HIV/Sexual Health Clinical Education Session

Transcription

1 HIV/Sexual Health Clinical Education Session About These Slide These slides may not be published, posted online, or used in commercial presentations without permission. Please contact for details. ASHM SSHC 2018 HIV/Sexual Health Clinical Education Centre

2 Journal Club 4/4/18 PLOS ONE and BMC ID Lucy Beattie Registrar Clinic 16 PLOS ONE Started 2001 Open access journal PLOS believes that scientific ideas, results and discoveries are a public good. As a leading Open Access publisher, our goal is to effectively communicate trustworthy work as quickly and as broadly as possible. Up to $2990 USD per article

3 Srithanaviboonchai K et al, Stigmatizing attitudes toward people living with HIV among general adult Thai population 16 th November 2017 Survey to general Thai population respondents Asks questions about attitudes to HIV UNAIDS definitions Can be used as bench mark for future research Stigmatizing attitudes toward people living with HIV among general adult Thai population

4 Stigmatizing attitudes toward people living with HIV among general adult Thai population Results 76.9% anticipated stigma 69.2% perceived stigma 57% fear of HIV infection 37.6% expressed social judgement 52.1% practice discrimination 24% wanted to keep children living with HIV separate from other children Females more stigmatizing thoughts age group least stigmatizing thoughts compared with older and younger groups Beyeza Kashesya et all, Stigma gets in my way: Factors affecting client provider communication regarding childbearing among people living with HIV in Uganda 20 th February 2018 Survey to 400 HIV clients in heterosexual relationships wanting to conceive 98% had desire to discuss childbearing intentions 44% had discussions 28% provider initiated Stigma (internal) was barrier to communication Limitation only from client s perspective

5 Bernstein K et al Re emerging and newly recognized sexually transmitted infections: Can prior experiences shed light on future identification and control? 27 th December 2017 essay Shigella Ebola Zika Infections found to be possible sexually transmitted Needs further research Could be useful for future epidemics Re emerging and newly recognized sexually transmitted infections: Can prior experiences shed light on future identification and control?

6 Re emerging and newly recognized sexually transmitted infections: Can prior experiences shed light on future identification and control? N meningitidis isolated in men with urethritis Usually found in respiratory mucosa, can be carried in nasopharyngeal 10% people carry nasopharynx? Spread by orogenital sexual contact Higher incidences in MSM than hetero males Kesler et al, Prosecution of non disclosure of HIV status: Potential impact on HIV testing and transmission among HIV negative men who have sex with men In Canada 181 HIV positive persons were criminally charged for failing to disclose their HIV status prior to sex ( ) 150 HIV negative MSM, Toronto 7% were less likely or much less likely to get HIV test due to concern over future prosecution Could result in 18.5% increase in population spread Theoretically treatment as prevention impaired

7 Test of cure, retesting and extragenital testing practices for Chlamydia trachomatis and Neisseria gonorrhoeae among general practitioners in different socioeconomic status areas: A retrospective cohort study, Retrospective cohort analysis lab data 48 Dutch GP practices CT 20% TOC, 24% retest at GP CT 2.4% TOC and 6.1% retest elsewhere NG 25% TOC and 15% retest at GP NG 2.7% TOC and 12.3% retest elsewhere 0.3% tested on extragenital sites Velten et al, Interoception and sexual response in women with low sexual desire October 2017 Sample of 52 women with Sexual Interest/ Arousal Disorder (SIAD) They completed a self reported measure of interoception assessment Heart beat accuracy test (Objective measure interoception) laboratory based assessment of physiological sexual arousal (vaginal pulse amplitude) and self reported sexual arousal (arousometer) while viewing an erotic film No relation between interoception and sexual concordance Use of mindfulness to aid sexual arousal controversial

8 Marti Pastor et al, Health related quality of life inequalities by sexual orientation: results from the Barcelona Health Interview Survey 3277 adults answered Health Related Quality of Life (HRQoL) survey EQ 5D covers 5 aspects of health mobility, self care, usual activities, pain/discomfort and anxiety/depression Alcohol/drugs etc 3200 opposite sex only 77 same sex of varying frequency (2.3%) (LBG) Marti Pastor et al, Health related quality of life inequalities by sexual orientation: results from the Barcelona Health Interview Survey LBG group reported More chronic conditions Higher consumption tobacco More psychoactive substance use When chronic conditions adjusted for, difference between HRQoL by sexual orientation not significant = major role Mental health 185% higher probability of having problems among gay/bisexual men than heterosexual, not for women Physical health LBG men and women both had higher chance of problems in usual activities (110%) and mobility (77%)

9 BMC Infectious diseases Open access since 1999 UK based First and largest open access science publisher Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia 2018 journal Cross sectional analysis MSM partners in Melbourne Sexual Health Centre (MSHC) Culture methods to test pharyngeal/rectal/urethral (if symptomatic) Logistic regression models to look at association between gonococcal infections of urethra, rectum and pharynx in MSM partners

10 Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia 1) men with urethral gonorrhoea treated as the index case, to assess the distribution of gonorrhoea in their partners 2) men with pharyngeal gonorrhoea treated as the index case, to assess the distribution of gonorrhoea in their partners 3) men with rectal gonorrhoea treated as the index case, to assess the distribution of gonorrhoea in their partners 732 MSM couples, 495 couples completed rectal/pharyngeal testing Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia Results 1464 men (732 couples) 990 (495 couples) had complete testing (rectal and pharyngeal)

