Sexual Health Clinic Research Articles

Potential public health impacts of gonorrhea vaccination programmes under declining incidences: A modeling study.

Gonorrhea is the second most common sexually transmitted disease notified in Singapore in 2023. Evidence suggests that the 4CMenB vaccine designed to protect against Neisseria meningitidis infection may offer partial cross-protection against gonorrhea. This generated interest in using 4CMenB for the purpose of staving gonorrhea transmission. We explored the efficacy of potential gonorrhea vaccination strategies in the context of historically declining gonorrhea incidence. We employed an integrated transmission-dynamic model, calibrated using Bayesian methods to local surveillance data to understand the potential public health impact of 4CMenB in reducing gonorrhea acquisition and transmission in men who have sex with men (MSM) in Singapore. We explored the efficacy of implementing six vaccination programmes: (1) offering vaccination to all male adolescents in schools (vaccination before entry [VbE]), (2) offering vaccination to individuals attending sexual health clinics for testing (vaccination on attendance [VoA]), (3) offering vaccination to individuals attending sexual health clinics and who were diagnosed with gonorrhea (vaccination on diagnosis [VoD]), or (4) vaccination according to risk (VaR), by offering vaccination to patients who were diagnosed with gonorrhea plus individuals who tested negative, but report having more than five sexual partners per year. We further examined how altering (5) VoA and (6) VoD strategies changed if the strategies only targeted high risk groups (VoA(H),VoD(H)). We assessed efficacy by examining vaccination impact relative to no vaccination and when behavioral parameters were held constant. We further ascertained the effects of varying vaccine uptake (10%, 33%, 100%), vaccine efficacy (22%, 31%, 47%), and duration of protection (1.5, 4, 7.5 years) on the effectiveness of each vaccination strategy. For a hypothetical 10-year vaccination programme, VbE had 14.18% of MSM gonorrhea cases averted over the time the programme was implemented. VoA had the highest protective impact on the MSM population with 40.26% averted cases (95% credible interval (CrI): 18.32%-52.57%), but required more vaccine doses than any other strategy. VoD had a smaller impact (12.04% averted cases (95% CrI: 7.12%-15.00%)), but was three times more efficient than VoA in terms of averted cases per dose. VoA(H) and VoD(H) improved the efficiency of VoA and VoD strategies by increasing averted cases per dose to 0.22 and 0.24 respectively, but conferred similar protective effects as VoA (VoA(H): 40.10% averted cases (95% CrI: 18.14%-52.55%)) and VoD (VoD(H): 12.04% averted cases (95% CrI: 7.12%-15.00%)), respectively. VaR (40.10% averted cases (95% CrI: 18.14%-52.55%)) had almost the same impact as VoA, but was more efficient by requiring administration of fewer doses than VoA, with 0.21 (95% CrI: 0.12-0.27) averted cases per dose. Sensitivity analyses indicated that VaR had the greatest public health impact with the highest number of averted cases per dose for vaccines of any efficacy or duration of protection (or both), although VoD and VoD(H) saved more vaccine resource and had the highest number averted MSM cases per dose for highly protective vaccines of long protection. Vaccination of MSM against gonorrhea, according to risk in sexual health clinics in Singapore, can be considered to reduce gonorrhea acquisition and transmission. Development of gonorrhea-specific vaccines which focuses on protective efficacy and the implementation of efficient vaccination programmes can maximize public health impact.

Determinants of Familiarity and Experience with HIV Pre-Exposure Prophylaxis in Primary Care Providers in Ontario, Canada.

Despite increased access to HIV pre-exposure prophylaxis (PrEP) in Canada, familiarity and experience among primary care providers (PCPs)-including family doctors and those working with key populations-remains limited. To understand the barriers and facilitators of PrEP familiarity and experience, we conducted a situational analysis in PCPs in sub-urban and rural Ontario. We surveyed a non-probabilistic sample of PCPs using an online questionnaire, designed with the Consolidated Framework for Implementation Research (CFIR). Poisson regressions with robust variance were used to assess the relationship between CFIR domains, sociodemographic, and practice characteristics on both PrEP familiarity and experience. A total of 54 PCPs participated (6% response rate), comprising 80% physicians and 20% nurses. Nearly 30% of the sample worked with key populations, including sexual health clinics and community care centers, 18% of respondents reported high familiarity with PrEP, and 44% reported PrEP experience (referred, started a conversation, or prescribed). PrEP familiarity and experience were associated with working in an organization serving key populations, working with gender minorities, and having colleagues providing PrEP. Providers with a positive perception of PrEP and its necessity for populations at risk were more likely to have PrEP-related experience. Higher familiarity and experience were reported by PCPs with specific clinical skills related to PrEP, and with the perception that PrEP was compatible with their practice as primary provider. Our findings suggest that organizational support, and additional training and education would facilitate PrEP provision by PCPs in suburban/rural Ontario.

