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Client and staff experiences of a co-located service for hepatitis C care in opioid substitution treatment settings in New South Wales, Australia(2013) Treloar, Carla; Rance, Jake; Grebely, Jason; Dore, GregoryJournal ArticleInternationally, there are ongoing efforts to increase access to hepatitis C (HCV) assessment and treatment to counter a generally low uptake of treatment among people with a history of injecting drug use. The aim of this qualitative study was to examine client and staff attitudes towards and experience of co-location of HCV and opioid substitution treatment (OST) services. METHODS: In-depth interviews were conducted with 57 clients and 19 staff from four NSW clinics participating in the Australian ETHOS study. RESULTS: Client and staff participants typically welcomed integrated treatment, citing issues of convenience, reduced travel time and costs, persistent cues to engagement and immediacy of access to care. Positive attitudes towards the initiative were expressed even by clients who had not engaged with HCV care. Providing co-located care largely avoided the negative, stigmatising or discriminatory experiences that participants reported encountering in settings less familiar with people who use drugs. A minority of client participants expressed concerns about the lack of privacy and/or confidentiality available in the co-located model, preferring to seek HCV care elsewhere. CONCLUSIONS: The co-location of HCV care in OST clinics was welcomed by the large majority of participants in this study. Besides issues of convenience, the appeal of the co-located service centred on the familiarity of existing relationships between clients and staff in the OST setting. While some clients remained distrustful of OST and chose not to take up HCV care in this setting, the co-located treatment model was overwhelmingly successful amongst both client and staff participants.
(2011) Deacon, Rachel; Wand , Handan; Stelzer-Braid , Sacha; Treloar, Carla; Maher, LisaJournal ArticleUnderstanding patterns of newly acquired hepatitis C virus (HCV) infection is fundamental to assessing the impact of prevention and treatment interventions. However, identifying newly acquired cases is difficult, usually requiring documented testing before and after exposure. As the proportion of cases identified as newly acquired by current New South Wales surveillance methodologies is significantly lower than that identified nationally, the impact on the identification of newly acquired cases of systematic reporting of past negative HCV test results from notifying laboratories was assessed. HCV notifications data for 2007 from two New South Wales laboratories were analysed. Cases with a negative HCV antibody test within the past 24 months were classified as newly acquired. These were linked to the NSW Department of Health (NSW Health)-identified cases to assess the effectiveness of accessing laboratory data. The laboratories accounted for approximately half of all new HCV notifications in 2007. Of the 2,206 newly diagnosed cases, 21 (1.0%) were newly acquired, 18 of which had not been identified under the current surveillance system, increasing the total number of newly acquired cases to 83 from 65. This increased the yield by 28% and increased the proportion of newly acquired cases from 65/4,192 (1.6%) to 83/4,196 (2.0%). Laboratory-identified cases were significantly more likely than NSW Health-identified cases to be aged 30 years or over. Combined with current reporting mechanisms, laboratory data on previous HCV test results have the potential to increase the number of newly acquired cases identified through the New South Wales surveillance system and to enhance the identification of cases among those aged 30 years or more.
(2011) Bryant, Joanne; Ward, James; Worth, Heather; Hull, Peter; Solar , Sarina; Bailey , SandraJournal Article
Factors associated with specialist assessment and treatment for hepatitis C virus infection in New South Wales, Australia(2011) Grebely, Jason; Bryant, Joanne; Hull, Peter; Hopwood, Maxwell; Lavis, Yvonna; Dore, Gregory; Treloar, CarlaJournal ArticleAssessment and treatment for hepatitis C virus (HCV) in the community remains low. We evaluated factors associated with HCV specialist assessment and treatment in a cross-sectional study to evaluate treatment considerations in a sample of 634 participants with self-reported HCV infection in New South Wales, Australia. Participants having received HCV specialist assessment (n = 294, 46%) were more likely to be have been older (vs <35 years; 35¨C44 OR 1.64, P = 0.117; 45¨C54 OR 2.00, P = 0.024; ¡Ý55 OR 5.43, P = 0.002), have greater social support (vs low; medium OR 3.07, P = 0.004; high OR 4.31, P < 0.001), HCV-related/attributed symptoms (vs none; 1¨C10 OR 3.89, P = 0.032; 10¨C21 OR 5.01, P = 0.010), a diagnosis of cirrhosis (OR 2.40, P = 0.030), have asked for treatment information (OR 1.91, P = 0.020), have greater HCV knowledge (OR 2.49, P = 0.001), have been told by a doctor to go onto treatment (OR 3.00, P < 0.001), and less likely to be receiving opiate substitution therapy (OR 0.10, P < 0.001) and never to have seen a general practitioner (OR 0.24, P < 0.001). Participants having received HCV treatment (n = 154, 24%) were more likely to have greater fibrosis (vs no biopsy; none/minimal OR 3.45, P = 0.001; moderate OR 11.47, P < 0.001; severe, OR 19.51, P < 0.001), greater HCV knowledge (OR 2.57; P = 0.004), know someone who has died from HCV (OR 2.57, P = 0.004), been told by a doctor to go onto treatment (OR 3.49, P < 0.001), were less likely to have been female (OR 0.39, P = 0.002), have recently injected (OR 0.42, P = 0.002) and be receiving opiate substitution therapy (OR 0.22, P < 0.001). These data identify modifiable patient-, provider- and systems-level barriers associated with HCV assessment and treatment in the community that could be addressed by targeted interventions.