11 Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia Urethral gonorrhoea 33 men (3.3% of 990) 11 (33.3%) had partner with pharyngeal gonorrhoea 22 (66.7%) had partner with rectal gonorrhoea One partnership (2 men) both had urethral Odds ratio of having urethral gonorrhoea 4.6 if partner had pharyngeal (95% CI 1.2 to 17.1) Odds ratio 48.1 if partner had rectal (95% CI 18.3 to 126.7) Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia Pharyngeal gonorrhoea 26 men (2.6% of 990) 11 (42.3%) had partner with urethral gonorrhoea 11 (42.3%) had partner with rectal gonorrhoea 3 partnerships (6 men) both had pharyngeal Odds ratio of having pharyngeal gonorrhoea 18.3 if partner had urethral (95% CI 6.9 to 48.8) Odds ratio of having pharyngeal gonorrhoea 8.9 if partner has rectal (95% CI 3.2 to 24.6)

12 Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia Rectal gonorrhoea 48 men (4.8% of 990) 22 (45.8%) had partner with urethral gonorrhoea 11 (22.9%) had partner with pharyngeal gonorrhoea 8 partnerships (16 men) both had rectal Odds ratio of having rectal gonorrhoea was 63.9 if partner had urethral gonorrhoea (95% CI 24.7 to 165.6) Odds ratio of having rectal gonorrhoea was 3.4 if a partner had pharyngeal gonorrhoea (95% CI 1.0 to 12.2) Odds ratio of having rectal gonorrhoea was 6.9 if partner had rectal gonorrhoea (95% CI 2.4 to 20.3) Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia Discussion Transmission between rectal/pharyngeal > Urethral Likely pharynx < > pharynx transmission Potential direct transmission pharyngeal < > rectum Transmission urethra < > urethra uncommon Transmission rectum < > rectum unfeasible

13 Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia My thoughts: Largest same sex male partnership based study of gonorrhoea, small numbers positive results Using culture vs NAAT Lower sensitivity at rectal/pharyngeal sites Higher infection load (more transmissible) Cornelisse V et al, Concordance of gonorrhoea of the rectum, pharynx and urethra in same sex male partnerships attending a sexual health service in Melbourne, Australia Limitations NAAT more sensitive than culture for pharyngeal/rectal infections Only tested symptomatic males (urethral) Doesn t account for other partners Didn t ask about sexual practices

14 THANK YOU

15 Developing resources to assist people living with HIV associated neurocognitive disorder (HAND) HIV and Sexual Health Journal Club and the Clinical Education Session 10:20 11:10 HRS 4 April 2018 David Crawford RN., Treatments Officer HIV associated neurocognitive disorder (HAND) HAND is an umbrella term used to describe a subcortical neurodegenerative disease caused by HIV 1 infection May affect more than 20% of PLHIV Spectrum disease with 3 categories causing varied disability Antinori et al, 2007; Clifford & Ances, 2013

16 Cognitive domains affected HAND affects several cognitive domains: Motor skills Psychosocial Memory Concentration Executive function Antinori et al, 2007 Background Discussion with PLHIV following an international conference Established a HAND Think tank with key stakeholders Develop survey to get more information from PLHIV

17 Method A survey was distributed via the PLNSW website, over a four week period in 2015 Results (i) Total 163 responses 37 responses were excluded (n=28 international responses and 9 duplicate responses) Leaving 126 surveys included in the analysis

18 Results (ii) Knowledge of HAND 75% had heard of HAND 68% were concerned about HAND Results (iii) Anxiety about HAND 66% had anxiety about discussing HAND with others 20% stated their anxiety impeded them from ever discussing their concerns

19 Results (iv) who PLHIV spoke to 56% had spoken to someone about their concerns 79% had a positive response 15% said they would not discuss subject ever again Who they talked to... 83% HIV medical specialist 72% family doctor 74% to either their partner, a family member or a social worker

20 Who they talked to... (cont d) 21% to their nurse 9% to either the HIV treatment officer, neurologist or neuropsychologist 6% with other individuals such as a mental health nurse. Did PLHIV feel they had been listened to? Do you feel listened to about your concerns? Yes n= 42 No n=12 Total 54 n % Who listened to your concerns? HIV doctor Partner Family doctor Friend Other Family Social worker 22 (51%) 6 (14%) 5 (12%) 3 (9%) 3 (7%) 2 (5%) 1 (2%)

21 Signs and Symptoms (S&S) 42% said that other people had noticed some change in them 24% had noticed some cognitive changes in their friends who they knew were HIV positive Could they talk to their friends they had noticed changes in? 39% said they would be able to discuss cognitive changes with their friends; 19% said they would not 50% would like tips for broaching subject with doctor and significant others

22 Plan to develop a series of resources Develop, focus test and evaluate Utilise expert clinical panel Work with people living HIV and HAND Who these resources should target PLHIV with signs and symptoms which may be HAND HAND2018.pdf Significant others (partners, family, friends)

23 Next steps: Resource for Partners, Family, and Friends Resource draft and being focus tested soon for Partners, Family and Friends.