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The proceedings contain 159 papers. The topics discussed include: microelimination of hepatitis C among people living with diagnosed HIV in England;laboratory implementation of emergency department blood-borne virus (EDBBV) opt-out screening in a London tertiary center;a review of sexual health and blood-borne virus care provided to inmates at admission into UK prisons and secure facilities;implementation of routine opt-out blood-borne virus (BBV) screening in 34 emergency departments (EDs) in areas of extremely high HIV prevalence in England;impact and experiences of offering HIV testing across the whole city population through primary care clusters and GP surgeries in the texting 4 Testing (T4T) project;'Not PrEPared': barriers to accessing PrEP in England;HIV care during the SARS-COV-2 pandemic for Black people with HIV in the UK;clinical presentation of mpox in people with and without HIV;and 'if you don't know, how can you know?': a qualitative investigation of HIV pre-exposure prophylaxis knowledge and perceptions among women in England.
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Background: South Africa experienced five COVID-19 waves and over 90% of the population have developed immunity. HIV prevalence among adults is 19% and over 2 million people have uncontrolled viral loads, posing a risk for poor COVID-19 outcomes. Using national hospital surveillance data, we aimed to investigate trends in admission and factors associated with in-hospital COVID-19 mortality among people with HIV (PWH) in South Africa. Method(s): Data between March 5, 2020 and May 28, 2022 from the national COVID-19 hospital surveillance system, SARS-CoV-2 case linelist and Electronic Vaccine Data System were linked and analysed. A wave was defined as the period for which weekly incidence was >=30 cases/100,000 people. Descriptive statistics were employed for admissions and mortality trends. Postimputation random effect multivariable logistic regression models compared (a) characteristics of PWH and HIV-uninfected individuals, and (b) factors associated with mortality among PWH. Result(s): 68.7% (272,287/396,328) of COVID-19 admissions had a documented HIV status. PWH accounted for 8.4% (22,978/272,287) of total admissions, and 9.8%, 8.0%, 6.8%, 12.2% and 6.7% of admissions in the D614G, Beta, Delta, Omicron BA.1 and Omicron BA.4/BA.5 waves respectively. The case fatality ratio (CFR) among PWH and HIV-uninfected was 24.3% (5,584/22,978) vs 21.7% (54,110/249,309) overall, and in the respective waves was 23.7% vs 20.4% (D614G), 27.9% vs 26.6% (Beta), 26.2% vs 24.5% (Delta), 18.2% vs 9.1% (Omicron BA.1) and 16.8% vs 5.5% (Omicron BA.4/BA.5). Chronic renal disease, malignancy and past TB were more likely, and hypertension and diabetes were less likely in PWH compared to HIV-uninfected individuals. Among PWH, along with older age, male sex and presence of a comorbidity, there was a lower odds of mortality among individuals with prior SARS-CoV-2 infection (aOR 0.6;95% CI 0.4-0.8);>=1 dose vaccination (aOR 0.1;95% CI 0.1-0.1);and those admitted in the Delta (aOR 0.9;95% CI 0.8-0.9), Omicron BA.1 (aOR 0.5;95% CI 0.5-0.6) and Omicron BA.4/BA.5 (aOR 0.5;95% CI 0.4-0.7) waves compared to the D614G wave. PWH with CD4< 200 had higher odds of in-hospital mortality (aOR 1.9;95% CI 1.8-2.1). Conclusion(s): In South Africa, mortality among PWH was less likely in the Delta and Omicron waves but PWH had a disproportionate burden of mortality during the two Omicron waves. Prior immunity protected against mortality, emphasizing the importance of COVID-19 vaccination among PWH, particularly PWH with immunosuppression.
