they could determine if it was the same virus.  To be included on the research the gay couple had to attend at least twice per year, the positive person had a viral load, STI check and questionnaire, while the negative partner had an HIV test and STI check plus the questionnaire. The following is just a glimpse of the statistics from the research

·         343 couple were followed

·         2 international sites (Thailand and Brazil), 13 Australian sites for recruitment

·         ~40% in the first year of the relationship – historically there is a larger potential for transmission in this first year compared with longer term relationships

·         75% of the pos people were on ART for the entire study, 25% commenced during the course of the study

·         Of all the positive participants on ART -  75% were fully suppressed, this was due to numbers from the Thai cohort skewing the figures – the Australian cohort had much greater numbers of positive participants being fully suppressed.

·         At the beginning of the study only 7% of negative men were on prep – this grew to 30 % by the end of the research

·         35% of the participants had a STI during the research period

·         In the Australian cohort ~68% reported condomless anal intercourse (CAI) at the beginning of the study and 88.9% by the end. 

·         There were 3 partners who became positive through the project – none of these infections were linked to the positive partner.  All 3 people reported CAI outside of the regular relationship

The conclusion was that with the partner having an undetectable VL there were no linked transmissions.  It is not clear how the role of STI plays in this cohort with regard to transmission of HIV.

Annual Surveillance Report 2017

Key points from the HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2017

  • Gonorrhoea and syphilis are increasing while HIV is stable for the fifth year in a row.
  • the biggest increases in gonorrhoea rates are in young, urban heterosexuals
  • The HIV notification rate is rising in Aboriginal and Torres Strait Islander people while decreasing in the non-indigenous Australian born population. 
  • Asian born MSM were disproportionately diagnosed with HIV in 2016
  • Over 30 000 people were cured of hepatitis C last year
  • 63% of people living with chronic hepatitis B in Australia were diagnosed in 2016. Only 17% were receiving care and 7% were receiving treatment.
  • Rates of STIs in the Aboriginal and Torres Strait Islander population compared to non-indigenous populations: gonorrhoea (7 times as high), infectious syphilis (5 times as high) and chlamydia (3 times as high)
  • The number of newly diagnosed hepatitis B cases has halved in Aboriginal and Torres Strait Islander people over the past five years but has remained stable in non-indigenous populations

Dr Anna McNulty is the Conjoint Associate Professor for the School of Public Health and Community Medicine, the University of NSW as well as the Director of Sydney Sexual Health Centre and NSW Sexual Health Info link.

DR A. McNulty spoke about the HIV Dried Spot test which is an internet-based self -sampling test. Participants actually test themselves. The beauty of this test is that it increases access to HIV testing and fits in well with NSW HIV 96Normal 0 false false false EN-GB X-NONE X-NONE elimination Strategy for 2016-2020.The strategy targets the Men having sex with Men and culturally and linguistically diverse background as high priority populations.They are difficult to come forward

The spot test is advertised on print, digital and print media, especially on dating websites. Participants then register on line and their kits are sent via the post. The instructions are simple and an additional lancet is added in case the first one is spoiled. The participants will send back the kit to the laboratory where the test is done. The results are provided by a nurse via the phone or SMS.

Those that are positive are linked to care.

The Self-collecting method attracted people who have never tested before or those who rarely tested to test in the comfort of their own homes. The young, gay and homosexually active men are in this bracket. it was noted that there was an increase in access to CALD participants especially women.

The disadvantage of this method is that sexual behaviours will be under-reported. 

 

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This afternoon we had an opportunity to listen to Ms. Barbara Telfer, an Epidemiologist for HIV support program Health protection in NSW.

 She spoke passionately about  NSW goals to Virtually eliminate HIV transmission by 2020. Increase in HIV testing, diagnosis and early treatment irrespective of the CD4 count are the tools used to drive this goal home.The aim is to start treatment at least six months of diagnosis, follow them up to ascertain initiation of ART, retention in care and monitoring of CD4 count and viral load.

The surveillance started in 2013 and is ongoing and information required from participants was the year of diagnosis, demographics, language spoken at home, risk exposure, past testing history, cd4 count, and HIV viral load at diagnosis.

