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The final information station on this Italian inspired food for thought train was a digestive Espresso of Epidemiology “Understanding our evolving epidemic”.
First up was HIV and Ageing – Rosan van Zoest (PhD student at the Amsterdam Institute for Global Health and Development) used cohort data from large studies to separate the Myths from Reality. The opener of the talk was a review of all the suggested AANCC’s (age-associated non-communicable comorbidities). The following speech-bubbles were presented for unpacking “HIV causes accelerated ageing”, “Ongoing inflammation is the cause of comorbidities”, “Comorbidities are due to antiretroviral toxicity”, “AANCC’s occur more often in PLHIV” and “HIV causes premature ageing”. Data from the COBRA, POPPY and AGEHIV studies were used to respond to the statements and one of the key factors strengthening the evidence was the importance of recruitment of appropriate HIV-negative controls and reference was given to the COBRA study that used HIV- and age matched blood bank donors as a comparison. After reviewing the evidence, Rosen concluded when reviewing evidence one should be careful not compare ‘apples and oranges’, control groups are vital, AANCC’s are more prevalent in PLHIV, comorbidity risk in PLHIV is likely multifactorial and when considering the above speech-bubbles the following should be considered; smoking, drug and alcohol use, CVD risk and DM, weight related conditions such as obesity and anorexia, HCV, systemic and intrathecal immune activation, certain ARVs and nadir CD4.
As Milan is one of the fashion capitals of the world it seemed appropriate at some point that we talk about Modelling… kind of… Supporting the development of evidence based police/management guidelines was presented by Mikaela Smitt from Imperial College London. This session was focussed on the “black box” of modelling studies and for those that can comprehend this analogy she used a picture of big yellow minion and thought bubble “WHAAA?!?!?!” as the opening slide…a sentiment I am familiar when trying to get my head around modelling. Needless to say, she unravelled it brilliantly.
What is modelling and what does it do? It predicts the future, compares interventions, uses epidemiological mechanisms, uses fundamental parameters and suggests resource allocation.
What is good model practice? A new acronym was given to use here (and a picture of the popular Harry Potter Hogwarts popular sport) QUEDDACH. The QUESTION is concise and specific including outcomes, measures, settings and timelines. The DESIGN includes what key elements and interactions are represented. The DATA is underpinned by key/strong data sources. The ASSUMPTIONS should be defined as well as what impact they have on the results. The CHECKS and sensitivity/uncertainty analyses should be done.
And finally what are the potential problems with modelling data? Wrong tool is used for the job, garbage in = garbage out, Complex questions = greater uncertainty
And so for my final blog of Mind stimulating Mozzarella… (Sorry am running out of cheesy puns.. whoops and again!)
“What is happening with new HIV diagnoses in gay men in England and why? Interpreting monitoring (outputs) and surveillance (outcomes) information” presented by Professor Noel Gill from Public Health England. Noel started by commenting on England as a high-income setting, the open access network of 200 STI clinics held in high regard by at risk community and excellent surveillance and monitoring systems. He posed the temporal changes from 2010 onwards noting the HIV complacency with increasing survival and better ARV regimens, problematic increasing density of sexual networking driven by the arrival of geospatial hook-up smartphone apps and a marked increase in bacterial STI’s. Trends in common STI diagnoses were examined as well as reviewing some of the policy developments affecting them such as behavioural interventions, lower thresholds of access to HIV testing (e.g. the Dean St 1hr promise, self-sampling and Self-testing), Increases in HIV testing frequency following recommendations of 3 monthly testing for those having condomless AI with new or casual partners and HIV PrEP (PROUD trial commencing in 2013).
Noel concluded with the following information on Preventing HIV in MSM. Combination prevention has seen a 50% increase in MSM clinic attendees from 2011 – 2016, intensified testing of those at risk has seen an average of 2.5 test annually in 2016 and suggested the question clinicians should be asking is “How frequently are you testing, not when did you last test”. Shortening the time to treatment initiation in PLWHIV and HIV PrEP has all had a significant contribution. Noel closed by highlighting the commencement of the IMPACT study a pragmatic health technology assessment of PrEP and its implementation that aims to answer the key questions under real world conditions and at sufficient scale. The results will inform service commissioners on how to support clinical and cost-effective PrEP access in the future.
Thank you to ASHM for your generous scholarship funding for myself and the other Australian sexual health clinicians who benefited from this – we had a blast! Ciao x