P-519. Long-acting Injectable PrEP Uptake and Persistence in a Sexual Health Clinic

Abstract Background HIV pre-exposure prophylaxis (PrEP), a powerful tool for HIV prevention, has traditionally been taken as a daily oral medication. Long-acting injectable (LAI) cabotegravir is superior to daily oral PrEP for HIV prevention and was approved for use as LAI-PrEP in 2021. We aimed to evaluate the uptake of LAI-PrEP and six-month LAI-PrEP persistence in a sexual health clinic. Participant characteristics (N=36) LAI: Long acting injectable PrEP: Pre-exposure prophylaxis Methods In February 2023, an LAI-PrEP pilot was implemented in a county sexual health clinic serving a diverse patient population in a designated ending the HIV epidemic in the South. Through state funding, patients at risk of HIV through sexual transmission were eligible to receive initial doses of LAI-PrEP at no cost and same-day initiation was encouraged. We evaluated the first 12 months of implementation. The primary outcome was LAI-PrEP persistence at 6 months. Statistical analyses were performed (SPSS version 29) using chi-square test for categorical variables with a significance level of 0.05. LAI-PrEP – long-acting injectable pre-exposure prophylaxis Results During the 12-month period, 55 people initiated LAI-PrEP, with 36 eligible for the six-month PrEP persistence evaluation. This population was 83% men, 31% Black, 58% Hispanic/Latino, and the median age was 32 (range 20-58) years. 75% received oral PrEP previously. LAI-PrEP six-month persistence rate was 72% (26 of 36). Among the 10 people with LAI-PrEP discontinuation, 1 transitioned to oral PrEP, 2 no longer had an indication for PrEP (change in serodifferent relationship status), and 7 were lost to follow-up. LAI-PrEP persistence differed by race (46% Black vs 88% white, p=0.007) and sexual orientation (37% heterosexual, 89% gay, 67% bisexual, p=0.019). LAI-PrEP – long-acting injectable pre-exposure prophylaxis Conclusion In the first year of LAI-PrEP implementation, LAI-PrEP uptake was favorable in our clinic, especially among priority populations for HIV prevention. Loss to follow-up was the most common reason for discontinuation, but change in PrEP method or loss of PrEP indication accounted for 30% of discontinuations. Nevertheless, the differences in persistence rates suggest a need for targeted interventions to improve long-term adherence in minority and heterosexual groups. Addressing PrEP persistence in these populations is crucial for optimizing the impact of LAI-PrEP in communities with a high burden of new HIV infections. Disclosures All Authors: No reported disclosures

P-549. Early Results from a Community-Based HIV Rapid Start Initiative, Memphis TN

Abstract Background In 2023, Memphis ranked second in the US for the highest rates of new HIV infections. Friends for All (FFA) is a community-based organization located in Memphis whose aim is to prevent the spread of HIV and improve health outcomes of those living with HIV through a holistic and client-centered approach. To improve health outcomes for people diagnosed with HIV and prevent further transmission, FFA launched a rapid test and treat HIV initiative with the primary aim of increasing viral suppression and retention in care. Methods We offered free HIV testing at our sexual health clinic and pop-up community testing sites. Individuals that tested positive for HIV and had no prior HIV diagnosis were offered rapid start HIV treatment, defined as treatment initiation within 72 hours. Staff administered an assessment of barriers to linkage and scheduled the appointment. Results Between July 2023 and March 2024, FFA tested 2131 clients for HIV. Of the 125 who tested positive, 14 met rapid start criteria. We successfully initiated treatment inside the 72-hour window for 12 (83%) of the 14 eligible. Ninety days post rapid start, 10 (83%) achieved viral suppression and 10 (83%) attended at least 3 medical appointments. The two clients who did not initiate rapid start treatment were identified at pop-up events outside of normal clinic hours, and it was not possible to schedule an appointment within 72 hours. Both of these clients did, however, initiate treatment within 7 days of diagnosis. Conclusion While linkage to rapid start ART has been successful in the clinical setting, barriers remain at the patient and organizational level that prevent similar outcomes in the outreach setting. Patients reported barriers to appointment attendance, including food insecurity and transportation. At the organizational level, limited access to ART outside of clinic hours and prescriber requirements for in-person care prevent successful linkage from outreach settings. We are investigating the use of a mobile unit to initiate rapid start treatment in outreach settings and telehealth options for ongoing HIV care. To address patient level barriers, FFA will continue to provide transportation and food services to those living with HIV. Disclosures David Closs, MPH, Gilead Sciences: Grant/Research Support

