STI Testing Research Articles

Sexually transmitted infections amongst men who have sex with men (MSM) in South Africa.

There is limited data about bacterial STIs in MSM populations in sub-Saharan Africa. Our retrospective analysis used data from the HVTN 702 HIV vaccine clinical trial (October 2016 to July 2021). We evaluated multiple variables. Polymerase chain reaction testing was conducted on urine and rectal samples to detect Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) every 6 months. Syphilis serology was conducted at month 0 and thereafter every 12 months. We calculated STI prevalence and the associated 95% confidence intervals until 24 months of follow-up. The trial enrolled 183 participants who identified as male or transgender female, and of homosexual or bisexual orientation. Of these, 173 had STI testing done at month 0, median age was 23 (IQR 20-25) years, with median 20.5 (IQR 17.5-24.8) months follow-up (FU). The clinical trial also enrolled and performed month 0 STI testing on 3389 female participants, median age 23 (IQR 21-27) years, median 24.8 (IQR 18.8-24.8) months FU and 1080 non-MSM males with a median age of 27 (IQR 24-31) years, median 24.8 (IQR 23-24.8) months FU. At month 0, CT prevalence was similar in MSM and females (26.0% vs 23.0%, p = 0.492) but was more prevalent in MSM compared to non-MSM males (26.0% vs 14.3%, p = 0.001). CT was the most prevalent STI among MSM at months 0 and 6 but declined from month 0 to month 6 (26.0% vs 17.1%, p = 0.023). In contrast, NG did not decline in MSM between months 0 and 6 (8.1% vs 7.1%, p = 0.680) nor did syphilis prevalence between months 0 and 12 (5.2% vs 3.8%, p = 0.588). Bacterial STI burden is higher in MSM compared to non-MSM males, and CT is the most prevalent bacterial STI amongst MSM. Preventive STI vaccines, especially against CT, may be helpful to develop.

Investigating point-of-care diagnostics for sexually transmitted infections and antimicrobial resistance in antenatal care in Zimbabwe (IPSAZ): protocol for a mixed-methods study

IntroductionSexually transmitted infections (STIs) can cause serious morbidity, including pelvic inflammatory disease, and adverse pregnancy outcomes. In low/middle-income countries, limited laboratory infrastructure has resulted in a syndrome-based approach being used...

STI and HIV testing: examining factors that influence uptake among domestic Australian-born, domestic overseas-born and international tertiary students studying in Australia

ObjectivesSexual health knowledge among international students in Australia is lower than domestic students, however, little is known about what factors affect the uptake of STI testing, nor if there are differences for overseas-born domestic students.MethodsWe included sexually active respondents from a survey of university students in Australia (N = 3,075). Multivariate regression and mediation analyses investigated associations of STI and HIV testing with STI and HIV knowledge respectively, sexual risk behaviour and demographics, including comparisons among: domestic Australian-born, domestic overseas-born, and international students.ResultsSTI and HIV knowledge was positively associated with STI and HIV testing respectively (STI OR = 1.13, 95% CI: 1.09, 1.16; HIV OR = 1.37, 95% CI: 1.27, 1.48). STI knowledge was significantly lower for international than domestic Australian-born students (10.8 vs. 12.2 out of 16), as was STI testing (32% vs. 38%); the difference in knowledge accounted for half the difference in STI testing rates between these two groups. International students from Southern Asia, and Eastern Asia reported the lowest STI testing rates. HIV testing was highest amongst international students from Africa and North America. Higher sexual risk behaviour, younger age, and identifying as gay or bisexual were positively associated with higher STI and HIV testing rates.ConclusionsOur study supports greater investment and commitment by universities for the provision of sexual health education that can promote access to testing to improve the health of their students.

Improving provider-initiated testing for HIV and other STI in the primary care setting in Amsterdam, the Netherlands: Results from a multifaceted, educational intervention programme.