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Background: Given the paucity of data on safety and effectiveness of mRNA COVID-19 booster vaccinations in lower income settings with high HIV prevalence, we evaluated a heterologous mRNA-1273 (Moderna) boost after priming with 1 or 2 doses of Ad26.COV2.S (Janssen, Johnson & Johnson) vaccine among health care workers (HCWs) in South Africa. Method(s): SHERPA is an open-label, phase 3 mRNA-1273 booster study, nested in the Sisonke Phase 3b implementation trial, that vaccinated ~500000 HCWs with 1 or 2 doses of Ad26.COV2.S from Feb and Dec 2021. Sisonke participants were offered mRNA-1273 boosters between 23 May and 12 Nov 2022 (median 17 and 8 months after 1 and 2 Ad26.COV2.S, respectively), with data cut-off on 12 Dec 2022. Reactogenicity and adverse events (AEs) were self-reported via an online data entry link shared by SMS with participants 1, 7 and 28 days after boosting. Using national databases analyses are underway to compare effectiveness against COVID-19 infections and severe disease with Sisonke participants who did not receive the booster. Result(s): 12188 HCWs (79.5% female, 28.6% with self-reported previous COVID-19 diagnosis) received a mRNA-1273 booster, of whom 44.6% and 55.4% had received 1 and 2 prior Ad26.COV2.S vaccines in Sisonke, respectively. 3056 (25.2%) reported being HIV positive, more among those receiving only 1 previous Ad26.COV2.S (26.8% vs 23.9%), and 1.4% reported not being on antiretroviral therapy. 17.0% of participants reported hypertension and 6.4% diabetes mellitus. 262 participants (2.1% of women, 2.5% of men) reported 234 reactogenicity events and 95 AEs post-vaccination, with more reported by those with prior COVID-19 infection (3.5% vs 1.6%), HIV negative status (2.5% vs 1.2%) and those who received 2 prior doses of Ad26.COV2.S (2.4% vs 1.8%) (Table). Among 159 (1.3%) reporting injection site reactions the commonest were pain (59.7%), swelling (42.1%) and induration (20.1%). Of 177 (1.5%) systemic reactogenicity events (all grade 1 or 2 severity), the commonest were myalgia (69.5%), headache (67.8%) and fever (37.9%). 14 participants had AEs of special interest or serious AEs, of which 4 (all AESIs of ageusia or anosmia) were deemed related to the booster. 13 COVID-19 infections occurred a median of 125 days post booster vaccination (IQR 90-154) after 3477 person-years of follow up. Conclusion(s): A mRNA-1273 booster administered after 1 or 2 doses of Ad26. COV2.S was well tolerated regardless of HIV status, other chronic conditions or prior COVID-19 infection.
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Background. An estimated HIV prevalence of 9.2% for all transgender persons nationally with a significantly higher prevalence for transgender women at 14.1%. A paucity of published data exists defining the risk of HIV in transgender or nonbinary (TGNB) youth of color. The Bronx has the highest incidence of homelessness and the highest unemployment rate in the country, which peaked at 24.6% during COVID19. We assessed SDOH in TGNB youth of color and the impact on their ability to prioritize and access HIV prevention. Methods. An assessment of sexually active TGNB youth 14-27 years (N=101) in 2021-2022 was conducted to evaluate potential barriers to HIV prevention by querying the 4 U's: 1) Unemployed 2) Uninsured / Underinsured 3) Unstable housing and 4) substance Use disorder. The assessment also integrated questions about gender affirmation, HIV / STI prevention. Information obtained was used to assess knowledge gaps that affect their understanding of HIV risk. Based on the results, a research tool, ARTISTA (Assess Risk for Transmitted Infections in Sexually active Transgender Adolescents) was implemented to improve gaps in understanding HIV / STI risk in TGNB youth. Ultimately, ARTISTA can be used to influence policies for HIV Prevention in this population. Results. Patient's mean (+sd) age was 20 (+ 2.7) years, 50% were trans female, 50% trans male, 66% were youth of color. Gender affirming care was associated with increased odds of STI testing (adjusted odds ratio = 1.90 95% confidence interval = 1.33-2.73 with no relation to gender identity. Despite awareness, initiation of PrEP and adherence among trans females was disappointing. Trans females, 24%(10/41) initiated PrEP, 2 seroconverted;1 stopped and 7 are 70% adherent to daily oral PrEP. Unemployment (23%), Unstable housing (11%), Uninsured (10%) and Substance Use disorder (40%) were priorities over prevention. Conclusion. Gender affirmation is associated with an opportunity to improve awareness of HIV / STI prevention. ARTISTA assessment reveals it's not just about PrEP, but about the social / structural barriers to access and uptake. SDOH must be addressed in this population if we are serious about ending the epidemic.
