Substance Use and Sex Index version 2 (SUSI-2): Validation of a brief questionnaire for the measurement of behaviours associated with transmission of blood borne viruses and sexually transmitted infections.

Background: Organ donor referrals may be declined when social or medical history suggests increased risk of blood borne virus (BBV) transmission, although this information can be limited. Inaccurate risk assessments can lead to either missed opportunities for donation, or transmission of BBV to recipients. We aimed to identify potential missed opportunities, when referrals were declined due to perceived BBV risk, and BBV transmissions via transplantation. Methods: We used the New South Wales (NSW) Biovigilance Public Health Register, SAFEBOD. This register linked donor referrals in NSW to administrative health databases, including hospital admissions data, notifiable conditions information management system and the death register. For missed opportunities, we examined BBV diagnoses in linked health data for donor referrals (2010-2015) who did not donate due to perceived increased viral risk for HIV, Hepatitis B (HBV) and Hepatitis C (HCV); this included those with active or past infection (based on serology or medical report), or high risk behaviour at referral. For transmissions, we examined donor-recipient pairs 2000-2015 for new BBV diagnoses in linked-health data within 12 months after transplant, and classified transmissions using a standardised algorithm (Green, 2015). Results: Of 2,961 persons referred for organ donation in NSW (2010-2015), there were 1,164 persons eligible for donation. 165 persons did not donate due to perceived increased BBV risk (Figure 1), and 33 of these 165 (20%) had no evidence of any BBV infection up to their terminal contact with health services. In NSW (2000-2015), 2,194 organ donors donated 3,940 organs to 2765 recipients. 2,096 donors had baseline BBV transmission risk and 98 had increased BBV transmission risk. There were 3 proven/probable transmission events (2 HBV, 1 HCV), all from donors with active or past BBV (Figure 2). There were no deaths due to transmissions. Conclusions: BBV risk assessments are largely accurate with few transmissions but up to 20% rejected referrals may be missed opportunities. Routinely collected administrative health data may provide a useful additional information source to aid decision-making.

Australian Aboriginal and Torres Strait Islander people experience disproportionately higher rates of sexually transmissible infections (STIs) and blood borne viruses (BBVs) when compared with the non-Indigenous population. Both incidence and prevalence data for bacterial STIs, such as chlamydia, gonorrhea, trichomonas, and syphilis in remote areas of Australia are reported at rates many times higher than that of non-Indigenous Australians. Similarly, rates of hepatitis B are disproportionately higher for non-Indigenous people in remote communities. The Young Deadly STI and BBV Free project was designed to increase the uptake of STI and BBV testing and treatment in young Aboriginal and Torres Strait Islander people living in remote and very remote areas of South Australia, Western Australia, Queensland, and the Northern Territory. Peer education formed one component of this pilot project and involved training up to 100 young Aboriginal and Torres Strait Islander people across 19 communities in a culturally appropriate and respectful manner on the transmission, testing, and treatment of STIs and BBVs. The trained peer educators were then required to deliver three community education sessions to young people in their respective communities in an effort to raise awareness about STIs and BBVs and encourage testing and treatment uptake. Preliminary evaluation findings, limited to the trained peer educators, revealed the peer educator training program contributed to STI and BBV knowledge gains among the trained peer educators and positively influenced their behavioral intentions and attitudes pertaining to STIs and BBVs. Working with remote Aboriginal and Torres Strait Islander populations on a highly sensitive, stigmatized topic presented many methodological challenges, particularly in terms of ensuring the collection of reliable evaluation data across geographically remote communities. The challenges and strengths associated with the implementation of the peer education training program along with implications for developing culturally inclusive evaluation practices will be discussed.