In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands. GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done. GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04-1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63-1.19). HIV testing increased most among patients who were female and ≤19 or 50-64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01-1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05-1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97-0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing. The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.

The epidemic of HIV and syphilis and the correlation with substance abuse among men who have sex with men in China: A systematic review and meta-analysis.

In China, the HIV/AIDS epidemic among men who have sex with men (MSM) has been expanding in recent years. Substance abuse in MSM was not well studied as the independent risk factor for HIV and syphilis infection and other sexually transmitted diseases. The present review aimed to determine the correlation between HIV/Syphilis infections and substance abuse and other sexual risk behaviors among MSM. We conducted a comprehensive search of PubMed, Web of Science, Embase, Scopus, Chinese National Knowledge Infrastructure, Chinese Wanfang Data, and VIP Chinese Journal Database for relevant articles of quantitative studies published between 2010 and May 31, 2022. Meta-analysis was performed using R software. Pooled estimated of the association-odds ratio, with 95% confidence intervals were calculated using random-effects models stratified by study design. Q statistics and I2 were used to measure the heterogeneity. Our meta-analysis included 61,719 Chinese MSM from 52 eligible studies. The pooled HIV prevalence rate among substance-abusing MSM was 10.0% (95% CI = 0.08-0.13). Substance abusers were more likely to have a higher prevalence of HIV (OR = 1.59) and syphilis (OR = 1.48) infections than non-substance abusers. Substance abusers were also more likely to seek sexual partners through the internet or social media applications (OR = 1.63), engage in unprotected anal intercourse (UAI) (OR = 1.69), group sex (OR = 2.78), and engage in commercial intercourse (OR = 2.04) compared to non-users. Regarding testing behaviors, substance abusers had a higher proportion of HIV or STI testing in their lifetime (OR = 1.70) compared with non-substance abusers (p < 0.05). They were also more likely to have had more sexual partners (≥2; OR = 2.31) and more likely to have consumed alcohol (OR = 1.49) in the past 6 months. Our study shows the correlation between substance abuse and HIV/Syphilis infection. Eliminating disparities in HIV/Syphilis infection among substance abusing men who have sex with men (MSM) can be achieved if the Chinese government and public health sectors could provide targeted knowledge popularization and diagnosis interventions among high-risk populations.

STI testing and subsequent clinic attendance amongst test negative asymptomatic users of an internet STI testing service; one-year retrospective study.

To explore the characteristics of online STI test users, and assess the frequency and factors associated with subsequent service use following a negative online STI test screen in individuals without symptoms. One-year retrospective study of online and clinic STI testing within a large integrated sexual health service (Umbrella in Birmingham and Solihull, England) between January and December 2017. A multivariable analysis of sociodemographic and behavioural characteristics of patients was conducted. Sexual health clinic appointments occurring within 90 days of a negative STI test, in asymptomatic individuals who tested either online or in clinic were determined. Factors associated with online STI testing and subsequent clinic use were determined using generalized estimating equations and reported as odds ratios (OR) with corresponding 95% confidence intervals (CI). 31 847 online STI test requests and 40 059 clinic attendances incorporating STI testing were included. 79% (25020/31846) of online STI test users and 49% (19672/40059) of clinic STI test takers were asymptomatic. Online STI testing was less utilised (p<0.05) by men who have sex with men (MSM), non-Caucasians and those living in neighborhoods of greater deprivation. Subsequent clinic appointments within 90 days of an asymptomatic negative STI test occurred in 6.2% (484/7769) of the online testing group and 33% (4960/15238) for the clinic tested group. Re-attendance following online testing was associated with being MSM (aOR 2.55[1.58 to 4.09]-MSM vs Female) and a recent prior history of STI testing (aOR 5.65[4.30 to 7.43] 'clinic tested' vs 'No' recent testing history). Subsequent clinic attendance amongst online STI test service users with negative test results was infrequent, suggesting that their needs were being met without placing an additional burden on clinic based services. However, unequal use of online services by different patient groups suggests that optimised messaging and the development of online services in partnership with users are required to improve uptake.