Rates of condom and non-condom-based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction?(2011) Mao, Limin; Kippax, Susan; Holt, Martin; Prestage, Garrett; Zablotska, Iryna; de Wit, JohnJournal ArticleObjective Three decades into the HIV epidemic and with the advancement of HIV treatments, condom and non-condom-based anal intercourse among gay men in resource-rich countries needs to be re-assessed. Methods The proportions of men engaging in a range of anal intercourse practices were estimated from the ongoing cross-sectional Gay Community Periodic Surveys in six states in Australia from 2007 to 2009. Comparisons were made between HIV-negative men, HIV-positive men with an undetectable viral load and those with a detectable viral load. Results Condoms play a key role in gay men's anal intercourse practices: 33.8% of HIV-negative men, 25.1% of HIV-positive men with an undetectable viral load and 22.5% of those with a detectable viral load reported consistent condom use with all male partners in the 6 months before the survey. Among HIV-negative men, the second largest group were men who had unprotected anal intercourse (UAI) only in the context of HIV-negative seroconcordant regular relationships. Among HIV-positive men, the second largest group was men who had UAI in casual encounters preceded by HIV status disclosure to some, but not all, casual partners. Conclusions A minority, yet sizeable proportion, of men consistently engaged in a number of UAI practices in specific contexts, suggesting they have adopted deliberate HIV risk-reduction strategies. While it is important that HIV behavioural prevention continues to reinforce condom use, it needs to address both the challenges and opportunities of the substantial uptake of non-condom-based risk-reduction strategies.
Factors associated with hepatitis C knowledge among a sample of treatment naive people who inject drugs(2011) Treloar, Carla; Hull, Peter; Bryant, Joanne; Hopwood, Maxwell; Grebely, Jason; Lavis, YvonnaJournal ArticleBackground Assessment and uptake of treatment for hepatitis C among people who inject drugs (PWID) is low and strategies to enhance hepatitis C care in this group are needed. Knowledge of hepatitis C and its treatment is one precursor to decisions about treatment. Methods We conducted a cross-section study designed to evaluate treatment considerations in participants with self-reported hepatitis C infection in New South Wales, Australia. Participants were recruited from needle and syringe programs, opiate substitution clinics, pharmacies that dispensed opiate substitution treatment and from the mailing list of a community-based hepatitis C organisation and completed a self-administered survey. Knowledge of hepatitis C was assessed by a 48-item scale addressing the natural history and treatment of hepatitis C. Factors associated with knowledge were assessed by ordinal regression. Results Among the 997 participants recruited, 407 self-reported acquiring hepatitis C through injecting drug use and had never received hepatitis C treatment. Knowledge about hepatitis C was overall poor and the effects of the long term consequences of hepatitis C were over-estimated. Higher knowledge scores were associated with recruitment site, higher education levels and recent contact with a general practitioner. One-third of participants indicated that they did not intend to have treatment and one-fifth did not answer this question. Conclusion Knowledge is a precursor to informed decisions about hepatitis C treatment. These results indicate that efforts to support those less engaged with hepatitis C care (and specifically those on opiate substitution treatment) and those with lower literacy are required.
