Policy and regulatory support for HIV point-of-care testing (POCT) in Australia has recently emerged. International HIV POCT services for men who have sex with men (MSM) have adopted predominantly community-based and non-physician led models.
Methods: To inform the implementation of a community-based HIV POCT service targeting MSM in Melbourne, HIV negative gay and other MSM completed an online survey in April 2013. We describe service preferences and, after presenting a vignette describing a proposed community-based POCT service model, factors associated self-reported likelihood to seek HIV POCT through the service.
Results: Most participants (N=274) identified as gay (91%) and residing in metropolitan Melbourne (93%). Sexual risk and HIV testing behaviours were broadly similar to other behavioural surveys of gay men; 28% reported recent UAIC and 71% reported their last HIV test within past 12 months. Most participants reported HIV testing at a gay-friendly general practice (35%) or a sexual health clinic (32%). Nearly half the participants (47%) reported they would be ‘very likely’ to attend the service for HIV POCT (a further 36% reported they would be ‘likely’ to attend). Those reporting being ‘very likely’ to attend for a HIV POCT expressed a preference for after-hours weekday testing (OR=2.81; 95%CI=1.63-4.83), perceived their HIV testing frequency as inadequate (OR=2.42; 95%CI=1.33-4.42) and reported their last HIV test at a sexual health clinic compared to a gay-friendly general practice (OR=1.26; 95%CI=1.02-1.55). They also reported insufficient time (OR=2.12; 95%CI=1.11-4.07), difficulty finding convenient appointment times (OR=3.49; 95%CI=1.32-9.17) and returning for test results (OR=2.36; 95%CI=1.37-4.07) as barriers to current HIV testing.
Conclusion: While international experiences offer useful insights, HIV POCT service models in Australia must account for local community preferences. A community-based service model was overwhelmingly supported by participants and was particularly appealing to those reporting previously identified structural service barriers to conventional HIV testing.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.