The effects of COVID-19 on New York State’s Drug User Health Hubs and syringe service programs: a qualitative study

BackgroundSyringe service programs (SSPs) deliver critical harm reduction services to people who inject drugs (PWID). Some SSPs in New York State received enhanced funding to provide additional services to combat opioid overdose fatalities. These SSPs, known as Drug User Health Hubs, provide buprenorphine for the treatment of opioid use disorder and other health-related services in addition to their syringe services. While the COVID-19 pandemic posed widespread challenges to the delivery of health services nationwide, the effect of the pandemic on SSPs uniquely impacts PWID. This study examines the impact of COVID-19 on service delivery of Drug User Health Hubs and stand-alone SSPs in New York State.MethodsBetween July 2020 and September 2020, we performed eleven semi-structured virtual interviews with staff from three Health Hub SSPs and three stand-alone SSPs. The interviews explored the effect of the COVID-19 pandemic on SSPs and their clients as well as the changes implemented in response. Interviews were recorded and transcribed. We performed content analysis to identify emerging themes from the data.ResultsDue to the COVID-19 pandemic, some SSPs temporarily shut down while others limited their hours of operation. SSPs modified their service delivery to maintain syringe services and naloxone distribution over other services such as STI and HCV testing. They virtualized components of their services, including telemedicine for the provision of buprenorphine. While SSPs found virtualization to be important for maintaining their services, it negatively impacted the intimate nature of client interactions. Participants also described the impact of the pandemic on the well-being of PWID, including isolation, worsened mental health challenges, and increased drug overdoses.ConclusionsIn response to the COVID-19 pandemic, SSPs demonstrated innovation, adaptability, and togetherness. Despite the challenges posed by the pandemic, SSPs continued to be key players in maintaining access to sterile supplies, buprenorphine, and other services for PWID. In addition to adapting to COVID-19 restrictions, they also responded to the dynamic needs of their clients. Sustainable funding and recognition of the critical role of SSPs in supporting PWID can help to improve outcomes for PWID.

Prevent2Protect Project: Regulatory Focus Differences in Sexual Health Knowledge and Practices

The way people perceive risks and make decisions about their health is regulated by two motivational systems—prevention of harm or promotion of pleasure. People more focused on prevention strive to avoid negative outcomes and enact more health-protective behaviors. In contrast, people more focused on promotion strive to attain positive outcomes and take more risks with their health. Building upon recent evidence extending this framework to sexual behaviors and health, we conducted a pre-registered online survey (OSF) with Portuguese and Spanish adults (N = 742; Mage = 31.42, SD = 9.16) to examine whether self-reported STI knowledge and sexual health practices differ based on predominant regulatory focus. This study was part of the Prevent2Protect project (OSF). Results showed that prevention-focused participants had heard about more STIs and retrieved more of their knowledge from scientific sources but had been tested for fewer STIs in the past. In contrast, promotion-focused participants indicated they had specific knowledge about more STIs, retrieved more of their knowledge from medical and peer sources, and had been tested for more STIs in the past. They also reported more frequent STI testing, using free testing facilities or asking their family practice doctor to get tested, more routine sexual health check-ups, and more use of other contraceptive methods, such as birth control pills. These results remained unchanged after controlling for demographic differences. Overall, our findings showed that different motives in sexuality shape sexual health knowledge and sexual health practices.

Sexually transmitted infection testing and prevalence among MSM using event-based dosing HIV pre-exposure prophylaxis.

Event-based dosing (EBD) of HIV PrEP is as effective at preventing HIV transmission in MSM as daily dosing. There are limited data on the differences in STI testing frequency between MSM using EBD-PrEP and daily dosing. A total of 20% of 418 PrEP users were using EBD-PrEP and had a lower number of sexual partners (22 (27%) vs 142 (42%), P =0.008), tested for STIs less frequently (115 (18%) vs 69 (50%), P <0.001), but were diagnosed with a similar number of STIs ((35% vs 34%, P =0.54) compared to daily users. More research is needed to understand the optimal frequency for STI testing in MSM using EBD PrEP.

