Introduction: The World Health Organisation (WHO) Initiative for the elimination of mother to child transmission of syphilis (eMTCT ) has identified Papua New Guinea (PNG) as one of 12 priority countries. The most recent national sero-surveillance data indicates a syphilis prevalence of 4.8% in pregnant women. Syphilis diagnosis in antenatal clinics (ANC) relies on rapid point of care (RPOC) tests. These tests are based on detection of anti-treponema pallidum antibodies, and cannot differentiate active syphilis infection, past infection or yaws. Here we provide estimates of active syphilis and other STIs in ANC attendees in PNG.
Methods: Reactive RPOC tests were confirmed using the rapid plasma reagin (RPR) test. According to PNG guidelines, active syphilis was defined as a reactive RPOC test with RPR titre greater than 1/8. Neiserria gonorrhoea, Chlamydia trachomatis and Trichomonas vaginalis were detected using real-time PCR. Provider initiated HIV counselling and testing (PICT ) was offered to all women.
Results: To date, 260 women have been recruited from two ANCs. Of 22 reactive RPOC tests (8.3%), 10 were confirmed, providing an active syphilis prevalence of 3.9%. Uptake of PICT was 77% and HIV prevalence 1.5% (n=3). The prevalence of N. gonorrhoea, C. trachomatis and T. vaginalis was 10.3%, 22.1% and 20.6% respectively.
Conclusion: These data confirm high rates of active syphilis in pregnant women in PNG. However the limitations of using a single RPOC test for syphilis diagnosis in this setting are also demonstrated. Over-diagnosis leading to over-treatment has implications for antibiotic resistance, and social consequences associated with partner notification. This emphasises the need for accurate RPOC diagnostics for active syphilis. The high prevalence of other treatable STIs in this population suggest that broadening the scope of the eMTCT initiative to include interventions for the management of these STIs would also improve maternal and child health.
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.
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.
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.
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.
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.
Background: People Living with HIV (PLHIV) who are transitioning from custodial settings are at risk of experiencing treatment interruptions and loss to follow up for vital HIV care. The NSW Persons In Custody HIV Community Referral Project (PICHCRP) aims to ensure PLHIV who are transitioning from custodial settings back into the community receive seamless HIV service, care and support.