P-500. Awareness and preferences for every 2 month long-acting injectable HIV Pre-Exposure Prophylaxis (PrEP) versus daily oral PrEP among cisgender women in the United States and the Dominican Republic

Abstract Background Globally, cisgender women (CGW) represent 53% of people with HIV and 45% of new acquisitions (2022). Female sex workers (FSW) are 30 times more likely to acquire HIV (vs women overall); in the US 54% of new diagnoses in CGW are Black women. HIV pre-exposure prophylaxis (PrEP) coverage in US CGW remains low at 15%. Long-acting injectable (LAI) PrEP may help address inequities and expand use, as 2013-22 CDC data shows 7% of US people prescribed oral PrEP were female compared to 12.5% for injectable PrEP. Presented here is a mixed methods study assessing awareness and preferences for PrEP in CGW. Methods Cross-sectional surveys were conducted among CGW in Washington, DC and Santo Domingo, Dominican Republic (DR) from 11/’22-07/’23. DC CGW were recruited in reproductive health clinics; DR CGW were FSW recruited by peer navigators. CGW were ≥ 18 years, receiving care at the participating clinic and not living with HIV. Results In DC (n=302), 86.4% identified as Black; in the DR (n=300), all identified as mixed race and Latina ethnicity. 71.2% (DC) and 94.3% (DR) never heard of oral PrEP; 91.1% (DC) and 98.3% (DR) never heard of LAI PrEP. 3% (DC) and 1% (DR) had ever used PrEP. Mean number of sex partners (past 6 months, DC) was 2.1, with 6.5% always using a condom [Table 1]. In the DR, always condom use was > 80% for sex with clients, < 42% with steady partners. An interest in using some form of PrEP was 4.8% in DC vs 80.3% in the DR [Figure 1]. Preference for LAI PrEP was 73.2% (DC) and 71% (DR) among all participants [Figure 2]. CGW thought it easier to get to a clinic every 2 months than to take a daily pill (DC, 64.9%; DR, 60.0%;) [Table 2], and would worry more about people discovering PrEP pills than being seen at a PrEP clinic for injections (DC, 59.9%; DR, 55.7%). PrEP service location preferences were family planning or primary care clinics (DC), and pharmacies or sexual health clinics (DR). Self-assessment of potential HIV acquisition was majority not likely/impossible (DC, 88%; DR, 53%); most DC CGW never used PrEP because they had not heard of it. Conclusion Gaps in HIV knowledge, PrEP awareness and uptake exist for CGW. PrEP decision making is multifactorial and varies by population. CGW should be informed of their options and educated about potential reasons for PrEP use in a setting accessible and comfortable to them. Disclosures Aimee A. Metzner, PharmD, AAHIVP, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Alan Oglesby, MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Allison O’Rourke, MPH, ViiV Healthcare: Grant/Research Support Wendy W. Davis, EdM, ViiV Healthcare: Grant/Research Support Rachel Scott, MD,MPH,FACOG, DHHS Perinatal Guidelines: Board Member|UW STD Prevention Training Center (UW STD PTC): Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|Vindico CME: Honoraria Tamara Taggart, PhD, MPH, HealthHIV: Honoraria Deanna Kerrigan, PhD, MPH, ViiV Healthcare: Grant/Research Support

P-2344. Genomic Analysis of Monkeypox Virus (MPVX) Outbreak in Bangkok, Thailand in 2022-2023

