ABSTRACT
Background: Clinical practice guidelines recommend universal screening for mental health (MH) in the perinatal period using a screening tool such as the Edinburgh postnatal depression scores (EPDS). Objectives: To identify whether women attending antenatal and postnatal midwifery clinics at Mater Mothers Hospital were screened as per recommended protocol and to identify if those women who were identified as high risk of perinatal depression were appropriately referred. Additionally, to identify whether the COVID-19 pandemic and subsequent widespread use of telehealth impacted screening rates and referral patterns. Methods: The MatriX/ObstetriX database was searched for all completed EPDS screens at Mater Mothers Hospital for a 12-month period up to February 2020 and screening rates were compared to gold standard practice. The same data were collected for the 6-month period after the declaration of the SARS COVID-19 pandemic. Women with an EPDS score >12 at initial booking were identified and the electronic clinical record was then searched for details of referrals to any perinatal MH services (general practitioner, Mater Perinatal Mental Health service, psychologist, psychiatrist, non-government organisation or other MH service). Findings: Preliminary findings indicate screening rates were lower in the COVID-19 group (82.7% vs 88%). Rates of women identified as high risk (score > 12) were not statistically different between the two groups (5.88% vs 6.6%). Further findings regarding referral patterns are to be presented at Congress. Conclusion: Screening rates using the EPDS were below expected clinical standard practice prior to the onset of the COVID-19 pandemic;however, screening rates further declined with the widespread use of tele health.
ABSTRACT
Background: People living with HIV (PWH) may represent a high-risk group for adverse clinical outcomes from SARS-CoV-2. The duration of protection from SARS-CoV-2 and emerging variants of concern (VOC) infection in PWH following vaccination is unclear. Furthermore, the role of preexisting SARS-CoV-2 immune responses, likely acquired from prior exposure to circulating human coronaviruses (HCoVs), on vaccine-mediated immunity remains to be determined. Understanding the kinetics of immune responses to SARS-CoV-2 and VOCs, and the impact of preexisting SARS-CoV-2 immunity on vaccine-mediated immune responses will be critical in informing COVID-19 vaccination policies in PWH. Methods: In this sub-study of the Phase II/III COV002 trial (open-label, non-randomised clinical trial ID: NCT04400838), 54 HIV+ male participants on antiretroviral therapy (undetectable viral loads, CD4+ T cells >350 cells/ul) and 50 HIV-sex and age-matched controls received two doses of ChAdOx1 nCoV-19 (AZD1222) 4-6 weeks apart and were followed for 6 months. Immune responses to vaccination were determined by ELISA (standard and MSD assay), neutralisation, ACE-2 inhibition, IFNγ ELISpot, activation-induced marker (AIM) assay and T cell proliferation assays. Results: 6 months after vaccination, antibody IgG levels to SARS-CoV-2 S and RBD proteins, ACE-2 inhibition and T cell responses to S protein were significantly higher than baseline (Table 1). Both humoral and cell-mediated immunity waned over time, but with no significant difference compared with HIV-individuals vaccinated with the same regimen. T and B cell-mediated immune responses to VOCs α, β, γ, and δ were detectable, although at lower magnitudes than wild type. Prior exposure to circulating β coronavirus HKU1 and OC43 was associated with measurable proliferative SARS-CoV-2 T cell response at baseline and a higher magnitude of post-vaccine T cell responses. Conclusion: Our data demonstrate no significant difference in ChAdOx1 nCoV-19 vaccine-mediated immune responses by HIV status. For all groups, we show waning but detectable immune responses against SARS-CoV-2 and VOCs 6 months after vaccination supporting the on-going policy to vaccinate against SARS-CoV-2 and reinforces the argument for long-term monitoring of responses.
ABSTRACT
This discussion paper addresses the safety of HIV cure studies, particularly those involving stopping antiretroviral therapy, known as an analytic treatment interruption (ATI) in the context of the SARS-CoV-2 pandemic. More than 30 studies listed on ClinicalTrials.gov include an ATI and many others were planned to begin over the next 12 months but most were halted due to the COVID-19 pandemic. We consider the ethics, risks and practical considerations to be taken into account before re-opening HIV cure clinical trials, noting the specific risks of ATI in the context of circulating SARS-CoV-2.