The 'Antiretrovirals, Sexual Transmission Risk and Attitudes' (ASTRA) study. Design, methods and participant characteristics.

Andrew Speakman,Kazeem Aderogba,Jonathan Elford,Jane Anderson,Ed Wilkins Ed Wilkins,William J Burman,Richard Gilson,Simon Edwards,Martin Fisher,Margaret Johnson,Simon Collins,Monica Lascar,Graham Hart,Alison Rodger,Nicky Perry,Lorraine Sherr,Alec Miners,Andrew Phillips ,Anna María Geretti ,Rebecca O’connell ,Anne M Johnson ,Jeffrey J Mcdonnell ,Fiona Lampe

doi:10.1371/journal.pone.0077230

Abstract

Life expectancy for people diagnosed with HIV has improved dramatically however the number of new infections in the UK remains high. Understanding patterns of sexual behaviour among people living with diagnosed HIV, and the factors associated with having condom-less sex, is important for informing HIV prevention strategies and clinical care. In addition, in view of the current interest in a policy of early antiretroviral treatment (ART) for all people diagnosed with HIV in the UK, it is of particular importance to assess whether ART use is associated with increased levels of condom-less sex. In this context the ASTRA study was designed to investigate current sexual activity, and attitudes to HIV transmission risk, in a large unselected sample of HIV-infected patients under care in the UK. The study also gathered background information on demographic, socio-economic, lifestyle and disease-related characteristics, and physical and psychological symptoms, in order to identify other key factors impacting on HIV patients and the behaviours which underpin transmission. In this paper we describe the study rationale, design, methods, response rate and the demographic characteristics of the participants. People diagnosed with HIV infection attending 8 UK HIV out-patient clinics in 2011-2012 were invited to participate in the study. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire, and their latest CD4 count and viral load test results were recorded. During the study period, 5112 eligible patients were invited to take part in the study and 3258 completed questionnaires were obtained, representing a response rate of 64% of eligible patients. The study includes 2248 men who have sex with men (MSM), 373 heterosexual men and 637 women. Future results from ASTRA will be a key resource for understanding HIV transmission within the UK, targeting prevention efforts, and informing clinical care of individuals living with HIV.

Highlights

Effective anti-retroviral therapy (ART) has resulted in a dramatic improvement in life expectancy for those infected withHuman Immunodeficiency Virus (HIV) [1] [2] [3], at the same time as an increase in HIV prevalence in the United Kingdom (UK)
When using the limited information recorded in the study log to compare those that did (n=3258) and did not (n=942) return questionnaires, these groups were found to be similar in terms of gender (% female: 19.6% versus 21.5% for returners and non-returners respectively, χ2(1) = 1.8, p = 0.18), proportion with HIV viral load ≤50c/mL (76.3% versus 76.4%, χ2(1) = 0.008, p = 0.93) and proportion with CD4 count
The study recruited only during selected clinical sessions at each of the eight clinics, the total number of patients invited to participate represents a large proportion of all those attending the participating clinics over the study period (5112/12566 = 41%) and questionnaires were obtained from 26% (3258/12566) of this total clinic population

Summary

Introduction

Effective anti-retroviral therapy (ART) has resulted in a dramatic improvement in life expectancy for those infected withHuman Immunodeficiency Virus (HIV) [1] [2] [3], at the same time as an increase in HIV prevalence in the United Kingdom (UK). 96,000 it is estimated that 40,100 (42%) are men who acquired HIV from sex with men, 51,500 (54%) are men and women who acquired HIV through heterosexual sex and 2,300 (3%) acquired HIV through sharing drug injection equipment. The majority of those acquiring HIV through heterosexual sex (around 60%) are of African origin. Of those who are aware of their HIV infection and are under care, about 84% are taking ART. Many individuals infected with HIV by heterosexual transmission were born outside the UK and acquired HIV in their country of origin, there is evidence of ongoing heterosexual transmission within the UK [5] [6]

Methods

Results

Conclusion