Abstract Background Since early May 2022, cases of mpox (monkeypox) have been reported in countries where the disease is not endemic, alongside continued reports from endemic regions. This marks the first time that multiple mpox cases and clusters have been concurrently reported in both non-endemic and endemic countries across diverse geographical areas. As of March 8, 2024, there were 94,776 confirmed mpox cases globally, with 721 cases in Thailand—most of which were reported from Bangkok. Figure 1 The phylogenetic tree was constructed from 60 Mpox genomes collected in Bangkok, Thailand, during 2022-2023. The tree was produced using the maximum likelihood method in IQ-TREE2 with 1000 replicates of ultrafast bootstrap and HKY+F+I nucleotide substitution model and visualized by ggtree library in R. Methods We collected biological samples, mostly lesion swabs from suspected Mpox cases at STI Clinics in Bangkok, Thailand, from July 2022 to September 2023. Whole Genome Sequencing (WGS) was performed on 60 specimens from mpox cases in Bangkok, primarily lesion swabs, that were PCR-positive for MPXV with a cycle threshold (Ct) value below 30. A hybridization probe-capture–based approach was utilized for sequencing, specifically Illumina RNA Prep with Enrichment kit with the Viral Surveillance Panel. Consensus genomes were generated using an in-house pipeline based on reference mapping (BWA v0.7.17) to the Mpox reference genome from Nigeria (GenBank accession no. NC_063383. Results Phylogenetic analysis from WGS revealed that the predominant MPXV clade in Bangkok is IIb, with most specimens belonging to lineage IIb-C (48/60), followed by IIb-A (9/60) and IIb-B (3/60) as shown in Figure 1. Lineage IIb-A was detected in samples from 2022, while IIb-B and IIb-C were prominent in 2023. We identified multiple clusters with similar genomes in lineage IIb-C from different individuals, with percent identity ranging from 99.970% to 99.999% (197,184 nucleotides), suggesting ongoing community transmission. There is no clear introduction of lineage IIb-C into Thailand, however, the phylogenetic tree indicates the transmission of locally transmitted lineage to other countries. We detected the unique activity of APOBEC mRNA editing in serial samples from immunocompromised hosts. No mutations associated with resistance to tecovirimat were identified. Conclusion Our study demonstrated the introduction of MPXV from multiple countries, confirming ongoing community transmission in Bangkok during 2022-2023. Continuing genomic surveillance is crucial for tracking the epidemiology and viral evolution. Disclosures All Authors: No reported disclosures

Implementation of a sexual health clinic in an oncology setting: patient and provider perspectives

BackgroundSexual dysfunction is prevalent among cancer survivors, significantly impacting patient and partner quality of life. Despite this, sexual health clinics (SHCs) remain rare in cancer centres across Canada. An innovative clinic was developed at Princess Margaret Cancer Centre in Toronto, Canada to address this significant gap in survivorship care. This study examines factors affecting the provision of sexual healthcare and the implementation of a sexual health clinic within a large urban centre.MethodsThe Quality Implementation Framework was used to explicate patient and provider experience and identify barriers and facilitators to integrating sexual healthcare into routine cancer care workflows. Healthcare providers and patients representing selected cancer types (prostate, cervical, ovarian, testicular, bladder, kidney, and head and neck cancer) participated in semi-structured interviews. Interviews were transcribed and analyzed using the Framework qualitative analysis protocol.ResultsThe analysis identified three organizing domains and ten themes that describe the unique aspects of the sexual healthcare experience and critical factors for sexual health implementation. Both patients and providers described a lack of sexual health support in the oncology setting and emphasized the need for comprehensive and personalized care. Limitations of current care provision included mutual silence between patients and providers due to discomfort in discussing sexual issues, insufficient provider confidence in delivering optimal sexual healthcare, and constraints related to space and time. Key Factors for implementing a sexual health clinic in oncology emphasized the importance of having a dedicated clinic, flexibility in service delivery, proactive patient engagement, and ongoing staff education.ConclusionsFindings highlight significant challenges in addressing sexual health in an oncology setting, underscoring the need for specialized sexual health clinics that are integrated with, but distinct from, routine oncology care. This study further emphasizes the need for incorporating sexual healthcare in survivorship programs as well as the necessity of conducting thorough implementation research, involving multiple stakeholders, prior to launching new programs.

Increasing incidence of Mycoplasma genitalium is driven by people living with HIV and PrEP users.

Mycoplasma genitalium (MG) is responsible for non-gonococcal urethritis. Our aim is to describe MG positivity rate and incidence in specific populations. Retrospective, surveillance study included all samples collected from 2018 to 2022. All samples were tested with Anyplex II STI7 (Seegene). Incidence rate (IR) was calculated, incidence rate ratios (IRRs) were assessed using Poisson regression model. The study included 13,504 samples belonging to 7,692 individuals. Overall positivity rate was 2.9% (95%CI 2.6-3.2). Subgroups showed significant differences: 13.6% in PrEP users, 5.2% in STI clinic, 4.6% in people living with HIV (PLWH), 1.2% in Gynecology/Obstetrics Department, 0.5% in Fertility clinic, and 0.5% in the "Other" group (p < .001). A significant increasing temporal trend was registered for PLWH. Over a cumulative follow up of 2,554 years, 293 incident infections were registered with an IR of 11.5 per 100PYFU. Departments showed diverse IRs: 7.9 per 100PYFU for PLWH, 30.1 per 100PYFU for PrEP users, 22.7 per 100PYFU for STI clinic. Poisson regression model found a significant increase in incident rates over time in the overall study population driven by PLWH and PrEP users. MG is uncommon in the general population with stable trends, while PLWH and PrEP users exhibit increasing positivity rate and incidence.

