Lights, camera research! Short film and social media to recruit to HIV research in Indonesia.

Introduction: HIV prevalence among men who have sex with men has increased in Indonesia, amid reports of growing stigma against lesbian, gay, bisexual and transgender individuals and policies that have pushed back public health outreach to these groups. Methods: We assessed the utility of tailored short film and targeted social media engagement to recruit men who have sex with men in Indonesia to HIV social science research. A short HIV testing promotion film, anonymised short survey and invite to a wider research study was embedded on a website platform and disseminated using geo and social/community group targeting for 1 month via a social networking app and social media platforms. Results: From 3 January 2021 to 3 February 2021, there were over 2200 hits of the website within Indonesia. A total of 177 male web users who identified as men who have sex with men or preferred not to declare their sexuality, engaged by watching the short film and completing the survey, they were aged between 17 and 60 years old, of Indonesian nationality and living in Indonesia. Of these, 88% indicated having at least one HIV test in their lifetime, 66% had felt shame with respect to their sexuality and 53% indicated feeling afraid to have a HIV test. Ninety (51%) of the 177 validated using their email or mobile phone number demonstrating willingness to be contacted to join a further study. Twenty-three eligible men who have sex with men, aged 21-55 years old, joined a further social science research study. Participants were from diverse backgrounds and included men born in provinces outside Bali, of different socio-economic and employment backgrounds and diverse relationship contexts. Discussion: Engaging, empowering digital media involving key health messaging can provide health education in more effective ways, build trust and bring communities together. Targeted digital and social media approaches could reach increasingly marginalised and vulnerable communities to promote individual and public health and enable recruitment to valuable medical research.

Post-exposure prophylaxis in the era of pre-exposure prophylaxis.

OBJECTIVES: 56 Dean Street (56DS), a sexual health clinic in London, provides a quarter of England's HIV post-exposure prophylaxis following sexual exposure (PEPSE). Since the limited introduction of pre-exposure prophylaxis (PrEP) in 2015, PEPSE demand has fallen. METHODS: We performed a case-note review of individuals who received PEPSE at 56DS in August 2018. RESULTS: Two hundred and forty three PEPSE were given; 97% (236) fitted recommended indications according to UK national guidance. Twenty-eight (12%) had documented prior PrEP use; the most common reason for not taking PrEP was lack of supply (15/28; 54%). Up to 1st April 2020, of 215 who had not previously used PrEP, 106 (49%) re-attended 56DS for PrEP initiation. CONCLUSIONS: At 56DS, PEPSE is appropriately given for high-risk HIV exposures. For those who use PrEP, It is important to support their adherence and ensure adequate supply. As PrEP uptake increases, the need for PEPSE may decrease.

Sexual behaviours and sexually transmitted infection outcomes in a cohort of HIV-negative men who have sex with men attending sexual health clinics in England.

Men who have sex with men (MSM) attending sexual health (SH) clinics are at high risk for HIV acquisition and are disproportionately affected by sexually transmitted infections (STIs). We collected standardised behavioural data from MSM attending clinics to characterise sexual behaviours and identify predictors for HIV and STIs. In 2012­2013, HIV-negative MSM attending five SH clinics in England reported sexual behaviours in the previous three months via a self-administered questionnaire. Behaviours were linked to the individual's clinical records using national surveillance. The prevalence and incidence of bacterial STIs (gonorrhoea, Chlamydia, lymphogranuloma venereum and syphilis) and incidence of HIV were calculated. Adjusted odds ratios and hazard ratios with 95% confidence interval (CI) were reported for significant predictors. Of 1278 HIV-negative MSM, 54% were of white ethnicity and UK-born and 43% were 25­34 years old. Almost all men reported at least one partner in the last three months. Half reported condomless anal sex and 36% condomless receptive anal intercourse (CRAI). Incidence of bacterial STIs was 46/100 (95%CI 39­54) person years (py) and of HIV was 3.1/100 (95%CI 1.7­5.6) py. A STI at baseline and CRAI with increasing numbers of partners were associated with both incident infections. In this cohort of MSM high-risk behaviours and STIs were prevalent. Engagement in CRAI increased the likelihood of subsequent infection, while men diagnosed with a bacterial STI were at increased risk of a future STI. Clinical and behavioural risk assessments to determine an individual's risk of infection could allow a more nuanced prevention approach that has greater success in reducing transmission.

High HIV incidence in men who have sex with men attending for postexposure prophylaxis: a service evaluation.

BACKGROUND/AIMS: There are limited outcome data for men who have sex with men (MSM) who have received HIV postexposure prophylaxis (PEP). The objective of this service evaluation was to determine HIV incidence and repeat PEP use among MSM PEP recipients in London, UK. METHODS: Retrospective electronic case-note review of all MSM who were prescribed PEP between January and April 2013 at a central London sexual health service. RESULTS: 530 MSM received PEP between 1 January and 30 June 2013. Of these, 449 had more than 30 days subsequent follow-up at our service. Median age was 31 years. PEP indication was unprotected anal intercourse, 98% (receptive 88% and insertive 10%) and other, 2%. Up to 1 November 2015, total follow-up was 756 person-years. 183 users received repeat PEP. The total number of repeat PEP courses was 442. 57 MSM newly acquired HIV: the HIV incidence was 7.6 per 100 person-years. CONCLUSIONS: PEP was associated with a high risk of subsequent HIV seroconversion in this cohort; this group may be appropriate candidates for pre-exposure prophylaxis.

Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation.

BACKGROUND: An estimated one in eight men who have sex with men (MSM) in London lives with HIV, of which 16% are undiagnosed. It is a public health priority to minimise time spent undiagnosed and reduce morbidity, mortality and onward HIV transmission. 'Dean Street at Home' provided an online HIV risk self-assessment and postal home HIV sampling service aimed at hard-to-reach, high-risk MSM. OBJECTIVES: This 2-year service evaluation aims to determine the HIV risk behaviour of users, the uptake of offer of home sampling and the acceptability of the service. METHODS: Users were invited to assess their HIV risk anonymously through messages or promotional banners on several gay social networking websites. Regardless of risk, they were offered a free postal HIV oral fluid or blood self-sampling kit. Reactive results were confirmed in clinic. A user survey was sent to first year respondents. RESULTS: 17 361 respondents completed the risk self-assessment. Of these, half had an 'identifiable risk' for HIV and a third was previously untested. 5696 test kits were returned. 121 individuals had a reactive sample; 82 (1.4% of returned samples) confirmed as new HIV diagnoses linked to care; 14 (0.25%) already knew their diagnosis; and 14 (0.25%) were false reactives. The median age at diagnosis was 38; median CD4 505 cells/µL and 20% were recent infections. 61/82 (78%) were confirmed on treatment at the time of writing. The post-test email survey revealed a high service acceptability rate. CONCLUSIONS: The service was the first of its kind in the UK. This evaluation provides evidence to inform the potential roll-out of further online strategies to enhance community HIV testing.

Is PEP prescribed appropriately?

We describe the characteristics of HIV post-exposure prophylaxis (PEP) recipients and PEP indications at 56 Dean Street, a central London sexual health clinic. PEP was prescribed on 577 occasions. Most (97%) was given for unprotected anal intercourse. Over a fifth of exposures involved recreational drug use. Of the patients prescribed PEP, 5.9% were given PEP more than once in this period. As a snapshot of HIV risk behaviour, we note the prevalence of drug use, sex without condom use and group sex among PEP recipients.

Does dropping day 5 PEP follow-up affect outcomes? An audit of HIV post-exposure prophylaxis at a central London sexual health clinic.

UK post-exposure prophylaxis (PEP) guidelines were updated by the British Association for Sexual Health and HIV (BASHH) in 2011. In 2013, we changed policy to omit day 5 PEP follow-up at 56 Dean Street as it was felt clinically unnecessary. This audit compares our performance against BASHH standards for PEP attenders during June 2012 and June 2013. We identified 162 PEP prescriptions; PEP assessment and appropriate sexually transmitted infection testing was done well. PEP completion rates and post-PEP HIV testing were lower than BASHH standards. Following omission of day 5 review, documentation that results have been checked was poor; however, attendance at follow-up was not adversely affected.

Interventions to increase access to STI services: a study of England's 'high-impact changes' across three central London clinics.

BACKGROUND: Increasing access to sexual health services is a key objective for the Department of Health in England and Wales. In 2006 it published 10 high-impact changes (HICs) designed to enhance 48 h access to genitourinary medicine services. However, there is limited evidence on the effectiveness of the proposed interventions. OBJECTIVE: To evaluate the implementation of five HICs in three sexual health clinics over 4 years. These HICs included a text message results service, nurse-delivered asymptomatic service, clinic refurbishment, a centralised booking service and an electronic appointment system. METHODS: The effect of HICs was evaluated by measuring clinical activity, number of sexual health screens performed, and patients seen within 48 h. These data were obtained from the clinic database, mandatory reports and Health Protection Agency waiting time surveys, respectively. RESULTS: The median number of new patients seen per month increased from 3635 to 4263 following the implementation of the five HICs. The follow-up/new patient ratio fell from 0.67 to 0.21 during the study. The biggest fall corresponded to a rise in patients receiving results by text message, from 0% to 40%. Only the centralised booking service was associated with a significant increase in the number of new patients seen. DISCUSSION: Providing results by text message was associated with a reduced number of follow-up patients, while implementation of a centralised booking service coincided with a significant increase in patient access. Further research is required to evaluate the relative importance of the other HICs.

OptionE: innovative model of HIV care increases satisfaction and reduces clinic visits.

OptionE incorporates nurse-led HIV clinics, review of blood results by doctors, patient contact by email and the option of home delivery of medication. Patient questionnaires showed increased satisfaction associated with fewer, shorter clinic visits. A retrospective case note review suggested clinical outcomes are as good as standard care.

KC60 coding: room for improvement--a study into consistencies and inconsistencies in the use of diagnosing codes.