Impact of rapid near-patient STI testing on service delivery outcomes in an integrated sexual health service in the United Kingdom: a controlled interrupted time series study

ObjectivesTo evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service.DesignControlled interrupted...

Field Services-Facilitated Treatment and Prevention: Challenges and Opportunities.

Assisted partner services (APS) is a longstanding public health strategy to reduce transmission of sexually transmitted infection (STI) and human immunodeficiency virus in the United States. However, with rapidly increasing rates of STI, innovations to APS are needed to allow health departments to conserve limited public health resources while improving the effectiveness of APS. Disease Intervention Specialists (DIS), public health staff who conduct APS, have a wealth of experience in identifying, locating, and interviewing index patients and their sexual partners, but are currently limited in the services that they are able to provide in the field. Although several state and local health departments are working to expand the role of DIS to incorporate less traditional APS activities, such programs are uncommon. We discuss several services that DIS could conceivably provide in the field, such as STI testing, treatment, and vaccination, and identify critical issues to be addressed to implement these changes in DIS activities on a larger scale. Broadening the scope of DIS activities may result in multiple benefits to health departments, including more effectively delivering STI testing and treatment to hard-to-reach populations, imparting more responsibility to DIS, thereby potentially increasing job satisfaction, and building a workforce that is better prepared for public health crises. Effective approaches to address variable state level regulations governing DIS scope of practice are needed.

2212. Improving Sexually Transmitted Infection Co-testing in a Large Urgent Care Network

Abstract Background Sexually transmitted infections (STIs) remain a serious public health concern. The state of Utah has the lowest percentage of adults 18-64 years-old ever tested for HIV (26.5%) and the lowest percentage tested for HIV in the previous 12 months (6.5%). Increasing HIV testing in Utah is of the utmost importance. Delayed diagnoses and missed testing opportunities for HIV and other STIs exist. Encounters for evaluation of possible gonorrhea (GC) or chlamydia (CT) infection is a critical opportunity to co-test for HIV and syphilis. With continued growth, urgent care (UC) sites are well-positioned to increase STI diagnosis and treatment. We aimed to develop a multi-faceted quality improvement (QI) bundle to increase STI testing in our UC centers. Methods Intermountain Healthcare (IH) is a vertically integrated healthcare network predominantly in Utah and operates a network of 35 UC clinics across the state. In 2020, qualitative interviews to evaluate barriers to STI testing were performed with UC clinicians. Based on these interviews a QI initiative was designed and implemented throughout 2021. The bundle included clinician education, electronic health record (EHR) improvements, and automatic referral for patients with a new diagnosis of HIV to an Infectious Diseases (ID) physician (Methods Image 1). We compared co-testing rates before (July 2018 – December 2020) and after the intervention began (March 2021 – April 2022). Methods Table 1 The quality improvement (QI) initiative began in 2021 and consisted of multiple components as detailed below. Results 13,715 and 5,628 UC encounters were associated with GC/CT testing during the pre-intervention and intervention periods, respectively. HIV co-testing was performed in 2,784 (20.3%) GC/CT testing encounters in the pre-intervention period and in 1,674 (29.7%) encounters during the intervention, a relative increase of 37.6%. HIV/syphilis co-testing was performed in 2,304 (16.8%) GC/CT testing encounters and 1,225 (21.8%) encounters during the pre-intervention and intervention phases, respectively. From January 1 2022 – April 1 2022 3 new outpatient HIV diagnoses were identified. The average time from diagnosis to contact with an ID provider was 30.0 hours. Results Image 1 Co-testing rates for GC/CT UC encounters are presented for HIV (blue), syphilis (green), and HIV/syphilis (orange). Testing reagent quality issues in early 2022 lead to an abrupt decline in syphilis co-testing and once these issues were resolved co-testing trends returned to similar rates prior to the reagent quality issue and testing limitation. Conclusion Multi-modal QI initiatives may increase STI testing rates within UC centers of integrated healthcare systems. Further study is needed to optimize STI screening, diagnosis, and care in UC centers. Disclosures Kimberly D. Brunisholz, PhD, MST, Johnson and Johnson: Advisor/Consultant.