Evaluating the Implementation of Home-Based Sexual Health Care Among Men Who Have Sex with Men: Limburg4zero.

Home-based sexual health care (including self-sampling testing) could reduce barriers to clinic-based testing. This study systematically evaluated the implementation of home-based sexual health care ('Limburg4Zero') among men who have sex with men (MSM) in a mixed urban-rural region of the Netherlands. We systematically assessed implementation outcomes (contextual domains, population reached, effectiveness, adoption by health care providers (HCP), implementation fidelity, and maintenance) using the practical, robust implementation and sustainability model. We used a mixed-methods research design that combined survey and in-depth interview data from our priority population (MSM) and implementers with insights from our community advisory board and field notes from monthly meetings with the implementers. Of 1076 requested tests, 906 MSM received a (self-sampling STI/HIV) test kit and sexual health information. Most participants (median age 31) had a university or college degree and had a Western ethnicity. The return rate for laboratory testing was 67%. Home-based care participants more often never tested HIV before (39%) compared to STI clinic attendees (28%). Adoption by HCP was highly acceptable, although perceived pragmatic and technical challenges were experienced. Key elements of the home-based care service were implemented as designed, with co-created adjustments for optimization during the implementation. Maintaining the innovation in the long term was desirable, although future recommendations for efficient continuation should be considered. Implementation of home-based sexual health care has demonstrably increased care accessibility for MSM who had never previously been tested. Therefore, a systematic approach is crucial to foster the impact of home-based sexual health care.

Barriers and Facilitators in Accessing HIV Prevention Services for Men Having Sex with Men (MSM): A Comprehensive Analysis

Objectives: This study explores MSM’s perspective on HIV prevention needs, barriers, facilitators, and retention strategies in prevention programs. Method: In-depth interviews, key informant interviews, focus group discussions, and structured questionnaires were used to interview urban and rural Nigerian men having sex with men (MSM) aged 18 and older. Candidates were recruited using snowball referrals. Data analysis used IBM-SPSS 28. Result: Urban residents (67.6%) had more secondary education than rural residents (53.7%) in the 299 MSM research. Drug use was 84.2% in urban and 61.3% in rural MSM. The majority of rural MSM (90.1%) had multiple sexual partners, unlike urban residents (70.1%). Compared to rural people (8.0%), urban MSM reported greater sexual abuse rates (22.0%). Over 80% of MSM used condoms, attended HIV meetings, visited STI clinics, and used lubricant. However, less than 80% would attend a peer-led clinic or have peers assist with drug adherence. MSM attending private healthcare facilities stated that distance to service delivery points was a major barrier (60.6%). However, those attending public health facilities cited lack of information (67.0%), unpleasant facilities (76.1%), stigma (81.8%), and incapacity to handle police harassment (74.4%) as key hurdles to treatment. MSM views on HIV preventive programs are examined in this qualitative study. Despite economic limits, respondents preferred private hospitals due to confidentiality, stigmatisation, and discrimination difficulties at public hospitals, which hinder treatment acceptance. Conclusion: MSM in urban and rural settings have different HIV risk behaviours and access issues, requiring specific interventions.

Prevalence of Neisseria meningitidis carriage among men who have sex with men at a sexual health clinic in Brussels, Belgium: a cross-sectional study.

To assess the prevalence of Neisseria meningitidis (Nm) carriage among men who have sex with men (MSM) and examine potential risk factors associated with colonization. This was an observational, cross-sectional, monocentric study. Inclusion criteria were asymptomatic adult MSM. Recruitment took place at an outpatient sexual health clinic in Brussels, Belgium from October 2019 to March 2020. The primary outcome of this study was to determine the prevalence of meningococcal oropharyngeal carriage. Secondary outcomes included characterization of the participants colonized with Nm and serogroup identification of encapsulated strains. Ordinal logistic regression analysis was performed to evaluate for associations with Nm colonization. A total of 143 participants were included, of which 36 (25.2%) were found to be colonized with Nm. The most common encapsulated strain identified was serogroup B (50%). Colonized individuals had a median (IQR) age of 36.5 (29-43) years, 69.4% were Caucasian, and 38.9% indicated having 2 to 5 kissing-only partners while 47.2% reported having no sex partners during that same period. Multivariable analysis showed that not having been vaccinated against Nm in the past 5 years was the only characteristic significantly associated with being colonized with Nm (odds ratio 3.38; 95% confidence interval 1.26-6.58, p = 0.02). In this analysis of MSM, asymptomatic Nm carriage was observed to be 25.2% and serogroup B (50%) was the most frequently identified. Non-vaccination against Nm was the only factor significantly associated with colonization. Further research is needed to better understand Nm colonization in this population.