Twenty mock cases were designed. Thirty-two doctors completed the study, assigning local and KC60 codes for service provision and diagnoses. They gave a wide range of responses, often missing codes or adding inappropriate ones. Where the diagnosis was clear, e.g. gonorrhoea, 97% assigned the correct KC60 code. However, the KC60 codes for service provision (S1, S2, P1A, P3, etc.) were frequently omitted, representing a significant underestimate of workload. Some local codes were given by only 6-28% of clinicians, and when they included them, doctors were more likely to omit KC60 codes. Low response rates for local codes renders these codes unhelpful. Simplification of coding procedures is needed so that diagnoses and workload are documented accurately. This is crucial at a time of modernization of genitourinary (GU) Medicine services and the introduction of Payment by Results.

A review of HIV point-of-care tests.

Current epidemiological data show a large proportion of those with HIV in the UK remain undiagnosed. There is high level of transmission of HIV and other sexually transmitted infections among men having sex with men (MSM). There is credible evidence that there are increasing rates of HIV transmission in heterosexuals. In MSM the uptake of confidential HIV testing is increasing although 43% of those who are HIV positive may leave the clinic unaware of their infection. Rapid access to genitourinary (GU) medicine services varies but there is still a significant problem with less than 50% of those attending GU medicine clinics not being seen within 48 hours. Within our speciality, new methods are being developed to help improve access to diagnostic services. One of these developments is the increasing use of rapid point-of-care tests, which may overcome some of the barriers to HIV testing and diagnosis. We look at the availability, practical implications, benefits and potential difficulties of implementing these devices in HIV testing services.

Young people's views on provision of sexual health services.

OBJECTIVES: To identify the sexual health needs of young people in order to establish a service suited to these needs. METHODS: A peer designed questionnaire piloted to a small group of young people was followed by a more widely distributed, amended questionnaire. The questionnaire survey was delivered to 744 pupils aged 11-18 years in six secondary schools and a pupil exclusion unit in central London. Factors encouraging or discouraging the use of young people's sexual health services were measured. RESULTS: Several findings challenged existing models of care for young people's sexual health services. Notably, pupils wanted clinics to run more frequently than the usual once a week; the staff attributes that were most important were attitudinal rather than to do with sex, age, or physical appearance; and they did not mind if the waiting room contained older people. Many findings, however, agreed with existing data-young people wanted the clinic to be open after school; girls preferred to attend with a friend; a confidential, walk-in service was preferred. CONCLUSIONS: Large financial outlays are not necessary for the establishment of effective sexual health services for young people. Existing facilities and staff may be utilised with training of these staff to be sensitive to, and aware of, the needs of young people. Clinic opening times should coincide with school closing times. Although pupils stated a preference for female staff, this was not a high priority. More important was feeling that staff would listen to them and take their problems seriously, and that confidentiality would be maintained.

Can targeted HIV testing campaigns alter health-seeking behaviour?

This paper describes the evaluation of 'gimme 5 minutes' a multimedia HIV testing campaign aimed at gay and bisexual men in London particularly targeting those of Black and South European Origin and those under the age of 25 years old using peer images. The text linked a summary of the key issues of a pre-test discussion with detailed information on how to access testing at a specified testing centre (campaign clinic). The number and demographics of men who reported sex with men (MSM) testing at the campaign clinic were monitored and compared with those testing at two other central London clinics. There was a 4.5-fold rise (p < 0.001) in MSM testing at the campaign clinic. Increases were proportionately greater in the sub-populations targeted with peer images: South European origin, 14-fold rise (p < 0.001), Black origin, 6.5-fold rise (p = 0.003), and MSM under 25 years old, 9.5-fold rise (p < 0.001). There were no significant changes in the number of MSM testing for HIV at the two other central London clinics studied. The results suggest that including detailed information about accessing testing services may be a vital ingredient in the success of media campaigns focusing on HIV testing.

Sexual health provision and the Sexual Health and HIV Strategy for England: a questionnaire survey of general practitioners' views.

An anonymous postal survey was used to assess the views of general practitioners (GPs) on the expected contents of the Department of Health National Sexual Health and HIV Strategy for England prior to release. One hundred and seventeen GPs in four London Primary Care Groups took part (response rate=50%). The majority felt they currently have about the right amount of involvement in patient care (HIV 70%: GUM 66%); 88% of GPs felt they offer general sexual health care (Level one), and most wished to continue with this (85%). However, a sizeable minority of GPs wanted to be involved in the development of care guidelines (HIV 17%; GUM 22%), and 10% considered that they might wish to offer more specialist services (Level two). To achieve a Strategy goal to integrate sexual healthcare services in England, it is likely that there will need to be local consultation and support for GPs.

Advising patients with genital warts--a consensus approach.

This article reviews the evidence available to guide practitioners when advising patients with genital warts, by seeking to answer the questions most commonly asked in medical practice. It highlights where evidence is lacking and is intended to inform patients about their condition, and to identify areas where further research is warranted.