2083. HIV Testing Rates in NC Emergency Departments Before and During Covid Mitigation

Abstract Background During the early stages of the COVID-19 pandemic, non-emergent services were limited or suspended in multiple ways. Restrictions in primary care may have limited STI testing, such as HIV, where timely access to testing and care is critical to mitigation efforts. Conversely, Emergency Departments (ED) operated with fewer restrictions and more in-person options. Even though patient census numbers decreased in some areas from those seen pre-covid lockdown, EDs and hospitals often became overwhelmed with patients seeking care for both severe acute illness but just importantly services that might normally have been received in outpatient settings. Methods Observational study of HIV screening year-over-year in four EDs that are part of a large healthcare system located in the Southeast. Screenings of individuals 18 and over seen in the EDs were normalized per 1000 patients. Rates were also compared to two primary care clinics, located in the same metropolitan area, serving mainly Medicaid and uninsured patients. Results From March 2019 through February 2020 there were 33.47 tests per 1000 patients at two community clinics and 7.79 tests per 1000 patient at four EDs located in the same region during that span. From March 2020 to February 2021, screening numbers in the primary care clinics dropped to an average of 22.7/1000; however, screenings in the ED remained stable and slightly increased to 10.7/1000. From March 2021 to February 2022, screenings in the primary care clinics returned to an average 36.9/1000 with screenings in the ED still above pre-covid levels at 9.48/1000. These trends in the ED screening remained consistent across gender, race, and ethnicity. Patient census at four ED sites located in the southwestern region of North Carolina dropped significantly during the first year of physical distancing covid-19 mitigation measures when compared to the two years prior. These census numbers increased during the second year of covid-19 but failed to return to previous levels. During the first year of physical distancing covid-19 mitigation measures HIV testing rates in the emergency department remained constant, and even increased in more urban areas, despite the significant decrease in overall patient census. Conclusion With the observation that HIV screening decreased in primary care settings during the beginning of the covid-19 pandemic, there exists the possibility that new HIV infections may yet remain undiagnosed. That HIV testing remained constant in the ED, however, reinforces the importance of having embedded procedures in place for screening and linking both newly positive and at-risk patients into care to help mitigate the HIV epidemic. Disclosures All Authors: No reported disclosures.

2091. Transgender Adolescents of Color and HIV: Unique Challenges in Preventing New Infections

Abstract 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 non-binary (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. Disclosures All Authors: No reported disclosures.

Impact of COVID-19 on HIV service delivery in Miami-Dade County: a mixed methods study