Fannyhessea vaginae and clearance of Lactobacillus iners are associated with incident non-chlamydial non-Mycoplasma genitalium urethritis in men who have sex with women.

The etiology of nongonococcal urethritis (NGU) is incompletely understood. We sought to determine if genitourinary bacterial diversity or specific taxa were associated with incident NGU. From August 2014-July 2018, men who have sex with women attending a sexual health clinic were clinically evaluated, including Mycoplasma genitalium (MG) and Chlamydia trachomatis (CT) testing, at enrollment and six monthly visits. New cases of NGU (≥5 PMNs/HPF in urethral exudates plus either symptoms or visible discharge) and their visit preceding NGU diagnosis were matched 1:1 to two sequential visits without NGU (controls). We determined associations with incident NGU and applied broad-range 16S rRNA gene polymerase chain reaction and sequencing to urine samples from each visit. We used conditional logistic regression to evaluate the association of Shannon Diversity Index (SDI), species richness, Haemophilus influenzae, Fannyhessea vaginae, Lactobacillus iners, and Streptococcus mitis group with incident non-CT-non-MG-NGU (NCNM-NGU). Of 62 matched case-control pairs, median age was 32. Higher SDI the previous month was associated with higher odds of incident NCNM-NGU (adjusted odds ratio [aOR] = 2.8 per unit increase; 95% CI = 1.03-7.47), as was F. vaginae at NGU diagnosis (aOR = 5.1; 95% CI = 1.28-20.15), F. vaginae acquisition (aOR = 13.8; 95% CI = 1.96-97.33) and consistent carriage of F. vaginae (aOR = 16.1; 95% CI = 1.66-156.29). Odds of NCNM-NGU were higher when L. iners cleared between visits (aOR = 18.0; 95% CI = 1.08-299.24). Neither H. influenzae nor S. mitis group were associated with incident NCNM-NGU. F. vaginae acquisition/detection and L. iners clearance were associated with urethritis. This merits investigation in larger longitudinal studies using species-specific detection methods.

High prevalence of hepatitis C virus infection among adolescents and young adults attending HIV and sexual health clinics.

The prevalence of hepatitis C virus (HCV) infection among Thai adults is 0.5%-1.0%. This study aims to determine the prevalence of HCV infection among adolescents and young adults (AYA) accessing HIV/sexual health clinics. A cross-sectional study was conducted among AYA aged 15-24 years attending HIV/sexual health clinics in Bangkok, Thailand. The HCV infection prevalence, defined by anti-HCV antibody positivity using rapid diagnostic tests (SD BIOSENSOR, Korea), were reported with proportions and a 95% confidence interval (CI). Multivariate logistic regression was performed to identify factors associated with HCV infection. From March to August 2023, 300 AYAs with a median age of 21 (interquartile range 20-23) years were enrolled into the study. One-third (29.7%) were people living with HIV (PLHIV). The overall prevalence of HCV infection was 2.7% (95%CI 1.2-5.2). Prevalence was higher among PLHIV (5.6%) compared to AYA without HIV (1.4%) (p-value 0.053). The factor most significantly associated with HCV infection was people who used drugs (adjusted odds ratio 15.3, 95% CI 2.9-82.0, p-value 0.001). History of drug use was associated with the highest HCV infection prevalence. PLHIV had a trend of higher prevalence. HCV screening in HIV/sexual health clinics is recommended for early detection, treatment, and transmission reduction.

Methodological report of a cross-sectional survey of abortion-related knowledge, attitudes and practices amongst health professionals in Britain, strategies adopted and lessons learned: evidence from the SACHA Study