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Introduction/ Background: Rapid, scalable point-of-care COVID-19 testing at community-level may hold the key towards diagnosis and control in resource-limited settings. Our initial door-to-door symptom-based strategy yielded low COVID-19 cases. We therefore investigated COVID19 case detection using a strategy of community hubs in a peri-urban community (~27,000) with high TB/HIV prevalence in Zambia. Methods: COVID19 screening was delivered using “community hubs”, walk-in testing locations staffed by 2 Community Health Workers serving 3000 to 4000 people. Between May-October 2021 4 hubs were operated in high-risk transmission hotspots changing location weekly. All persons attending the hubs were offered COVID-19 testing (Panbio-AgRDT and a PCR (Cepheid-Xpert-Xpress TM or VitaPCRTM RT-PCR assay (Credo Diagnostics Biomedical, Singapore), depending on availability) and symptoms screening;TB/HIV screening and testing;counselling and linkage to routine care. Qualitative methods included: mystery shoppers, focus group discussions with different groups and observations. Results: Over 6 months, 2956 people were screened at the hubs, 1724 (58%) males with median age 30 years. Prevalence of COVID19 suggestive symptoms was 18.3% (540/2956). A total of 2938 antigen tests were done and 168 (5.7%) were positive. For PCR testing, by Xpert Xpress 370/1270 (29.1%) were positive and 113/951 (11.9%) by VitaPCR;157 (5.3%) were positive on both. Test positivity was strongly associated with being symptomatic (p<0.001). Antigen test positivity rate was 1.6% in asymptomatic versus 24.2% in symptomatic;for Xpert-Xpress 20.6% versus 46.5% and for Vita PCR 4.2% versus 30.4% respectively. Qualitative results are available. Impact: This study aims to generate and evaluate models of community-based COVID-19 services to improve the trace-screen-test- isolate cascade and management by overcoming barriers, reducing stigma, and enabling communities to access rapid-testing. Rapid dissemination of key findings will mitigate the impact of the SARS-CoV2 epidemic and to help increase the knowledge. Conclusion: Delivering COVID-19 case-finding using mobile community hubs is feasible and acceptable and contributed towards the district and national COVID19 response in Zambia. Symptomatic persons have a significant higher chance of being detected with SARS-COV-2.
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Background and Aims: In Spain, HIV, HBV, and HCV prevalence are lower in females. A 2017–2018 Ministry of Health serosurvey in 7, 675 primary care patients found 0.35% and 0.08% chronic HCV infection in men and women. A previous opportunistic, population-based screening program in 11, 449 primary care patients seen in our health department found 0.18% and 0.06% HIV infection prevalence, 1.11% and 0.56% chronic HBV infection prevalence, and 0.73% and 0.25% chronic HCV infection prevalence in men and women from February to December 2019. We aimed to assess HIV, HBV, and HCV prevalence among women seeking care in our health department’s 5 Sexual and Reproductive Health Units (SRHU), in the Human Reproduction Unit (HRU), and the Obstetrics and Gynecology Service (OGS). Method: We implemented opportunistic HIV, HBV, and HCV screening from March to October 2021, despite challenges related to a fifth wave of the SARS-CoV-2 pandemic. We used existing infrastructure and staff, aided by electronic health record system modifications, to identify screening eligibility and request serologies. Patients were eligible for testing upon verbal consent if they were between 18 and 80, and had no record of testing in the previous year, and required blood tests in their current health care visit. Follow-up or discharge was given, regardless of test results. A case manager contacted positive patients to ensure and monitor linkage to specialist medical care. Herein we analyze data from patients aged 18 to 45 — the maximum age of patients seen in the HRU. Results: We screened 934 women, of whom 48.1% (449) in SRHUs, 26.0% (243) in the HRU, and 25.9% (242) in the OGS (26%). Regarding age and nationality,14.6.% (136)were aged 18 to 25, 45.5% (425)were 26 to 35, 39.9% (373) were 36 to 45, and 20.6% (192) were foreigners. We found 1 (0.1%) HIV antibody positive patient (a 45-year-old from the Dominican Republic), 1 (0.1%) HBV surface antigen positive patient (a 36-year-old from China), 1 (0.1%) HCV antibody positive patient, and no HCV RNA positive patients. Conclusion: HIV prevalence among Valencian women in reproductive and sexual health serviceswas similar to the general population in primary health care in the area. In contrast, chronic HBV infection prevalence was low, and chronic HCV infection was not found. Our data suggest that opportunistic HBV and HCV screening of women aged 18 to 45 out of populations at increased risk is an inefficient public health strategy in our area