Statistics between 2013-2015 showed a general increase in HIV early ART initiation which is a positive change in clinical practice. The results were not impressive enough that there is need to reduce time to ART and increase early ART to the newly diagnosed especially CALD and residence in metro Sydney. Participants with a high CD4 count and or low Viral load or those lost in follow up post-diagnosis were top of the priority list.

It will be good to achieve this goal by 2020, were HIV infection will be a thing of the past.

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Posted by on in Workforce Development

Presenter – Joanne Leamy

Joanne led an enthusiastic presentation about the implementation of a large scale screening program in Far North QLD which adopted a peer education model to encourage STI and BBV screening among young people.

The scale of the project appeared somewhat daunting at the start. Fortunately, with much energy, and a strategy which put local communities at the centre, a significant improvement in testing rates has been achieved.  Aspects of the project included:

  • Screening in 10 remote communities and 2 towns in Far North QLD, targeted at young people.
  • Traditional owner groups were included in consultations.
  • Adequate staffing and ongoing staff training gave the project a real chance of success.
  • Peers were recruited with the help of local employment agencies and given basic STI training. They received wages for their work. All peers were residents in the communities.
  • Focus on workplace culture. It was acknowledged that working as a peer was not always easy. Support for peers was built in.
  • An understanding of attrition. Young people may change priorities, and new peers may need to be recruited.
  • Appropriate ‘branding’ of the screening drive in order to have cultural integrity.
  • Incentives, e.g. daily prizes such as footy jumpers.
  • Well planned outreach with adequate equipment.
  • Continuous quality improvement was included. While the reaction to feedback by clinilinic staff was not always initially enthusiastic, it has been an important factor in developing the program.

The program led to a clear increase in screening rates across the area, rising from 24% in 2013 to 53% in 2017. Interestingly, syphilis rates were not found to be as high as expected (10%). As an example of resources required, at one of the sites which had a target population of 130 to 170 15-29 year olds, 7 staff members were present for 4 days of testing.

Joanne acknowledged that without the peer workers providing targeted messages, hope, and support, the project was unlikely to have been as successful. An example of their contribution included being able to bring local language to the testing setting. The presentation demonstrated that improved access can be achieved with a lot of energy and the right mix of resources.

 

 

EPIC-NSW  commenced in March 2016 and provides free access to prep for high-risk people at 27 sites in NSW.

The question posed in this presentation is: are EPIC-NSW  participants representative of people at high-risk of HIV?  

A comparison was made of participants against data of HIV notifications in New South Wales. For age groups (young men were slightly underrepresented), areas of residence, and Aboriginal and/or Torres Strait Islander the enrolment data was closely aligned to HIV notification data.

However for region of birth, NE and SE Asia born men were underrepresented, 2.5x and 2.4x lower respectively. In response, ACON developed specific initiatives to engage with men from NE and SE Asia using culturally appropriate engagement initiatives such as resources in 6 languages eg posters at train stations. In response, in the 3rd quarter 2017 there has been an increase in enrolments from men born in NE Asia of 103% and SE Asia of 83%.

The comment was made by the presenter that there Is more work to be done.  

However it was very interesting to see how close EPIC-NSW participants demographics correlated to HIV notification data.

 

 

Presenter - Ms Danielle Collins, Nurse Practitioner Candidate, Alfred Health

Danielle walked the audience through some of the important considerations and challenges involved in establishing nurse led models of care. Her presentation highlighted the need for rigorous step by step planning, which requires organizational commitment and solid partnerships.

Danielle used two Victorian practice examples to draw attention to these key messages, one being a nurse led rural clinic focused on HIV prevention and the other a combined medical/nursing model aimed at increasing client participation in HIV care in a metropolitan hospital.

A brief summary of the ongoing evolution of nursing roles was given, with an acknowledgement that with planning, nurses are well placed to provide various aspects of care which can improve HIV prevention and treatment, particularly with the slow but steady breakdown of barriers to advancing scope of practice.

The rural example involved the roll out of PREP to a regional area via the establishment of a monthly nurse led clinic within an existing health service in Bendigo. The visiting Nurse Practitioner Candidate is supported in her role by access to an ‘on call’ physician, and the sexual health nursing staff at the clinic.

