Barriers And Facilitators Relevant To An HIV-Testing Clinic Model Among Chinese And Thai MSM At Sydney Sexual Health Centre (SSHC)

Dr Mcnulty talked about a decrease in HIV diagnosis in Australian born MSM but with no change in non-Australian MSM. She stated the Sydney Sexual health center is increasing its testing options which are free, far from being judgemental with expert staff who are confidentiality conscious. The center introduced the express clinic to overcome waiting times. They complete a number of questions on the computer with a brief encounter with a nurse.It attracted a hard to reach people born overseas although she was quick to explore more testing options with emphasis on confidentiality, free and non-judgemental services.

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PrEP Implementation

Brent Clifton is the Manager of Gay Men’s Sexual Health Programs. He has taken us to the journey of PrEP implementation. They developed 2 models: Nurse led, and Peer led.

He described how on the early days, PrEP medications can be accessed through import from doctors and from reputable medical sites

That all changed on December 2015, when then Health Minister Jillian Skinner announced a landmark clinical trial on PrEP in NSW named Epic NSW ("Expanded PrEP Implementation in Communities"). A proposal was then sent from ACON to: support the implementation and rollout of the Epic-NSW Study; lead the education and increase community awareness of PrEP. These proposals included a PrEP mailing list, a full-time staff position to lead the community education of PrEP, holding community forums (9 in total were held), community awareness during Mardi Gras Festival and the development of the campaign “Is PrEP right for You?”

They have 2 clinical partners RPA Sexual Health and SSHC. Both centres deliver Nurse and Peer led programs. One of the key services offered was dispensing of PrEP medications on site. This program saw a substantial increase in enrolment within a month.

Some of the peer experiences  they had were feeling less anxious about sex, what will be the possible side effects? they had more conversation about STI, undetectable viral load and some comments like “I’m not high risk enough but still want PrEP.

Some of the take home notes are If we have enough support and education on marginalized population we will be able to eliminate HIV. The availability of PrEP is very crucial in HIV elimination.

Dr Eric Chow is Senior Research Fellow at Melbourne Sexual Health Centre

Risk factors for gonorrhoea in heterosexuals

Eric came in after Praveena a research fellow at Kirby Institute discussed the rise in gonorrhoea infections in women aged between 20-39yrs in the period 2007-2016. She did not have any tangible evidence as to why the increase. One of her to do list was to research as to why?

 Eric timely came in to give possible risk factors that might have prompted the rise of gonorrhoea infections in this group of women. Possible factors were sexual partners and condom use, bisexual men, dating sites/apps, alcohol and drug use, travel and other unexplored factors.

There was not enough evidence on 5 of these risk factors to prove that they were the reason for the rise in Gonorrhoea. More information is required and its still work in progress.

Travel and sex to or from a high place of prevalence was the only reason why there is a rise in Gonorrhoea infections. 

Dr Praveena Gunaratnam

Research Fellow at Kirby Institute, UNSW Sydney

Praveena spoke on Gonorrhoea infections in women across all major cities, WA being on top of the list. She mentioned an alarming increase of 118% based on 2007-2016 statistics of women aged between 20-39yrs. She mentioned that the increase was not based on the increase in testing but an increase in infections.

Rates in Aboriginal and Torres straight islander women are higher than non-aboriginal women in all major cities.

Gonorrhoea is the major cause of pelvic inflammatory diseases and infertility in women. There is also a concern for increasing antimicrobial resistance.

Investigations via research into the reasons why the increase is the next step. Contributory factors are:

-changes in sexual behaviours e.g. dating apps

-a particular strain of gonorrhoea

-lower socio-economic factors

-inadequate health care access or a combination of these factors.

PrEP has been a major discussion point in the 2017 ASHM conference. In a joint symposium with the 2017 Sexual Health Conference, multiple speakers spoke of the rollout of PrEP in Australia and New Zealand. A/Prof Edwina Wright discussed ‘PrEP in Future Australia: How will it look?”

Edwina invited us to imagine the future of PrEP in Australia if PBS listing were to occur in 2018. One of the key points made was the need for rapid up-scaling of PrEP provision in the community. There have already been signs of over-saturation of clinics involved in the current PrEP studies, and PBS listing of PrEP would likely further overwhelm these resources. This leads to the question of which providers would be able to assist in providing appropriate PrEP counselling  – other practitioners besides medical practitioners could play a role here, including nurse practitioner and pharmacists. Criteria for PBS prescribing would likely exist to obtain authority – this would be based on the recently published ASHM guidelines on PrEP and would require individuals to be HIV negative, have normal renal function and aged over 18.

Another key issue raised by Edwina as well as numerous other speakers during the conference relate to inequity of access. Currently those accessing PrEP come from a similar demographic – gay, educated, Australian-born and employed individuals. Individuals from culturally and linguistically diverse backgrounds, those from lower socio-economic status, and those in rural communities are under-represented. Further strategies are required to try and reach out to these communities.

Another issue that requires further investigation is that of potential toxicity. As PrEP contains TDF, the long-term risk and toxicity to renal function or bone health remains to be determined. A PrEP registry could play an important role here to allow long-term follow-up of potential toxicity. Continuous follow-up of individuals on PrEP also remains vital, not only in assessing for potential complications, but also for ongoing routine screening of other STIs.

This session highlighted the need for increasing preparedness of clinicians in the community in being able to manage and counsel patients requesting PrEP, the number of which is likely to increase if/when PrEP becomes PBS listed. In addition, those currently accessing PrEP through clinical trials may prefer to see their general practitioners or other health practitioners in the community to continue receiving PrEP once the trial ends. Several PrEP resources are available to clinicians including the ASHM PrEP guidelines and an online PrEP module available on the ASHM website.