Australian gay men who have taken non-occupational post-exposure prophylaxis of HIV (PEP) are in need for effective HIV prevention methods(2011) Zablotska, Iryna; Prestage, Garrett; Holt, Martin; Poynten, Mary; de Wit, John; Guy, Rebecca; Mao, Limin; McAllister, John; Grulich, AndrewJournal ArticleBackground: Gay men who request non-occupational post-exposure prophylaxis (PEP) may seek pre-exposure prophylaxis (PrEP) should this become available. We explored trends and predictors of PEP use among Australian gay men to inform future biomedical preventi on programs. Methods: We used 2001-2010 data from Gay Community Periodic Surveys in three Eastern Australian, states and assessed PEP awareness and use in the six months before each survey, and among HIVuninfected, men in all surveys predictors of PEP use. Analytical methods included chi-square test for, trend and multivariate log-binomial estimation of associations. Results: The awareness of PEP significantly increased from 23% in 2001 to 64% in 2010. PEP use also, increased from 2.3% to 3.9%, respectively. PEP use was significantly associated with being in a regular, relationship with an HIV-serodiscordant partner, higher number of sex partners, engaging in anal, intercourse with casual partners and regularly testing for HIV/STI. However, fewer than 8% of men, who engaged in these practices reported PEP use. Conclusion: Our findings highlight the profiles of current PEP users: men in HIV-serodiscordant, relationships and men having high numbers of casual partners and unprotected anal intercourse with them. These men are in need of effective HIV prevention strategies and may be receptive to PrEP in the future. Presently, targeted HIV education to improve risk assessment skills may prevent some seroconversions through the appropriate use of PEP.Keywords: HIV, non-occupational exposure, sexual practices, HIV prevention, post-exposure, prophylaxis, pre-exposure prophylaxis.
Behavioural surveillance among gay men in Australia: Methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections(2011) Zablotska, Iryna; Kippax, Susan; Grulich, Andrew; Holt, Martin; Prestage, GarrettJournal ArticleBackground: The Australian HIV/STI behavioural surveillance system (repeated cross-sectional Gay Community Periodic Surveys, GCPS) has been conducted regularly since 1998 and covers six main Australian jurisdictions. In this paper, we reviewed its history and methodology, as well as the available indicators, their trends and their use. Methods: We described the design and history of GCPS. For analyses of indicators, we used Pearson–s chi-squared test and test for trend where appropriate. Results: About 90% of gay men in Australia have been tested for HIV; 60% to 70% of men, who were not HIV-positive, have been tested as recommended in the preceding 12 months. STI testing levels (~70% in the preceding 12 months) are high, but remain insufficient for STI prevention. In general, unprotected anal intercourse with regular (UAIR) and casual (UAIC) sex partners have increased over time. The prevalence and increasing trends in UAIR were similar across jurisdictions (p trend <0.01), while trends in UAIC differed across the states: during 2001-2008, UAIC declined in NSW (p trend <0.01) and increased elsewhere (p trend <0.01). Trends in UAIC were associated with HIV diagnoses. Conclusion: This review of the design, implementation and findings of the Australian HIV/STI behavioural surveillance highlights important lessons for HIV/STI behavioural surveillance among homosexual men, particularly the need for consistent and dedicated data collection over time and across jurisdictions. Investment in systematic HIV/STI behavioural surveillance appears to result in a better understanding of the HIV epidemic, availability of a warning system and a better targeted HIV prevention.
(2011) Zablotska, Iryna; Grulich, Andrew; de Wit, John; Prestage, GarrettJournal ArticleFamiliarity with and a history of prior sex with casual partners is associated with unprotected anal intercourse and may increase the risk of HIV transmission among gay men. Using data from the Sydney Gay Community Periodic Survey 2007, we explored the relationship between familiarity and unprotected anal intercourse with the last casual partner (UAI-LC). 51% of the men knew their last casual partner and 49% had previously had sex with him. Men were more inclined to engage in UAI-LC if they had previously had sex with this partner. HIV-negative men were more likely to have UAI-LC with a more familiar partner independent of his serostatus. Familiarity with and a previous history of sex between casual partners may result in a false sense of trust and may increase the risk of HIV transmission. HIV prevention services should address this issue and develop programs to improve men's skills in negotiating safer sex.
Fitness for duty: social, organisational and structural influences on the design and conduct of candidate hepatitis C vaccine trials involving people who inject drugs(2010) Treloar, Carla; Byron, Paul; Mccann, Pol; Maher, LisaJournal ArticleSeveral candidate vaccines for hepatitis C are currently in preclinical development or the early stages of clinical trials. Implementing trials of these vaccines among people who inject drugs will be challenging. Previous research, particularly willingness to participate studies in relation to HIV vaccines in marginalised groups, has focused on the modifiable characteristics of individual participants. This qualitative research with people who inject drugs, health staff and clinicians focuses on social, organisational and structural elements of vaccine trial designs which may exclude or reduce the participation of people who inject drugs.
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