The metropolitan project began from an understanding that many people living with HIV were presenting to tertiary hospitals with issues that were not directly HIV related. Management of these issues could have been potentially coordinated through an advanced nursing role. A specialist HIV nurse role was established, where the practitioner offers a health assessment and follow up for patients who have multiday admissions.

 Danielle noted a number of important points in relation to the planning and set up of these services.

  • Organizational support was key to achieving a workable model.
  • Funding can be difficult. Projects need a solid business case behind them. In a bulk billing setting financial modeling which takes into account slow clinic times must be factored in. Projects need to be viable if they are to be sustained.
  • Scope of practice also needs to be carefully thought out, with planning for all contingencies. Ask ‘what if?. Recognise the limits of practice as well as opportunities for autonomy. 
  • Collaboration is vital, particularly when moving into community settings. Projects need to be wanted by the client group and supported by the community. Find local leaders.

 

Danielle’s presentation demonstrated that the journey to innovation requires the enthusiasm of many players, sustained effort, and business acumen. It was also an optimistic take on the future contribution of nursing in the area of HIV related chronic illness management.

 

 

As people living with HIV age, the risk of  polypharmacy due to comorbidities rises. This presentation discussed whether medication review  by experienced HIV pharmacists would assist GPs to manage the complexities of drug interactions, adverse affects and adherence issues of ART and other co-medications.

PROM-GP study  is an ongoing nonrandomised prospective open study of 100 patients recruited from February 2016 to August 2016. The criteria was that patients had to have one or more of the following: be above 50 years old, on five or more medications including ARVs, have adherence issues or a recent hospital admission. A single 20 to 30 minute pharmacist/patient consultation occurred in the GP clinic. A report outlining medication related problems (MRP) and recommendations was provided to the GP. About 10% were reviewed by a panel. There was a follow-up at 3 to 4 months to assess whether the MRPs were resolved.

Results: 542 MRPs identified; 262 high/mod risk and 280 low risk. At 3-4 months 159 high/mod risk resolved and 162 low risk resolved. MRPs were varied with drug interactions, monitoring, education, toxicity, undertreated and compliance being the most common issues cited.

Panel review of 15 randomly selected patients (89 MRPs). Panel agreed with or even rated higher 73% of MRPs. 

Summary: PROM-GP study identified 2 mod/high risk MRPs and 3 low risk MRPs per patient.  62% of high moderate risk MRPs were resolved at 3 to 4 months. 

 Patients were very satisfied with the service.

The speaker commented that pharmacists love answering questions so encourage patients to ask away!

 

 

 

Innovative Models of Nursing Care and the Role of Advance Nursing Practice


Congratuations to all presenters on these inspiring sessions. The diversity demonstrated in these different models of care showed the adaption of nursing into various work settings.  

Leah showed us how being innovative in the way things are done can not only continue to achieve positive outcomes for clients living with HIV but also achieved the desired activity performance markers required by health departments.

Elizabeth reminded us that nurses are the linchpin in the treatment cascade encouraging us to act with a focus on justice, politics and collaborative leadership.

Danielle encouraged us to use creative thinking in our clinical delivery, to analyse the gaps, engage local partners and the local community and have a well defined scope of practice with appropriate governance.  

Joanne showed us how peer educators and community screens have achieved some substantial outcomes in the management of STI's in the Cape York.

Penny works across several jurisdictions to provided comprehensive SRH care to diverse communities in North Queensland. 

Bridget demonstrated the diverse role that nurses play in models of care to individuals with Hepatitis C from community settings, nurse led clinics to community care.

Karen has shown that even with a successful model of care for HIV positive pregnant women, consideration to adaptions in service delivery needs to be factored.  This has been successfully achieved by providing education to rural areas with supporting materials, sharing of CPG'S and shared cared models.

