Monkeypox Vaccination Strategy and Missed Opportunities in STI and HIV Prevention: An Urban Sexual Health Clinic's Experience During a Public Health Emergency

Stewart, Jessica; Bartkus, Mary; Sperring, Heather; Ruiz-Mercado, Glorimar; Johnson, Samantha; Pierre, Cassandra

doi:10.1093/ofid/ofad006

Cited by 5 publications

(7 citation statements)

References 3 publications

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“…Our elevated syphilis prevalence contrasts with international data, including other Latin American countries but is compatible with the alarming epidemiological syphilis scenario in Brazil [5,8,10,31]. Such findings might be related to shared sexual networks or higher risk of HIV acquisition in the context of a concomitant STI, and underscores the importance of mpox assessment as an opportunity to expand other STI diagnosis [32,33]. Despite presenting more often with fever, anogenital lesions and proctitis, PWH in our cohort showed similar proportions of hospitalization as individuals not living with HIV, which is still controversial in available global data [5,9,10,14].…”

Section: Discussionsupporting

confidence: 78%

“…From June 12 to 31 December 2022, 418 participants had a confirmed mpox diagnosis. Overall, median age was 33 years [interquartile range (IQR) [28][29][30][31][32][33][34][35][36][37][38][39][40]; 91.6% selfidentified as cisgender men, 5.7% as cisgender women and 2.6% as travesti or transgender women (TGW). The majority were black or pardo (60.5%, n ¼ 207/342), 38.6% were white (n ¼ 132/342) and 0.9% were indigenous (n ¼ 3/342).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil

Silva,

Coutinho,

Torres

et al. 2023

Aids

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Objectives: This study aimed to analyze characteristics of mpox hospitalization in a Brazilian cohort, further exploring the impact of HIV on mpox-related outcomes and hospitalization. Design: We conducted a descriptive analysis, comparing characteristics of individuals diagnosed with mpox according to hospitalization and HIV status, and described the mpox cases among those living with HIV. Methods: This was a single-center, prospective cohort study conducted at a major infectious diseases referral center in Rio de Janeiro, Brazil, that enrolled participants older than 18 years of age diagnosed with mpox. Information was collected on standardized forms, including data on sociodemographic, behavioral, clinical and laboratory characteristics. For comparisons we used chi-squared, Fisher's exact and the Moods median tests when appropriate. Results: From June to December, 2022, we enrolled 418 individuals diagnosed with mpox, of whom 52% were people living with HIV (PLHIV). PLHIV presented more frequently with fever, anogenital lesions and proctitis. The overall hospitalization rate was 10.5% (n = 43), especially for pain control. Among hospitalized participants, PLHIV had more proctitis and required invasive support. Mpox severity was related to poor HIV continuum of care outcomes and low CD4+ cell counts. All deaths (n = 2) occurred in PLHIV with CD4+<50 cells/mm3. Conclusions: HIV-related immunossupression likely impacts mpox clinical outcomes. This is of special concern in settings of poor adherence and late presentation to care related to socioeconomic inequalities, such as Brazil. The HIV continuum of care must be taken into account when responding to the mpox outbreak.

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Section: Discussionsupporting

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil

Silva,

Coutinho,

Torres

et al. 2023

Aids

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“… 28 Similarly, a US study reported a significant decline in HIV PrEP enrolment and STI testing when STI care was deprioritised by a need to upscale mpox vaccination with limited staff resource. 29 HIV testing rates among certain population groups such as heterosexual men and heterosexual and bisexual women are yet to return to the levels they were prior to the COVID-19 pandemic. 30 Disruption to routine sexual health services including HIV testing threatens the UK’s progress towards elimination of HIV transmission.…”

Section: Discussionmentioning

confidence: 99%

“…A service evaluation of a UK clinic described the temporary cancellation of routine sexual health services, such as warts clinics and vaccinations, in response to the increased workload brought about by the mpox outbreak 28. Similarly, a US study reported a significant decline in HIV PrEP enrolment and STI testing when STI care was deprioritised by a need to upscale mpox vaccination with limited staff resource 29. HIV testing rates among certain population groups such as heterosexual men and heterosexual and bisexual women are yet to return to the levels they were prior to the COVID-19 pandemic 30.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional survey of sexual health professionals’ experiences and perceptions of the 2022 mpox outbreak in the UK

Hayes,

Dakin,

Smuk

et al. 2024

BMJ Open

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ObjectiveTo understand the experiences and perceptions of sexual health professionals responding to the May 2022 mpox outbreak in the UK.DesignCross-sectional, anonymous, online survey collecting quantitative and qualitative data. Convenience sample recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness, support, and training; safety at work; vaccination; and well-being. Qualitative descriptive analysis of open-text responses was conducted to support interpretation of the quantitative data.ParticipantsParticipants who were employed as sexual health professionals in the UK and had direct clinical experience of mpox were included in the analysis. The survey was completed between 11 August and 31 October 2022 by 139 respondents, the majority of whom were doctors (72.7%), cis-female (70.5%) and White (78.4%).Results70.3% reported that they were required to respond to mpox in addition to their existing clinical responsibilities, with 46.8% working longer hours as a result. In the open-text data, respondents highlighted that workload pressures were exacerbated by a lack of additional funding for mpox, pre-existing pressures on sexual health services, and unrealistic expectations around capacity. 67.6% of respondents reported experiencing negative emotional impact due to their mpox work, with stress (59.0%), fatigue (43.2%) and anxiety (36.0%) being the most common symptoms. 35.8% stated that they were less likely to remain in their profession because of their experiences during the mpox outbreak. In the open-text data, these feelings were ascribed to post-COVID exhaustion, understaffing and frustration among some participants at the handling of the mpox response.ConclusionsThese findings indicate that sexual health services require increased funding and resources, along with evidence-based well-being interventions, to support sexual health professionals’ outbreak preparedness and recovery.

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Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022–2023 UK mpox outbreak

Biesty,

Hemingway,

Woolgar

et al. 2024

BMC Public Health

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Background Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022–2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak. Methods Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. Results Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. Conclusions The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022–2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

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Monkeypox Vaccination Strategy and Missed Opportunities in STI and HIV Prevention: An Urban Sexual Health Clinic's Experience During a Public Health Emergency

Cited by 5 publications

References 3 publications

Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil

Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil

Cross-sectional survey of sexual health professionals’ experiences and perceptions of the 2022 mpox outbreak in the UK

Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022–2023 UK mpox outbreak

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