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Background: In the U.S/Mexico border region, drug tourism (DT) has been linked to increased HIV risk among people who inject drugs (sharing injection equipment) and paying for sex. Sex and DT from the U.S. to Mexico drive bidirectional cross-border mobility, and have consequently played an important role in HIV spread in the border region, but prior to the COVID19 pandemic, HIV incidence remained <2 per 100 person years (PY). We assessed HIV incidence and associated risk factors among PWID during the COVID-19 pandemic. Methods: Participants are from La Frontera, a longitudinal study of PWID aged ≥18 from 3 groups: PWID who injected drugs in Tijuana ≤24 months ago but live in San Diego (SD DTs), and non-drug tourist (NDT) PWID, who live in SD county or Tijuana (TJ) but have never used illicit drugs across the border. Beginning in Oct/2020, participants underwent surveys and provided samples for HIV and SARS-CoV-2 serology every 6 months, and an egocentric social network (SN) survey. HIV prevalence, bivariate incidence-density rates, incident rate-ratios (IRR), and exact 95% confidence intervals (CI) were calculated for independent variables between baseline and follow-up. Results: To date, among 611 participants at baseline, HIV prevalence was 7.6% (SD DT: 3.8%, SD NDT: 3.5%, TJ NDT: 15.8%). Of the HIV-PWID returning for their 6 months visit thus far (n=286;93% follow-up), eight HIV seroconversions occurred during 118 PY of follow-up (Incidence: 13.53/100PY;95% CI: 5.84-26.66). Although not significant, incidence was notably higher among TJ NDT (19.9/100PY vs 1.82/100 PY SD DT vs 0 SD NDT;IRR 10.94, 95% CI 0.35, 22.59 TJ NDT vs SD DT), those who shared syringes/works with a network member (30.34/100PY vs. 7.31/100PY;IRR 4.15, 95% CI 0.37,9.19) and non-heterosexual participants (29.31/100PY vs 5.38/100PY;IRR 4.67, 95% CI 0.39, 9.67). Conclusion: Preliminary HIV incidence rates among PWID in the U.S./Mexico border region during the pandemic are high, and suggest a new HIV outbreak among PWID residing in TJ. Mobile harm reduction services providing syringes and HIV testing, as well as coordination with the municipal HIV program to allow for ART initiation and PrEP are urgently needed to prevent a continuing outbreak.
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Healthy life expectancy (HALE) measures the quality of life a person expects to live. This study aims to find out the most associated factors of HALE at birth globally. The data of 212 countries came from the World Health Organization, Worldometer, World Bank, and United Nations. HALE at birth is considered as the dependent variable;and social, economic, and health factors are considered as the predictors. Descriptive statistics, Pearson’s correlation analysis, and multiple linear regression models were used as the statistical tools to reach the objective. The results revealed that HALE is found lower in Central African Republic and higher in Singapore. The highest death rate due to coronavirus disease 2019 (COVID 19), alcohol consumption rate, human immunodeficiency virus (HIV) prevalence rate, and average household size are found in Nicaragua, Moldova Republic, Eswatini, and Senegal, respectively. And the lowest recovery rate from COVID 19, and universal health coverage (UHC) service index are found in Tajikistan, and Montserrat, respectively. The recovery rate from COVID 19, UHC service index, gross domestic product (GDP), current health expenditure, tuberculosis (TB) incidence, tobacco smoking, HIV prevalence rate and average household size were significantly correlated with the HALE at birth. The multiple linear regression models identified that the UHC service index, alcohol consumption rate, HIV prevalence rate and average household size are the most associate factors of HALE at birth globally. Therefore, the necessary steps should be taken to maximize the UHC service index, and to minimize the alcohol consumption rate, HIV prevalence rate and average household size for increasing the HALE at birth in the world.