SEXUAL BEHAVIOR AND STI INCIDENCE DURING THE FIRST 4 YEARS OF PrEP USE AMONG MSM

Background: A prospective demonstration project in Amsterdam (AMPrEP) provided pre-exposure prophylaxis (PrEP) to people vulnerable to HIV in 2015- 2020. Data on long-term trends in sexual behavior and incidence of STIs during PrEP use are needed to inform future PrEP programs. Therefore, we assessed sexual behavior and incidence rates of STIs among MSM and transgender women on PrEP over four years. Method(s): AMPrEP participants chose between oral PrEP daily (dPrEP) or event-driven (edPrEP) at baseline and could switch regimens at each 3-monthly study visit. They were tested for STIs at these visits and if necessary in between. Follow-up began at PrEP initiation and continued until 48 months of follow-up or was censored at March 15, 2020 (start COVID-19), whichever occurred first. We assessed changes over time in incidence rates (IR) of chlamydia, gonorrhea, and infectious syphilis using Poisson regression. We estimated the IR of Hepatitis C (HCV) diagnoses per consecutive year. We described the number of HIV diagnoses, and sexual behavior (i.e. number of sex partners, condomless anal sex acts with casual partners [CAS]). Result(s): A total of 367 (365 MSM) started PrEP and contributed 1249 person-years of observation. IRs of any STI was 87[95%CI 82-93]/100PY. There was no change in the IR of any STI and infectious syphilis over time on PrEP. We observed a slight decrease in incident chlamydia and gonorrhea in daily PrEP users (Table). Two incident HIV cases were diagnosed in the first year of follow-up. IRs for HCV were 1.5[0.6-3.6], 2.5[1.3-5.0], 0.7[0.2-2.7], and 0.4[0.1- 2.8]/100PY, per consecutive year on PrEP. Median number of sex partners per 3-month period decreased from 16[IQR 8-34] and 12[6-25] (dPrEP and edPrEP, respectively) at baseline, 15[7-30] and 8[3-16] at 24 months, and 12[6-26] and 5[2-12] at 48 months. Median number of CAS acts with casual partners were respectively 7[3-15] and 4[1-9] at baseline, 14[5-25] and 4[1-12] at 24 months, and 12[4-25] and 4[1-9] at 48 months. Conclusion(s): Over the first 4 years of PrEP use overall STI incidence was high and stable. Chlamydia and gonorrhea incidence declined slightly in daily users. Numbers of sex partners seemed to decrease in both dPrEP and edPrEP users. Number of CAS acts with casual partners appeared to increase first, and then stabilized. Notably, this did not result in increased incidence of STIs. Regular testing and treatment of STIs remain a priority among PrEP users. Biomedical prevention of STIs can be examined in this context.

Sustained Alveolar Fibroproliferation in Patients with Non-Resolving Covid-19 Related Ards Does Not Lead to Pulmonary Fibrosis

Introduction: Impairment of lung function and radiological abnormalities are a major concern in COVID-19 survivors, but, as of yet, patients with persistent COVID-19-related ARDS have still not been fully characterized especially regarding long-term lung injury and development of pulmonary fibrosis. The aim of this observational study is to investigate whether long-term pulmonary injury is related to fibroproliferative responses during ICU stay. Method(s): Twenty-eight PCR confirmed COVID-19 patients admitted to the ICU of the Amsterdam University Medical Centers (Amsterdam UMC), location VUmc, who underwent a diagnostic bronchoscopy with broncho-alveolar lavage (BAL) because of non-resolving COVID-19 related ARDS, were included. Bronchoscopy was repeated weekly when no clinical improvement was observed. Markers for epithelial injury and fibroproliferation were measured in BALF and plasma using specific Luminex assays or ELISA. Three and 12 months after hospital discharge, chest CT and lung function parameters were obtained during outpatient visits. Result(s): Pulmonary markers for epithelial injury and fibroproliferation were measured in BALF and compared to healthy controls (HC). Epithelial injury and fibroproliferation markers were significantly increased in critically ill COVID-19 patients as compared to HC. Plasma markers for fibroproliferation were not different as compared to HC. No signs of pulmonary fibrosis were found at 3 and 12 months after hospital discharge. Conclusion(s): Patients with non-resolving COVID-19 related ARDS show a sustained alveolar fibroproliferative response, however such fibroproliferative response is not associated with pulmonary fibrosis.

Increased clonality among Neisseria gonorrhoeae isolates during the COVID-19 pandemic in Amsterdam, the Netherlands.

Distancing measures during the COVID-19 lockdown led to a temporary decrease of casual sex partners among clients of the Centre for Sexual Health (CSH) in Amsterdam, the Netherlands. We investigated the effect of this change on the genotypic and phenotypic distribution of Neisseria gonorrhoeae (Ng) isolates from CSH patients. From each Ng-positive patient we sequenced one isolate, resulting in 322 isolates which constituted two groups: 181 isolates cultured from 15 January to 29 February 2020 (before the first lockdown) and 141 cultured from 15 May to 30 June 2020 (during the first lockdown). Patient characteristics showed significantly more symptomatic patients and significantly fewer reported sex partners during the lockdown. Phenotypic data showed an increase in low-level azithromycin resistance and ceftriaxone susceptibility during the lockdown, and this remained after the study period. The diversity in sequence types (STs) decreased slightly during the lockdown. A shift occurred from ST 8156 being predominant before lockdown to ST 9362 during lockdown and a remarkably low median SNP distance of 17 SNPs was found between ST 9362 isolates obtained during lockdown. These findings reflect restricted travel and the change in sexual behaviour of CSH clients during the lockdown, with a potentially increased local transmission of the ST 9362 strain during this period, which led to genotypic and phenotypic changes in the Ng population. This shows that public health measures have far-reaching consequences and should be considered in the surveillance of other infectious diseases.