BackgroundFacilitating access to HIV prevention and treatment is imperative in Miami-Dade County (MDC), a U.S. HIV epicenter. With COVID-19, disruptions to these services have occurred, leading HIV organizations to innovate and demonstrate resilience. This study documented COVID-19 related disruptions and resilient innovations in HIV services within MDC.MethodsThis mixed methods cross-sectional study included HIV test counselors in MDC. In the quantitative component (N=106), participants reported COVID-19 impacts on HIV service delivery. Data visualization examined patterns within organizations and throughout the study period. Generalized estimating equation modeling examined differences in service disruptions and innovations. In the qualitative component, participants (N=20) completed interviews regarding COVID-19 impacts on HIV services. Rapid qualitative analysis was employed to analyze interviews.ResultsQuantitative data showed that innovations generally matched or outpaced disruptions, demonstrating resilience on HIV service delivery during COVID-19. HIV testing (36%, 95%CI[28%, 46%]) and STI testing (42%, 95%CI[33%, 52%]) were most likely to be disrupted. Sexual/reproductive health (45%, 95%CI[35%, 55%]), HIV testing (57%, 95%CI[47%,66%]), HIV case management (51%, 95%CI[41%, 60%]), PrEP initiation (47%, 95%CI[37%,57%]), and STI testing (47%, 95%CI[37%, 57%]) were most likely to be innovated. Qualitative analysis revealed three orthogonal themes related to 1) disruptions (with five sub-components), 2) resilient innovations (with four sub-components), and 3) emerging and ongoing health disparities.ConclusionsHIV organizations faced service disruptions during COVID-19 while also meaningfully innovating. Our findings point to potential changes in policy and practice that could be maintained beyond the immediate impacts of COVID-19 to enhance the resilience of HIV services. Aligning with the US Ending the HIV Epidemic Plan and the National Strategy for HIV/AIDS, capitalizing on the observed innovations would facilitate improved HIV-related health services for people living in MDC and beyond.

Risk Factors and Incidence of Sexually Transmitted Infections in the Swiss HIV Cohort Study.

Sexually transmitted infections (STIs) are common among people with human immunodeficiency virus (PWH), but there are limited data about risk factors and incidence of STIs in large, representative cohort studies. We assessed incidence and risk factors of STIs reported by treating physicians within the Swiss HIV Cohort Study (SHCS). Sexually transmitted infections and demographic, clinical, and behavioral characteristics were prospectively collected at 6-month follow-up visits between October 2017 and November 2019. We used multilevel Poisson regression to assess incidence rate ratios of different STIs. Among 10 140 study participants, a total of 1634 STIs in 1029 SHCS participants were reported over 17 766 person-years of follow up (PYFUP). The overall incidence of any reported STI was 91.9 per 1000 PYFU (95% confidence interval [CI], 85.8 -98.5). Among the 1634 STI episodes, there were 573 (35.1%) incident cases of syphilis, 497 gonorrhea (30.4%), and 418 chlamydia (25.6%). Men who have sex with men (MSM) younger than 50 years represented 21% of the study population, but accounted for 61% of reported STIs. Male sex (adjusted incidence rate ratio [aIRR], 2.03; 95% CI, 1.36-3.02), MSM (aIRR, 3.62; 95% CI, 2.88-4.55), age group 18-34 years (aIRR, 1.78; 95% CI, 1.51-2.10), history of sexual relationships with occasional partners (aIRR, 6.87; 95% CI, 5.40-8.73), and reporting injecting drug use (aIRR, 2.48; 95% CI, 1.91-3.23) were associated with a higher risk of incident STIs. Sexually transmitted infections were frequent among PWH and varied considerably between age and risk groups. Screening programs and recommendations for STI testing need to be adapted according to risk factors and demographic characteristics.

Introducing video consultations at public sexual health clinics in the Netherlands: a mixed-methods study.

SummaryVideo consultations (in combination with remote STI testing) can benefit both public sexual health clinics (SHCs) and their clients. The Dutch public SHCs explored the extent to which video consultations are accepted and appreciated—compared to face-to-face consultations—by both young clients (under 25 years) and nurses who normally carry out consultations. A mixed-methods study, using online questionnaires and telephone interviews with both young clients (aged under 25 years) and nurses (focus groups), was conducted to evaluate acceptance and appreciation of video and face-to-face consultations of the SHCs. Young clients evaluated 333 video consultations and 100 face-to-face consultations. Clients rated the VCs and F2F consultations as being of equal high level on five evaluation criteria (e.g. how it feels to talk about sex with a nurse, contact with the nurse). These positive results were confirmed in the interviews. Most important perceived advantages of VCs were time saving, ease, and feelings of comfort and safety. The nurses evaluated 422 VCs and 120 F2F consultations, rating the VCs and F2F consultations on an equal high level on three evaluation criteria (e.g., contact with the client, possibility to continue asking questions). Increasing accessibility of SHC consultations, getting faster to the point and saving time were mentioned as advantages of VCs during the focus group sessions with nurses. Video consultations are accepted and appreciated by young clients and nurses. They can be used for standard STI consultations that do not require a physical examination.