BackgroundMost surveys examining health professionals’ knowledge, attitudes and practices around abortion have used convenience samples and have targeted doctors. Our goal in the SACHA Study, drawing on evidence-based strategies to maximise response rates, was to achieve a representative sample of a wider range of health professionals, working in general practice, maternity services, pharmacies, sexual and reproductive health (SRH) clinics and specialist abortion services in Britain, to explore the knowledge, attitudes and experience of abortion care and views on future models of delivery.MethodsA cross-sectional questionnaire-based survey of midwives, doctors, nurses and pharmacists in England, Scotland and Wales was undertaken between November, 2021 and July, 2022. We used a stratified cluster sampling approach to select a random sample of sites and all eligible staff within those services were asked to respond to the survey. Evidence-based strategies to maximise completion rates were adopted, including postal delivery of the one-page questionnaire with personal letter of invitation and a stamped address envelope for return, inclusion of an unconditional voucher and follow-up.ResultsOverall, 147 of the 314 (46.8%) health service sites randomly selected took part in the survey. Reasons for non-participation included local Research and Development (R&D) Department non-response, lack of resources or insufficient time to support or approve the study, lack of interest in or perceived relevance of the topic and insufficient capacity to take part, exacerbated by work demands during the COVID epidemic. Of the 1370 questionnaires sent to eligible identified participants within these services, 771 were completed and returned (56.3%). At the service level the highest proportion of returns was from SRH clinics (81.0%) and the lowest from general practice (32.4%). In relation to profession, returns were highest amongst midwives (69.6%) and lowest amongst pharmacists (36.5%).ConclusionsObtaining information about health professional knowledge, attitudes and practices is key to guide service development and policy and to identify gaps in training and service provision in abortion. Despite our attempts to gain a representative sample of health professionals, the challenges we experienced limited the representativeness of the sample, despite the use of an evidence-based strategy.

Preliminary clinical performance of a Cas13a-based lateral flow assay for detecting Neisseria gonorrhoeae in urine specimens.

Nucleic acid amplification testing (NAAT) for N. gonorrhoeae is unavailable in resource-limited settings. We previously developed a CRISPR-based lateral flow assay for detecting N. gonorrhoeae. We aimed to pair that assay with point-of-care DNA extraction, assess performance in clinical urine specimens, and optimize assay kinetics. We collected urine specimens among men presenting with urethritis enrolling in a clinical trial at the Massachusetts General Hospital Sexual Health Clinic. We assessed the quantified DNA yield of detergent-based extractions with and without heat. We selected one detergent for extracting all specimens, paired with isothermal recombinase polymerase amplification for 90 minutes and lateral flow Cas13a detection, interpreted via pixel intensity analysis. We also trained a smartphone-based machine-learning model on 1,008 images to classify lateral flow results. We used the model to interpret lateral flow results from the clinical specimens. We also tested a modified amplification chemistry with a second forward primer lacking the T7-promoter to accelerate reaction kinetics. Extraction with 0.02% Triton X resulted in an average DNA yield of 2.6 × 106 copies/µL (SD ± 6.7 × 105). We treated 40 urine specimens (n = 12 positive) with 0.02% Triton X, and using quantified pixel intensity analysis, the Cas13a-based assay correctly classified all specimens (100% agreement; 95% CI 91.2%-100%). The machine-learning model correctly classified 45/45 strips in the validation data set and all 40 lateral flow strips from clinical specimens. Including the second forward primer reduced incubation time to 60 minutes. Using point-of-care DNA extraction, our Cas13a-based lateral flow N. gonorrhoeae assay demonstrated promising performance among clinical urine specimens.IMPORTANCEUsing a CRISPR-based assay we previously developed for Neisseria gonorrhoeae detection, we developed new techniques to facilitate point-of-care use. We then demonstrated the promising performance of that assay in clinical specimens. Furthermore, we developed a smartphone-based machine learning application for assisting interpretation of lateral flow strip results. Such an assay has the potential to transform the care of sexually transmitted infections in low-resource settings where diagnostic tests are unavailable. A point-of-care pathogen-specific assay, paired with the connectivity offered by a smartphone application, can also support public health surveillance efforts in such areas.

The Missing Link: Hepatitis C Linkage to Care through a Public Sexual Health Clinic.

This study evaluates hepatitis C testing and referral for treatment among patients attending a public sexual health clinic. In patients with hepatitis C infection, progression from linkage to care to sustained virologic response was low. Innovative approaches are needed to optimally integrate hepatitis C care in sexual health clinics.

The association between antimicrobial resistance mutations and treatment outcomes for Mycoplasma genitalium infections from 2018 to 2022: a cross-sectional study from Auckland, New Zealand.

Background New Zealand has among the highest rates of antimicrobial resistance in Mycoplasma genitalium in the world. The aim of this study was to correlate treatment outcomes with 23S rRNA and parC mutations associated with macrolide and fluroquinolone resistance, respectively, in a cohort of sexual health clinic patients. Methods Laboratory and clinical data were collected for patients with M. genitalium infections attending Auckland Sexual Health Service between 1 January 2018 and 31 December 2022, who had a test-of-cure performed within 21-90days of a treatment episode. Treatment outcomes were correlated with the presence or absence of resistance mutations and treatment regimen utilised. Results A total of 95 infections from 93 patients met the study inclusion criteria. Eighty of 93 (86%) infections with available data were macrolide resistant, with 20 of 74 (27%) having both macrolide resistance and parC mutations. Sixteen of 20 (80%) of parC mutations were G248T (S83I), three of 20 (15%) G259T (D87Y) and one of 20 (5%) A247C (S83R). All macrolide-susceptible infections treated with doxycycline and azithromycin were cured (12/12), as were all macrolide-resistant infections without parC mutations treated with doxycycline and moxifloxacin (37/37). Cure rates for macrolide-resistant infections with parC mutations were lower, with variable and often multiple treatment courses; eight of 16 (50%) were cured using one course of sequential doxycycline and moxifloxacin, seven of nine (78%) with one course of minocycline, zero of two (0%) with pristinamycin and one of one (100%) with doxycycline and sitafloxacin. Conclusions Our findings highlight the differing treatment outcomes for infections with and without parC mutations, offering opportunities to refine management of M. genitalium infections.