To investigate risk behaviours associated with the transmission of blood borne viruses (BBVs) and sexually transmitted infections (STIs) among transient rural workers in Victoria. Cross-sectional study using a convenience sampling frame. Between June and August 2006, 89 participants were recruited from sites located in three rural centres in Victoria's Loddon and Mallee regions. Data were collected using a short questionnaire that asked about history of transient work, sexual history, condom use, alcohol and illicit drug use, and BBV history and testing. Finger-prick blood samples were collected in order to determine prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) exposure. Eighty-nine individuals completed a questionnaire, and 85 (96%) provided a finger-prick blood sample for antibody testing. Twenty-seven participants (30%) were consuming alcohol at levels risky to health. Thirty per cent of participants with new partners reported infrequent condom use. Illicit drug use (mainly marijuana) was widespread with more than 46% of the sample reporting recent use of illicit drugs. An HCV exposure prevalence of 2.4% was measured; no samples tested reactive for HIV antibodies. Compared with nationally representative data, our study sample reported high rates of alcohol consumption at levels risky to health, illicit drug use and infrequent use of condoms. These results suggest that transient workers and their contacts would benefit from the targeted provision of harm-reduction services, with a particular focus on sexual behaviour and alcohol and drug use.

The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women. This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment. A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing. The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group.

Prisoners frequently engage in high risk behaviours for sexually transmitted infections (STIs) and blood borne viruses (BBVs) and effective interventions are required to control the transmission of STIs and BBVs among prisoners. The variation in engagement in high risk behaviours among prisoner sociodemographic sub-groups in Western Australia, including differences between prisoners admitted to metropolitan and regional prisons, has not been systematically described. The objective of this article was to describe self-reported engagement in unprotected sex and sharing injecting equipment among prisoners on admission to prison in Western Australia, using routinely collected data. A retrospective medical record audit was conducted for a total of 946 individuals admitted to prisons in Western Australia. Quota sampling was used to ensure adequate sampling of females, juveniles, and individuals from regional prisons. Initial health assessment records completed on admission to prison in Western Australia were audited to evaluate self-reported engagement in unprotected sex and the sharing of injecting equipment among prison entrants. Unprotected sex in the previous 12 months was reported by 48% of prisoners, and ever sharing injecting equipment was reported by 16% of prisoners. Adults were more likely to report both unprotected sex (52%) and sharing injecting equipment (18%) than juveniles (40% and 11%, respectively). Adults admitted to a metropolitan prison were significantly more likely to report sharing injecting equipment (23%) than adults admitted to a regional prison (10%). Associations between risk behaviours, sex and Aboriginality differed among prisoners admitted to metropolitan and regional prisons. There is distinct sociodemographic patterning of high risk behaviours among prisoners in Western Australia by age, sex, Aboriginality and prison location. The effectiveness of interventions to prevent STI and BBV transmission in prisoners may be enhanced by addressing the diversity in the prison population, including the differences identified in reported risk behaviours between prisoners admitted to metropolitan and regional prisons. Culturally appropriate and comprehensive interventions are required to promote risk-reducing behaviours and address the health needs of all prisoners in Western Australia.

Purpose Sexually transmitted infections (STIs) and blood-borne viruses (BBVs) present a global health challenge as rates continue to rise among incarcerated adults. This paper aims to identify existing interventions used to reduce STIs and BBVs in incarcerated adult populations. Design/methodology/approach This review followed JBI methodology and considered studies from any adult incarceration facility in any language. Any intervention for reducing STIs and/or BBVs transmission was included. Databases searched included PubMed, CINAHL (EBSCO), Ovid Platform, PsycINFO (EBSCO), Cochrane CENTRAL and Scopus. Two independent reviewers screened titles, abstracts and full texts. The JBI standardized critical appraisal instruments were used to consider methodological quality. Findings are presented in narrative format. Findings Twenty-two studies were included in the review. Studies were conducted across a wide range of countries. While multiple distinct interventions and programs were used, many of the studies reported reductions in the number of STIs and/or BBVs. Overall, there is some evidence to support the introduction of targeted programs in correctional settings to reduce the number of STIs/BBVs. Further research on this topic using higher quality study designs is needed. Originality/value To the best of the authors’ knowledge, this systematic review summarizes and presents the most recent research on any type of quantitative design or intervention to reduce STIs and/or BBVs in incarcerated adults, including studies conducted in all geographical locations.