 

 

 

 

HIV Dried Blood Spot test:  Internet based self-sampling increased access to HIV testing

Anna McNulty

 

The HIV dried blood spot test is available for individuals living in NSW who are over the age of 16 yrs.  It provides another option for individuals to access HIV testing.  This test is provided free (health dollar cost $12) it is designed to be mailed out, with full instructions in the kit, it is performed in the individuals own time and posted back.  The average turn around time of returning a sample was 18 days.  Test results were given by text if negative and a phone call if positive. At this time it has resulted in 2 positive results that may not otherwise have been diagnosed. This provides a great option to those that face barriers to screening and has been used by some individuals as a means of ongoing screening.  It demonstrates the convenience of testing, the ability to remain anonymous and resulted in the screening of a diverse group of individuals.

https://www.hivtest.health.nsw.gov.au/The-Test

 

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Prof Damian Purcell from the Peter Doherty Institute in Melbourne presented some exciting research in this morning’s Late Breaker session looking at novel HIV latency reversing agents in the pursuit of an HIV cure.  We have heard previously about the ‘shock and kill’ approach to HIV cure, where latently infected cells are stimulated to produce new virus production with the aim of inducing cell death without activation. There have been several clinical trials using a variety of latency reversing agents (LRAs) including the histone deactylase inhibitors (HDACi) vorinostat and romidepsin. However, although these drugs were able to stimulate HIV transcription, they did not reduce the pool of latently infected cells. In addition, these drugs are non-specific and have an effect on all cells, even those uninfected.

 

Damian spoke of a model developed by his laboratory to target latently infected cells with full-length provirus containing the viral protein Tat. Using a cell line model with various reporters, his team was able to screen a library of drug-like compounds to assess latency reversal that is specific to Tat-containing (i.e. HIV-infected) cells. Multiple ‘hits’ were obtained from the screen, and narrowed down to 1 potential compound that was tested using CD4+ T-cells obtained from virally suppressed patients.  This compound was classed as an amidothiazole and was shown to increase unspliced HIV-RNA in patient-derived CD4+ T-cells ex vivo. It is thought to exert its latency reversing activity through interaction with the methyltranferase complex. This compound was also found to synergise with another class of LRA known as bromodomain inhibitors.

 

Identification of this this novel compound is exciting as it provides another step towards finding the ideal LRA that could be targeted towards latently infected cells while minimizing effects on uninfected cells. However, there is still further research required to see its efficacy in reversing latency – an important step would be to identify whether this compound actually stimulates production of functional virus (rather than just unspliced RNA). Further research into its safety profile would also be necessary.  

In the session on ‘Initiation, testing and diagnosis’, Dr Mark Bloch spoke of a new device that could be used for rapid HIV self-testing. The concept of rapid HIV testing has been around for some time, however it is not yet readily available in Australia. Mark spoke of the many benefits self testing could provide: possibly increasing uptake of testing and thus diagnosis – particularly for those in hard to reach communities (there is predicted 10% undiagnosed people living with HIV in Australia), as well as increased convenience, confidentiality and sense of autonomy. Of course it is not without risk – the potential for inaccurate results, ethical risks, and potential psychological danger in the event of a positive result in an environment without clinicians readily available to answer questions.

 

Mark’s study looked at the usability and performance of a new device – Atomo Galileo HIV self-test. In 521 individuals, concordance of the self-test was assessed with the conventional laboratory testing, and usability was assessed by assessing accurate performance of 6 critical steps. In this study, concordance of the self-test with lab testing was essentially 100% (99.8% - the 1 discrepancy was attributed to a false positive from the lab test). There was high usability scores demonstrated by close to 90% of all individuals performing all 6 critical steps.

 

The device itself looked simple and intuitive. It was not too dissimilar from a glucometer or a pregnancy test – with a lancet to prick the finger and chamber to collect blood (in the same device). A single band appeared in the event of a positive result alongside a control band. The test reportedly takes approximately 15 minutes to obtain a result.

 

This device has potential for use in difficult to access communities and resource limited settings, and removes additional barriers to testing and diagnosis. It remains to be seen what impact HIV self-testing will have in engagement with clinics and whether this would impact adherence to regular screening guidelines for other STIs.

 

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Mark directs us to his website ‘HIVST.org’ for further information on HIV self-testing.

Self- Testing in HIV has been a controversial topic, and from my experience with HIV in Timor I have been very skeptical it could be successfully performed

The two sessions from Mark Bloch and Anna Mcnulty however demonstrated to me that it was a feasible and potentially useful option. First Mark Bloch spoke of advantages/disadvantages of self testing.

Self testing has many advantages. It gives people the opportunity to test themselves in a comfortable environment at a time convenient to them. They no longer need to wait hours or days for a result. And no longer need to risk multiple people being aware of their diagnosis (huge issue with health facilities in Timor, as everyone is related). It also has the added benefit of being easy to do in rural and remote environments, where people would have to travel hours to get tested.

