Internet-based self-sampling for Chlamydia trachomatis testing

Söderqvist JGullsby KStark L, et al
Internet-based self-sampling for Chlamydia trachomatis testing: a national evaluation in Sweden

Abstract:

Objective Internet-based testing for Chlamydia trachomatis (CT) with self-sampling at home has gradually been implemented in Sweden since 2006 as a free-of-charge service within the public healthcare system. This study evaluated the national diagnostic outcome of this service.

Methods Requests for data on both self-sampling at home and clinic-based sampling for CT testing were sent to the laboratories in 18 of 21 counties. Four laboratories were also asked to provide data on testing patterns at the individual level for the years 2013–2017.

Results The proportion of self-sampling increased gradually from 2013, comprising 22.0% of all CT tests in Sweden in 2017. In an analysis of 14 counties (representing 83% of the population), self-sampling increased by 115% between 2013 and 2017 for women, compared with 71% for men, while test volumes for clinic-based sampling were fairly constant for both sexes (1.8% increase for women, 15% increase for men). In 2017 self-sampling accounted for 20.3% of all detected CT cases, and the detection rate was higher than, but similar to, clinic-based testing (5.5% vs 5.1%). The proportion of self-sampling men was also higher, but similar (33.7% vs 30.8%). Analysis of individual testing patterns in four counties over 5 years showed a higher proportion of men using self-sampling only (67%, n=10 533) compared with women (40%, n=8885).

Conclusions Self-sampling has increased substantially in recent years, especially among women. This service is at least as beneficial as clinic-based screening for detection of CT, and self-sampling reaches men more than clinic-based testing.

Strategies for inclusion and equality – ‘norm-critical’ sex education in Sweden

Sex Education, 2019,  DOI: 10.1080/14681811.2019.1634042
Abstract:
This article examines the tactical (counter) politics of inclusive and ‘norm-critical’ approaches in Swedish sex education, focusing on the enactment of this critical agenda in sex education practices and how teachers interpret and negotiate the possibilities and pitfalls of this kind of work.
The analysis draws on participant observation in sex education practices and in-service teacher training, as well as interviews with educators.
Three recurrent strategies lie at the centre of the analysis: the sensitive use of language to achieve inclusion; the organisation and incorporation of ‘sensitive’ content to resist stigmatisation; and the use of different modalities to produce a specific knowledge order.
The analysis shows how these strategies are grounded in norm-critical ideals, which become partly inflicted with tensions and discomforts when acted out in practice. The  analysis further shows how an inclusive and norm-critical agenda runs the risk of becoming static, in the sense of providing students with the results of critique rather than engaging them in it.

Giving gay men self-test kits increases HIV testing by 50% – but STI tests decrease

aidsmap/nam, 21 August 2018

Gay men who were offered HIV home-testing kits took 50% more tests than men who only took HIV tests at clinics or community organisations, a randomised controlled study from Seattle in the USA has found.

The men who could self-test took fewer tests for sexually transmitted infections (STIs), though it is not completely clear whether this was because they went less often for STI checkups or had fewer STI symptoms.

 

HIV incidence in Indigenous and non-Indigenous populations in Australia

The Lancet HIV: August 07, 2018

DOI: https://doi.org/10.1016/S2352-3018(18)30135-8

Ward, J ;McManus, H; McGregor, S;  et al.

Methods

Using the National HIV Registry at The Kirby Institute at UNSW, Sydney, NSW, Australia, we collated and analysed annual HIV notification data for 1996–2015. Patients who were not born in Australia were excluded. We calculated the rates of HIV diagnoses with annual trends in notification rates for Indigenous versus non-Indigenous Australians by demographic characteristics, exposure categories, and stage of HIV at diagnosis. For missing data, assumptions were made and verified through sensitivity analyses. Annual rate ratio (RR) and 4 year summary rate ratio (SRR) trends were calculated to determine patterns of HIV diagnosis in the two populations.

Findings

Between Jan 1, 1996, and Dec 31, 2015, 11 492 people born in Australia were reported with a diagnosis of HIV, of whom 461 (4%) were recorded as Indigenous Australians and we classified the remaining 11 031 (96%) as non-Indigenous Australians. For exposure to HIV, among Indigenous Australians a higher proportion of diagnoses occurred among women, and through injecting drug use and heterosexual sex than among non-Indigenous Australians (p<0·0001). Among Indigenous Australians, we found a significantly higher SRR of HIV diagnoses among men in the period 2012–15 than in previous periods (SRR 1·53, 95% CI 1·28–1·83; p<0·0001), and significantly higher diagnosis among Indigenous women (4·92, 4·02–6·02; p<0·0001) for the entire study period than among non-Indigenous women. Concurrently, a decrease in HIV diagnoses of 1% per annum (RR 0·99, 95% CI 0·98–0·99; p<0·0001) across the study period was seen among non-Indigenous people. Indigenous Australians were more likely to be diagnosed at an advanced stage of HIV infection than non-Indigenous Australians (20·8% vs 15·1%; p=0·0088).

Interpretation

Greater efforts should be made to include Indigenous people in prevention strategies, particularly newer biomedical interventions, such as scale up of pre-exposure prophylaxis and treatment as prevention initiatives in Australia. More involvement of Indigenous Australians in these approaches is also required to prevent widening of the gap in HIV diagnosis rates between non-Indigenous and Indigenous Australians.