This review will identify, synthesize, and make recommendations regarding the effectiveness of interventions to reduce sexually transmitted infections (STIs) and blood-borne viruses (BBVs) in incarcerated adult settings. High-risk sexual behaviors, intravenous drug use, piercing, and tattooing are well documented within incarceration environments. Despite the World Health Organization's Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 and the Global Health Sector strategies on, respectively, HIV, viral hepatitis, and sexually transmitted infections for the period 2022-2030, STI rates within adult incarceration environments continue to rise. Identifying and implementing best-practice interventions to prevent and manage STIs and BBVs will aid infection reduction in correctional settings. The review results will inform the development of educational programs, health promotion, and policies and procedures to improve health outcomes for incarcerated populations. This review will consider studies in any language from any adult incarceration facility. Studies set in juvenile facilities or detention centers will be excluded. Any intervention for preventing or reducing STI and/or BBV transmission will be included. This review will follow the JBI methodology for systematic reviews of effectiveness. Databases to be searched will include PubMed, CINAHL (EBSCO), Ovid Library, PsycINFO (EBSCO), Cochrane CENTRAL, and Scopus. Two independent reviewers will screen titles and abstracts and assess full-text citations against the inclusion criteria. Methodological quality will be appraised using JBI's standardized critical appraisal instruments. Where possible, studies will be pooled using meta-analysis. Where statistical pooling is not possible, findings will be presented in narrative format. Certainty of evidence will be ascertained using the GRADE approach. PROSPERO CRD42022325077.

You are asked to see a previously well 5-year-old boy who presented to the accident and emergency department. While playing in a public park he picked up a discarded 1...

2020 STD Prevention Conference: Disrupting Epidemics and Dismantling Disparities in the Time of COVID-19.

Although it is well documented that bloodborne viruses (BBVs), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) have been transmitted from patients to healthcare workers (HCWs), there has also been reported transmission from HCWs to patients during the provision of health care. With remarkable progress in infection prevention, diagnosis tools, treatment regimens and major improvements in guideline development methodology, there was a need to develop an evidence-based guideline to replace the 1998 Canadian consensus document for managing HCWs infected with BBVs. This article summarizes the Canadian Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings. A Guideline Development Task Group was established and key questions developed to inform the guideline content. Systematic reviews were conducted to evaluate the risk of HCW-to-patient transmission of HIV, HCV and HBV. Environmental scans were used to provide information on Expert Review Panels, disclosure of a HCW's serologic status and lookback investigations. Federal, provincial and territorial partners and key stakeholder organizations were consulted on the Guideline. The risk of HCW-to-patient BBV transmission was found to be negligible, except during exposure-prone procedures, where there is a risk that injury to the HCW may result in exposure of a patient's open tissues to the HCW's blood. Risk of ensuing transmission and the rate of transmission varied by BBV, and were lowest with HIV and highest with HBV. The Guideline provides key content, including recommendations regarding criteria to determine if a procedure is an exposure-prone procedure, management of HCWs infected with a BBV, including considerations for the HCW's fitness for practice, Expert Review Panels, HCW disclosure obligations and right to privacy and lookback investigations. This new Guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations related to preventing HCW-to-patient transmission of BBVs during the provision of care.