Changes in high-risk sexual behavior, HIV and other STI testing, and PrEP use during the COVID-19 pandemic in a longitudinal cohort of adolescent men who have sex with men 13 to 18 years old in the United States.

The COVID-19 pandemic has disrupted sexual health services among those most vulnerable to HIV acquisition, such as adolescent men who have sex with men (AMSM). We sought to characterize the changes in sexual-risk behaviors, HIV and other STI testing, and pre-exposure prophylaxis (PrEP) use among a longitudinal cohort of AMSM aged 13 to 18 years before and during the COVID-19 pandemic. We observed a significant decline in HIV testing and a marginal decrease in other STI testing since the pandemic began in March 2020. Outreach efforts and innovative remote delivery of sexual health services are needed to support access to healthcare services among AMSM as the pandemic persists.

Awareness of HIV pre-exposure prophylaxis among men who have sex with men using apps for sexual encounters in Turkiye.

New HIV diagnoses are rising in Turkiye. Men who have sex with men (MSM) are estimated to be the main driver of the epidemic. Pre-exposure prophylaxis (PrEP) was proven to be effective in reducing new HIV diagnoses and PrEP recently became available in Turkiye. To assess awareness of and willingness to use PrEP and the level of off-licence use among MSM. An anonymous self-completed questionnaire was sent out over the Hornet Gay Social Network from December 2019 to February 2020, available in Turkish and Arabic. It included 20 questions on HIV and STI testing, PrEP awareness, PrEP use, willingness to use, chemsex and sexual happiness level. Overall 4761 respondents who responded to more than 1/3 of the questions were eligible for analyses; 5.5% was Arabic speaking. The mean age was 30.5years, 31.4% had never tested for HIV, 40.5% knew what PrEP was, the most common source of knowledge was the internet (44.5%), 2.5% (120) had used PrEP in the last 12months and 1.7% (83) was current users. PrEP users had accessed drugs over the internet (47.6%), pharmacy (23%), and friends (13.8%). Almost 40% were willing to use PrEP in the following 6months. Younger and Arabic speaking respondents had lower rates of HIV testing (p = .001) and lower awareness for PrEP than comparators (p = .004). Awareness and willingness to use PrEP is high among MSM in Turkiye. The recent availability of PrEP in the country is a big step forward in terms of prevention.

Perceptions and Experiences of Returning Self-collected Specimens for HIV, Bacterial STI and Potential PrEP Adherence Testing among Sexual Minority Men in the United States.

Few studies among gay, bisexual and other men who have sex with men (GBMSM) have examined facilitators and barriers to self-collecting specimens for extragenital STI screening, and none have evaluated attitudes towards self-collecting hair samples that can be utilized for PrEP drug level testing to assess adherence. To address this gap, we interviewed 25 sexually active GBMSM who were offered a choice to self-collect and return finger-stick blood samples (for actual HIV testing), pharyngeal swabs, rectal swabs and urine specimens (for actual gonorrhea and chlamydia testing), and hair samples (to visually determine their adequacy for PrEP drug level testing): 11 who returned all, 4 who returned some, and 10 who did not return any. Participants found self-collecting finger-stick blood samples and rectal swabs more challenging than other specimens. Frequently discussed facilitators of return included an opportunity to confirm one’s HIV or STI status, limited access to a healthcare provider and a desire to advance research focusing on home-based testing. Commonly cited barriers to return included low self-efficacy pertaining to self-collection and apprehension around the possibility of delay or loss of specimens during transit. Offering additional support such as real-time video conferencing may prove helpful in future field-based research with GBMSM.