SEXUAL HEALTHCARE USE, PrEP USE, and the INCIDENCE of STI among MSM during COVID-19

Background: This study explores the effects of COVID-19 restrictions on sexual healthcare use, pre-exposure prophylaxis (PrEP) use, and sexually transmitted infection (STI) incidence among men who have sex with men (MSM) participating in a PrEP demonstration project in Amsterdam, the Netherlands (AMPrEP). Methods: We retrieved data from 2019-2020 for AMPrEP participants with ≥1 study visit in 2019 (n=305), and two questionnaires on COVID-19 measures and sexual behaviour in 2020 and 2021 (n=203;n=160). Analyses were stratified for three periods of COVID-19 restrictions (first: 15/3/2020-15/6/2020;second: 16/6/2020-15/9/2020;third: 16/9/2020-31/12/2020 or 1/4/2021 for COVID-19 questionnaire data). Evaluated endpoints included proportion returning for sexual healthcare during COVID-19, change in PrEP use (increased/unchanged vs. deceased/stopped;relative to 2019), and incidence of any STI (chlamydia, gonorrhoea, or syphilis;diagnosed at clinic/study visit) or HIV. We modelled determinants of care and PrEP use via multivariable logistic regression, and STI incidence using piecewise Poisson regression;comparing 2020 periods to those in 2019. Results: Of the 305 included in the analysis, 72.8% (n=222) of participants returned for care during COVID-19, among which 147, 190, and 148 visits took place during the first, second, and third period of COVID-19 restrictions, respectively. Daily (versus event-driven) PrEP use was significantly associated with returning for care across periods (p<0.001). Increased/unchanged PrEP use was reported by 55.2% (n=112), 58.1% (n=93), and 55.6% (n=89) during the first, second, and third periods, respectively. Increased/unchanged PrEP use was more likely among those reporting chemsex in the first (p=0.001) and third (p=0.020) periods, and those reporting increased/unchanged number of sex partners relative to 2019 during the second period (p=0.010). STI incidence was significantly lower in 2020 than 2019 during the first (IRR=0.43, 95%CI=0.28-0.68), yet seemed higher during the second (IRR=1.38, 95%CI=0.95-2.00) and third periods (IRR=1.42, 95%CI=0.86-2.33), albeit non-significantly (figure 1). No new HIV infections were diagnosed. Conclusion: COVID-19 restrictions coincided with reduced care and PrEP use. The significantly lower STI incidence during the first period of COVID-19 restrictions and subsequent increase suggests a delayed diagnosis effect. We need ways to ensure continued access to sexual healthcare during restrictions.

Short of drugs? Call upon operations and supply chain management

Purpose: This “impact pathways” paper argues that operations and supply chain management (OSCM) could help address the worsening drug shortage problem in high-income countries. This significant societal problem poses difficult challenges to stakeholders given the complex and dynamic nature of drug supply chains. OSCM scholars are well positioned to provide answers, introducing new research directions for OSCM in the process. Design/methodology/approach: To substantiate this, the authors carried out a review of stakeholder reports from six European countries and the academic literature. Findings: There is little academic research and no fundamental agreement among stakeholders about causes of shortages. Stakeholders have suggested many government measures, but little evidence exists on their comparative cost-effectiveness. Originality/value: The authors discuss three pathways of impactful research on drug shortages to which OSCM could contribute: (1) Developing an evidence-based system view of drug shortages;(2) Studying the comparative cost-effectiveness of key government interventions;(3) Bringing supply chain risk management into the government and economics perspectives and vice versa. Our study provides a baseline for future COVID-19-related research on this topic. © 2021, Emerald Publishing Limited.

P050 Motives and barriers for complying with ‘sexual distancing’ among MSM during the first COVID-19 pandemic lockdown, a qualitative study

BackgroundsOn March 12,2020 the Dutch government imposed a lockdown and heath measures to curb the COVID-19 pandemic. As part of social distancing, sexual distancing was one of these measures. Sexual distancing implied no sex with partners outside of one’s household. We tried to elucidate motives and barriers for complying with sexual distancing among men who have sex with men (MSM) and the relation with social distancing.MethodsIn this exploratory qualitative study we interviewed STI clinic visiting MSM during the first COVID-19 lock down using a semi-qualitative questionnaire from March-May 2020. We interviewed both men who complied and did not comply with the sexual distancing measures. The interviews were transcribed using verbatim transcription and analyzed using MAXQDA.ResultsWe included 18 non-compliers and 4 compliers. Motivations mentioned to comply with sexual distancing measures were: perceiving COVID-19 as a serious health threat, experiencing critically ill COVID-19 patients first hand, protecting someone dear from COVID-19, and being satisfied with social and/or sexual distancing measures. Barriers mentioned to comply with sexual distancing measures were: not being aware of the need for sexual distancing, being single, previously having had an active sex life, importance of the social aspect of sex, a strong urge for sex, having sex to reduce stress, being under the influence of alcohol or drugs, and not perceiving COVID-19 is a serious health threat.ConclusionOur findings suggest that the information on sexual distancing needs to be made more explicit, accessible, understandable, customized and relatable to the key populations. This will improve effective measures and health advises for the current COVID-19 pandemic and future droplet borne outbreaks.