Syphilis prevalence among a large regional online postal self-sampling STI testing service (OPSS)

ObjectivesIn England, infectious syphilis diagnoses have reached the highest annual number since 1948. Fifty per cent of syphilis testing is now provided through online postal self-sampling sexually transmitted infection (STI)...

Intimate Partner Violence Experiences among Men Who Have Sex in Hanoi, Vietnam.

Intimate partner violence (IPV) victimization is a pressing issue among men who have sex with men (MSM) and has profound health implications. This study aims to estimate the prevalence of IPV and identify factors associated with its occurrence among MSM in Hanoi, Vietnam. A cross-sectional study was conducted from March to May 2023 at an MSM-friendly sexual health clinic in Hanoi. Participants completed a self-administered questionnaire on a tablet after screening for eligibility. IPV victimization was assessed using a 21-item scale (the IPV-GBM scale). Logistic regression models were used to identify factors associated with IPV victimization in the past 12 months. Among 309 respondents, the mean age was 28 and half of participants reported using PrEP for 12 months or more. Two-thirds reported IPV victimization in the past 12 months (67%). Emotional IPV (47%) was most prevalent, followed by monitoring (39%), controlling (19%), and physical/sexual IPV (15%). Participants who were reported experiencing IPV in the past 12 months were more likely to be aged ≤ 24 years (aOR = 1.98, 95% CI: 1.14, 3.44), to report preferring the insertive sexual role (aOR = 2.02, 95% CI: 1.10, 3.70), or to report having more sexual partners (2-5 partners vs ≤ 1 partner: aOR = 2.02, 95% CI: 1.10, 3.70; ≥ 5 partners vs. ≤ 1 partner: aOR = 2.02, 95% CI: 1.10, 3.70). IPV victimization among MSM on PrEP in Hanoi is highly prevalent. Tailored interventions are needed to address these vulnerabilities and promote safer behaviors and healthier relationships. Efforts should prioritize younger MSM. Further research is necessary to explore IPV dynamics across diverse settings.

L-Serovar Rectal Chlamydia trachomatis in Patients Who Were Male-Assigned at Birth Attending Two Sexual Health Clinics, Baltimore, Maryland 2009-2016.

Lymphogranuloma venereum (LGV) caused by L-serovars of Chlamydia trachomatis (CT) is a sexually transmitted infection (STI) causing asymptomatic infection, and anogenital disease. Epidemiologically, LGV has been strongly associated with human immunodeficiency virus (HIV) infection. Using a retrospective longitudinal study design, we first described unadjusted and adjusted associations between demographic and sociobehavioral characteristics and rectal (r) CT (rCT) and rLGV in sexual health clinic attendees in Baltimore, MD, between 2009 and 2016 at baseline visits. Rectal samples that tested positive for CT with the Aptima AC2 assay underwent DNA extraction and in-house L-serovar PCR analysis. Then, patients were followed over 24 months and incident STIs were described using multivariable Cox-proportional hazard regression models. In 292/391 (73.4%) patients who were male-assigned at birth (MAB), LGV prevalence was 20/292 (6.8% (95% confidence interval, 4.2%-10.4%)). In the final multivariable regression model, LGV was significantly associated with age greater than 25 years, transgender identity, and a history of syphilis. Baseline LGV was not associated with incident HIV or gonorrhea, but after adjusting for age, race, HIV status, and history of syphilis, LGV was marginally associated with a new syphilis diagnosis (hazard ratio 2.35 (95% confidence interval, 0.96-5.73), P = 0.06) over 24 months follow-up. Lymphogranuloma venereum accounted for almost 7% of rCT in patients MAB attending sexual health clinics in Baltimore between 2009 and 2016. Lymphogranuloma venereum was not associated with prevalent or incident HIV as in other studies. FDA-cleared tests and better surveillance measures are required to understand changes in the epidemiology of LGV in the United States.