Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: a retrospective cross-sectional analysis

Needleman, Robert; Chow, Eric P F; Towns, Janet M; Cornelisse, Vincent J; Yang, Tim Z T; Chen, Marcus Y; Bradshaw, Catriona; Fortune, Ria; Fairley, Christopher K.

doi:10.1071/sh17182

Cited by 15 publications

(13 citation statements)

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“…Moreover, a substantial proportion of data was missing because it was not always systematically collected, hence we could only present the results of the time between last sexual contact and the onset of symptoms when the data is available. Third, sexual health services in Melbourne are quite limited and it is not always possible to see all individuals on the day that they present symptoms [17]. This could have contributed to more than five days elapsed since symptoms onset to presentation to the clinic in almost two-thirds of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…Other reasons besides sexual practices may include sociodemographic changes or changes in health services use. The increase in health care demand from the rising rates of sexually transmitted infections (STIs) may be making it harder to access health care, and consequently increasing the duration of untreated infection which would lead to ongoing transmission [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

et al. 2020

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Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid amplification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8-56.1%]; yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0-17.6%) and other genital symptoms in 40.8% (95% CI 33.1-49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

et al. 2020

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“…This was a retrospective cohort study of MSM of aged 16 years and older attending the Melbourne Sexual Health Centre (MSHC) between 22 January 2018 and 31 December 2018. MSHC is the largest sexual health centre in Victoria, Australia, with approximately 50 000 consultations per year and 40% of clients attending MSHC self-identify as having had sex with another man in the past 12 months 11…”

Section: Methodsmentioning

confidence: 99%

Hepatitis A vaccine uptake among men who have sex with men from a time-limited vaccination programme in Melbourne in 2018

et al. 2019

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ObjectivesIn 2017, an outbreak of hepatitis A among gay, bisexual and other men who have sex with men (MSM) was reported in Victoria, Australia. In 2018, the Victorian government implemented a free hepatitis A vaccination programme targeting all Victorian MSM. This study aimed to determine hepatitis A vaccine uptake among MSM in a sexual health clinic in Melbourne.MethodsAll MSM attending the Melbourne Sexual Health Centre (MSHC) in 2018 were included. Chart review was performed to determine the proportion of men vaccinated for at least one dose of hepatitis A and to examine why men did not receive the vaccine. Multivariable logistic regression was performed to examine the factors associated with vaccine uptake. Vaccine uptake was defined as receipt of at least one dose of hepatitis A vaccine.ResultsOf the 9582 MSM who attended MSHC in 2018, 61.3% (95% CI 60.3% to 62.2%) self-reported already being immune to hepatitis A. Of the 3713 remaining eligible men, 62.7% (95% CI 61.1% to 64.2%) received at least one dose of the hepatitis A vaccine on the day of attendance. Compared with MSM not living with HIV and not taking pre-exposure prophylaxis (PrEP), MSM taking PrEP (adjusted OR 1.28; 95% CI 1.01 to 1.62) were more likely to receive the vaccine. 1386 men (37.3%) did not receive the vaccine and 55.4% were not offered the vaccine by their treating clinician. 300 men (21.6%) were identified as non-immune after serological testing but did not return for vaccination. By the end of 2018, 85.5% of MSHC attendees (8196/9582) were immune to hepatitis A.ConclusionThe critical vaccination threshold for hepatitis A has been estimated at >70%. Continuation of the targeted hepatitis A vaccination programme will improve immunity among the MSM population to prevent ongoing transmission and the likelihood of future outbreaks.

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“…Males aged 16-80 years attending the Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017 who did not have sexual contact with another man were included in this analysis. The MSHC is the largest public sexual health centre located in the State of Victoria, Australia, providing approximately 45 000 consultations a year, 6 of which approximately 28% are for heterosexual males. 7 Demographic information, including questions on sexual contact with individuals overseas, is recorded for patients at each visit using a computer-assisted self-interview (CASI) or added to a patient's medical file by the clinician during the consultation.…”

Section: Study Population and Settingmentioning

confidence: 99%

Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–17

et al. 2019

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Background Since 2014 there has been an increase in gonorrhoea among heterosexuals in Australia. Sex with a partner from a country with high gonorrhoea prevalence has been identified as a risk factor for gonorrhoea in heterosexual females, but risk factors for heterosexual males remain unclear. This study determined risk factors for gonorrhoea among heterosexual males. Methods: Retrospective analysis was performed among heterosexual males attending Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017. Countries for overseas sexual partners were stratified as high-prevalence countries (HPC) or low-prevalence countries (LPC) based on the incidence of gonorrhoea. Results: The annual gonorrhoea positivity increased from 0.72% in 2007 to 1.33% in 2017 (Ptrend <0.001). Males attending MSHC as a contact of gonorrhoea had the highest odds of testing positive (adjusted odds ratio (aOR) 7.46; 95% confidence interval (CI) 4.46–12.49), followed by males identifying as Aboriginal and Torres Strait Islander (aOR 2.57; 95% CI 1.30–5.09), males who had injected drugs in the past 12 months (aOR 2.44; 95% CI 1.39–4.30) and males who had sex with a female from an HPC (aOR 2.18; 95% CI 1.77–2.68). Males aged ≥35 were at higher risk than those aged ≤24 years (aOR 1.44; 95% CI 1.14–1.82). Gonorrhoea positivity increased among males who had sex with females from an LPC (from 0.60% to 1.33%; Ptrend = 0.004) but remained the same over time among males who had sex with females from an HPC (2.14%; Ptrend = 0.143). Conclusions: There was an 80% increase in urethral gonorrhoea among heterosexual males between 2007 and 2017. Having sex with a female from an HPC is a significant risk factor for gonorrhoea. Gonorrhoea positivity among men having sex with a female from an HPC did not change over time, suggesting this risk factor has become less important.

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Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: a retrospective cross-sectional analysis

Abstract: The increase in the number of medical consultations required for the PrEPX study did not result in excessive demand for public sexual health services.

Cited by 15 publications

References 1 publication

Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

Hepatitis A vaccine uptake among men who have sex with men from a time-limited vaccination programme in Melbourne in 2018

Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–17

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