We review the effects of war on HIV and STI transmission and critically appraise short- and medium-term approaches to prevention. Our intent is to stimulate thinking about the potential for increased HIV/STI transmission in current and future armed conflicts with particular reference to Afghanistan and to encourage timely interventions to prevent a worsening HIV epidemic in Central and South Asia. (excerpt)

Issue/problemAt a series of health promotion events run by a clinical and social care service in the Dublin and Midlands region of Ireland, infection prevention and control (IPC) was compromised during blood glucose testing. At three events in 2024, single-person lancet devices were inadvertently reused on multiple individuals, comprising both service users and staff. The incident reflects potential broader gaps in IPC oversight for non-clinical settings, as well as specific risks associated with the shared use of single-person lancet devices.Description of the problemThe IPC breach was identified after the events, requiring Public Health and virology input to assess the risk of bloodborne virus (BBV) transmission. A rapid literature review found risks of Hepatitis B and C virus transmission from inadequate IPC during glucometry, with minimal risk for HIV. A risk assessment was completed using these findings and expert input. Open disclosure was undertaken and BBV testing offered to all affected individuals. Of 220 attendees, approximately 120 had blood glucose testing. Among them, 25 staff and 7 service users agreed to BBV testing.ResultsNo BBV infections were identified among the 32 individuals tested. However, the incident identified important gaps in training and IPC protocols for individuals conducting blood glucose testing at health promotion events. This incident highlights the need for strengthened IPC guidance for health promotion events and wider communication regarding the risks associated with the shared use of single-person lancet devices.LessonsThis incident underscores the need for structured IPC protocols, training and risk communication beyond clinical environments, particularly in relation to blood glucose testing. Guidance for health promotion events should include IPC considerations. These lessons are applicable beyond Ireland and may inform similar health promotion events in other countries.Key messages• Guidance for health promotion events should include infection prevention and control considerations, particularly in relation to blood glucose testing.• Individuals performing blood glucose testing should be trained on the risks of bloodborne virus transmission associated with the improper use of glucometry equipment.

Understanding experiences of and rationales for sharing crack-smoking equipment: A qualitative study with persons who smoke crack in Montréal

BackgroundPassive surveillance is the principal method of sexually transmitted infection (STI) and blood-borne virus (BBV) surveillance in Australia whereby positive cases of select STIs and BBVs are notified to the state and territory health departments. A major limitation of passive surveillance is that it only collects information on positive cases and notifications are heavily dependent on testing patterns. Denominator testing data are important in the interpretation of notifications.ObjectiveThe aim of this study is to establish a national pathology laboratory surveillance system, part of a larger national sentinel surveillance system called ACCESS (the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance). ACCESS is designed to utilize denominator testing data to understand trends in case reporting and monitor the uptake and outcomes of testing for STIs and BBVs.MethodsACCESS involves a range of clinical sites and pathology laboratories, each with a separate method of recruitment, data extraction, and data processing. This paper includes pathology laboratory sites only. First established in 2007 for chlamydia only, ACCESS expanded in 2012 to capture all diagnostic and clinical monitoring tests for STIs and BBVs, initially from pathology laboratories in New South Wales and Victoria, Australia, to at least one public and one private pathology laboratory in all Australian states and territories in 2016. The pathology laboratory sentinel surveillance system incorporates a longitudinal cohort design whereby all diagnostic and clinical monitoring tests for STIs and BBVs are collated from participating pathology laboratories in a line-listed format. An anonymous, unique identifier will be created to link patient data within and between participating pathology laboratory databases and to clinical services databases. Using electronically extracted, line-listed data, several indicators for each STI and BBV can be calculated, including the number of tests, unique number of individuals tested and retested, test yield, positivity, and incidence.ResultsTo date, over 20 million STI and BBV laboratory test records have been extracted for analysis for surveillance monitoring nationally. Recruitment of laboratories is ongoing to ensure appropriate coverage for each state and territory; reporting of indicators will occur in 2019 with publication to follow.ConclusionsThe ACCESS pathology laboratory sentinel surveillance network is a unique surveillance system that collects data on diagnostic testing, management, and care for and of STIs and BBVs. It complements the ACCESS clinical network and enhances Australia’s capacity to respond to STIs and BBVs.International Registered Report Identifier (IRRID)DERR1-10.2196/13625

Assessing the prevalence of HIV, HBV, and HCV infection among people with severe mental illness