Priorities for preventing a concentrated HIV epidemic among Aboriginal Australians

Priorities for preventing a concentrated HIV epidemic among Aboriginal and Torres Strait Islander Australians

James S Ward, Karen Hawke and Rebecca J Guy
Med J Aust 2018; 209 (1): 56. || doi: 10.5694/mja17.01071
Published online: 2 July 2018
Greater efforts are required to prevent human immunodeficiency virus infection (HIV) escalating among Aboriginal and Torres Strait Islander Australians. Recently released national data highlight a 33% increase in new HIV diagnosis rates among Aboriginal and Torres Strait Islander people, from 4.8 per 100 000 population in 2012 to 6.4 per 100 000 population in 2016. In the same period, newly diagnosed HIV rates among Australian-born non-Indigenous people decreased by 22% (from 3.7 per 100 000 population in 2012 to 2.9 per 100 000 population in 2016).

Expanded HIV PrEP implementation in communities in NSW (EPIC-NSW): design of an open label, single arm implementation trial

BMC Public Health 
https://doi.org/10.1186/s12889-017-5018-9

 Published: 2 February 2018

Abstract:

Background

The New South Wales (NSW) HIV Strategy 2016–2020 aims for the virtual elimination of HIV transmission in NSW, Australia, by 2020. Despite high and increasing levels of HIV testing and treatment since 2012, the annual number of HIV diagnoses in NSW has remained generally unchanged. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among gay and bisexual men (GBM) when taken appropriately. However, there have been no population-level studies that evaluate the impact of rapid PrEP scale-up in high-risk GBM. Expanded PrEP Implementation in Communities in NSW (EPIC-NSW) is a population-level evaluation of the rapid, targeted roll-out of PrEP to high-risk individuals.

Methods

EPIC-NSW, is an open-label, single-arm, multi-centre prospective observational study of PrEP implementation and impact. Over 20 public and private clinics across urban and regional areas in NSW have participated in the rapid roll-out of PrEP, supported by strong community mobilization and PrEP promotion. The study began on 1 March 2016, aiming to enroll at least 3700 HIV negative people at high risk of HIV. This estimate took into consideration criteria for PrEP prescription in people at high risk for acquiring HIV as defined in the NSW PrEP guidelines. Study participants receive once daily co-formulated tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and are followed for up to 24 months. Follow-up includes: testing for HIV at 1 month, HIV and other sexually transmissible infections three-monthly, HCV annually and monitoring of renal function six-monthly. Optional online behavioural surveys are conducted quarterly. The co-primary endpoints are (i) HIV diagnoses and incidence in the cohort and (ii) HIV diagnoses in NSW.

Discussion

EPIC-NSW is a population-based PrEP implementation trial which targets the entire estimated population of GBM at high risk for HIV infection in NSW. It will provide a unique opportunity to evaluate the population impact of PrEP on a concentrated HIV epidemic.

Do Estrogen Therapies Affect Sexual Function in Early Postmenopause?

JAMA Internal Medicine, 2017

Transdermal estrogen therapy delivered through the skin modestly improved sexual function in early postmenopausal women, according to an article published by JAMA Internal Medicine.

Declining estrogen levels around the menopausal transition are commonly associated with sexual dysfunction, which can be an important determinant of women’s health and quality of life.

In the new article, Hugh S. Taylor, M.D., of the Yale School of Medicine, and his coauthors report on an ancillary study of a clinical trial that examined changes in sexual function in recently postmenopausal women.

 

The updated 2017 ASHM HIV pre-exposure prophylaxis (PrEP) Guidelines

Journal of Virus Eradication, 2017; 3: 168–184

Daily use of co-formulated tenofovir and emtricitabine for HIV pre-exposure prophylaxis (PrEP) by populations at high risk of HIV infection is now recommended in guidelines from the United States, Europe and Australia and globally through the 2015 WHO guidelines. 

These 2017 Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine‘s (ASHM) PrEP Guidelines are an updated adaptation of the 2014 US Centers for Disease Control‘s PrEP guidelines and are designed to:

    • Support the prescription of PrEP using forms of coformulated tenofovir and emtricitabine that have been registered in Australia by the Therapeutic Goods Administration and other bioequivalent generic drugs that are available in Australia through self-importation, private prescription or Australian PrEP clinical trials
    • Assist clinicians in the evaluation of patients who are seeking PrEP
    • Assist clinicians in commencing and monitoring patients on PrEP including PrEP dosing schedules, management of side-effects and toxicity, use of PrEP in pregnancy and in chronic hepatitis B infection and how to cease PrEP

Daily PrEP with co-formulated tenofovir and emtricitabine, used continuously or for shorter periods of time, is recommended in these guidelines as a key HIV-prevention option for men who have sex with men (MSM), transgender men and women, heterosexual men and women, and people who inject drugs (PWID) at substantial risk of HIV acquisition.

Child Living with HIV Maintains Remission Without Drugs Since 2008

National Institute of Allergy and Infectious Diseases (NIAID), July 24, 2017

A nine-year-old South African child who was diagnosed with HIV infection at one month of age and received anti-HIV treatment during infancy has suppressed the virus without anti-HIV drugs for eight and a half years, scientists reported today at the 9th IAS Conference on HIV Science in Paris. This case appears to be the third reported instance of sustained HIV remission in a child after early, limited anti-HIV treatment.

New kind of male contraceptive faces biggest hurdle: drugmakers

The Age,  Published 

Doctors are on the cusp of launching the first new male contraceptive in more than a century. But rather than a Big Pharma lab, the breakthrough is emerging from a university start-up in the heart of rural India.

Years of human trials on the injectable, sperm-zapping product are coming to an end, and researchers are preparing to submit it for regulatory approval. Results so far show it’s safe, effective and easy to use – but gaining little traction with drugmakers.