However one of my worries has been the quality of the results, as they are more likely to be inaccurate when performed by untrained hands. on top of this the person undergoing the test may not undergo adequate counselling/ understand the significance of a positive result. Another concern centers around missing numerous other crucial tests that would also routinely be performed in those receiving HIV tests. 

To my surprise however 88% of those performing a rapid HIV test in NSW were capable of following all the steps correctly (though i imagine this would be much less in a place with poor education like Timor).

Following Marks talk Anna Mcnulty went on to discuss self testing with Dry Blood Spot. This had the advantage of being easy to post to and from the household of those being tested and relatively easy to be performed. It's had a slow uptake in NSW, though the MSM community seem to be catching on.

Self-testing definitely has an important role in reaching those communities who would not otherwise engage in healthcare due to concern of confidentiality, convenience, geography and comfort.

The team from SAHMRI gave 3 presentations of which this was the last. The first 2 gave a good background to the service. Katy who gave this talk is from Broome so covers the Kimberley region.

This presentation was focused on the 'Young Deadly and Syphilis Free" campaign, recently launched.

The campaign aimed to deliver a multifaceted education and awareness campaign of syphilis in remote areas.

Components included media strategy (examples were played - including a great TV commercial and a radio advertisements linking themes of testing during pregnancy and general testing - which are also being developed in local languages), posters and education materials, social media strategy (e.g. Facebook page) and health service engagement strategy (e.g. there is a fortnightly electronic email for HCW. (available via This email address is being protected from spambots. You need JavaScript enabled to view it. )).

(Syphilis animation and other TV ads are available on youtube, website, links from Facebook page).

Stakeholders were young people and health services/youth agencies.

Considering social media - 

Of Facebook posts the video postings seem to be the most popular/greatest % reach of all postings. 'Likes' of the page were mainly 25-34yo group. 

Some data presented about some remote FB pages not being active, and that Facebook use potentially overstated in initial consultations.

Diva Chat messaging is popular in remote areas - provided free by Telstra. This platform offers advertisement appearing as banners across young people. Diva Chat is used for hooking up a lot there. High usage rates across stages.

Instagram - less engagement with this group of young people in remote areas. Only 54 followers. Bust most popular on this is condemn, and lubricious.

YDSF website went live on 1st July this year (part of the STI/BBV page). Some google analytics were presented for this page including channels of traffic as well as visitors.

Posted by on in Uncategorised Posts

The first ASHM conference symposium on HTLV-1 proved extremely insightful, as to date I had very limited exposure and education related to it. 

Numerous speakers provided comprehensive talks on this largely neglected topic. Two back to back session from Graham Taylor (imperial college London( and Fabiola Martin (University of Queensland) provided a great overview of the topic.

Like HIV, HTLV-1 is a retrovirus, however rather than triggering cell death, HTLV-1 triggers Tcells to proliferate. Where there is cell proliferation there is risk of mutations and malignancy. The virus is transmitted sexually, vertically and through blood exposure. 95% of those exposed are asymptomatic, however the virus may cause a HTLV-1 inflammatory syndrome characterized primarily by myelopathy. It also can eventually cause T cell leukemias/ lymphomas (emphasizing the importance of monitoring LDH and lymphocytes). Median age of onset of symptoms is 48, though its usually 7 years before patient present.

In terms of treatment steroids have shown improvement in the short term (though usually benefit does not persist beyond 4 wks. More recent studies suggest a role for steroid sparing agents with one showing at 48wks slight improvement in spasticity, walk tests, CSF VL and no increase in VL in the blood. Other more promising agents include AZT (for unclear reasons) in combination with interferon, and in Japan monoclonal antibodies to ccr4.

My take home message from this is in patients from endemic areas who present with a myelopathy, a HTLV-1 should be part of my routine work up.

The Multicultural HIV and Hepatitis Service (MHAHS) has launched a multilingual communication communication toolkit… https://t.co/eXa72MaSv2

ASHM ASHM

#ASHMResource HIV Management in Australasia is a ‘living resource’ for health practitioners managing people with HI… https://t.co/yKj1D4aCrE

ASHM ASHM