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Teker, Buhari; Schim van der Loeff, Maarten F; Boyd, Anders; Hoornenborg, Elske; Stam, Arjen J; de Vries, Henry J C; Jongen, Vita Willemijn
doi: 10.1136/sextrans-2024-056276pmid: 39643436
ObjectiveVarious European countries noted increasing Neisseria gonorrhoeae (Ng) positivity among cis-gender women and heterosexual men. We assessed changes over time in Ng among men who exclusively have sex with men (MSM), men who exclusively have sex with women (MSW), men who have sex with men and women (MSMW), women and transgender and gender diverse people (TGP).MethodsWe analysed data collected between 2018 and 2023 at the Centre for Sexual Health, Amsterdam. We modelled temporal changes in Ng positivity rates (ie, number of positive results per 100 tests) using relative risk regression with a covariate representing three time periods: pre-COVID-19 (1 January 2018–12 March 2020), during COVID-19 (13 March 2020–1 March 2022), and post-COVID-19 (2 March 2022–31 December 2023).ResultsWe included 110 878 consultations pre-COVID-19, 84 917 during COVID-19 and 108 282 post-COVID-19. Positivity rates of Ng went from 12.4% to 13.0% in MSM, 1.7% to 2.3% in MSW, 6.7% to 9.9% in MSMW, 1.3% to 2.9% in women and 8.1% to 10.4% in TGP pre-COVID-19 and post-COVID-19, respectively. Significant increases were observed among MSW (relative risk (RR)=1.31,95% CI 1.12 to 1.53), MSMW (RR=1.47, 95% CI 1.26 to 1.72) and women (RR=2.25, 95% CI 2.03 to 2.49). An increased number of sexual partners and inconsistent condom use were associated with an increased Ng risk.ConclusionA substantial relative increase in Ng risk among MSW, MSMW and women, but not MSM or TGP, was observed post-COVID-19. Changes in sexual behaviour were associated with these changes. Continuous surveillance of Ng in heterosexual individuals is needed to monitor changes, alongside implementing prevention strategies for sexually transmitted infections.
Harrison, China; Family, Hannah; Kesten, Joanna; Denford, Sarah; Scott, Jennifer; Sabin, Caroline; Copping, Joanna; Harryman, Lindsey; Cochrane, Sarah; Saunders, John; Hamilton-Shaw, Ross; Horwood, Jeremy
doi: 10.1136/sextrans-2024-056308pmid: 39542715
ObjectivesExpanding delivery of oral pre-exposure prophylaxis (PrEP) to community pharmacies could improve access, aligning well with the UK government’s goals to eliminate new HIV acquisitions by 2030. Using the Capability, Opportunity, Motivation, Behaviour (COM-B) model for behaviour change, the aim of this research was to explore the barriers and facilitators of community pharmacy PrEP delivery, for pharmacists and community members.MethodsCommunity members at elevated risk of acquiring HIV and community pharmacists were recruited to participate in semi-structured interviews. Interviews were recorded, transcribed, and thematically analysed within the framework of the COM-B model.Results17 interviews with pharmacists (pharmacy owners n=7; employed pharmacists n=6; locums n=4) and 24 with community members (black African women n=6; other women n=2; young adults aged 18–25 years n=6; transgender people n=6; female sex workers n=4) were carried out. Capability barriers included suboptimal awareness and knowledge of PrEP, pharmacy facilities and pharmacist roles in delivering public health services. Opportunity barriers included a lack of staff capacity, privacy and pharmacy screening and monitoring facilities. Motivational barriers included a concern that increased access could increase sexually transmitted infections and involve a financial cost. Capability facilitators included awareness raising, HIV and PrEP training and education. Opportunity facilitators included PrEP appointments and the accessibility of pharmacies. Motivational facilitators included a preference for pharmacy delivery over other models (eg, sexual health, General Practitioner (GP)), and a belief that it would be discrete and less stigmatising.ConclusionPharmacy PrEP delivery is acceptable but for it to be feasible, results point to the need for the development of a behaviour change intervention focusing on education, training and awareness raising, targeting pharmacists and community members to stimulate patient activation and de-stigmatise HIV. This intervention would need to be facilitated by system and environmental changes (eg, commissioning service).
Napierala, Sue; Bair, Elizabeth F; Omollo, Ouma Dan; Egbe, Teniola I; Wesonga, Julius Oduor; Rajaratnam, Anisha; Celum, Connie; Thirumurthy, Harsha; Agot, Kawango
doi: 10.1136/sextrans-2024-056266pmid: 39516007
Fidalgo, Berta Isabel; Iglesies, Jordi; García, David; Vergara, Andrea; Fuertes de Vega, Irene; Horvath, Laura; Zboromyrska, Yuliya; Bosch, Jordi; González, Ana; Riera-Monroig, José; Roca, Ignasi; Alguacil, Marina; Casals-Pascual, Climent; Pitart, Cristina; Mallolas, Josep; Blanco, José Luis; Espasa, Mateu
Mullen, Dolores; Edney, Jessica; Phillips, Dawn; Wilkie, Ruth; Reid, David; Lowndes, Catherine M; Buitendam, Erna; Sinka, Katy; Mandal, Sema; Mercer, Catherine H; Saunders, John; Mohammed, Hamish; Ogaz, Dana
doi: 10.1136/sextrans-2024-056358pmid: 39567005
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ObjectivesBetter data on aetiological prevalence of sexually transmitted infections (STIs) among African men could greatly strengthen STI prevention efforts and convey benefits to women as well. In an ongoing study among men in Kenya, we analysed baseline STI prevalence and individual characteristics associated with STI.MethodsIn Siaya County, Kenya, we recruited men aged 18–39 years who self-reported engagement in transactional sex and alcohol use. We administered a baseline questionnaire to participants and conducted testing for HIV, herpes simplex virus type 2 (HSV-2), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection. Characteristics associated with bacterial STIs were analysed using logistic regression and we estimated the positive and negative predictive values (PPV/NPV) of syndromic management of these infections.ResultsWe enrolled 1500 participants from July 2022 to March 2023. Participant mean age was 27.9 years, 62.2% were married/cohabitating and 53.5% were heavy alcohol users (Alcohol Use Disorders Identification Test-Consumption≥4). Participants reported a mean of 4.2 sexual partners and 3.5 transactional sex partners in the past 3 months. HIV prevalence was 9.5%, HSV-2 was 38.7%, CT was 14.3% and NG was 2.5%. Combined CT and/or NG infection was detected in 16.1% of participants.Compared with participants uninfected, those testing positive for CT and/or NG were younger (p=0.001), had more sexual partners (p=0.027) and transactional sex partners (p=0.039), were less likely to have used a condom at last sex (p=0.015) and were more likely to self-report having an STI besides HIV in the past 12 months (p=0.002). The PPV and NPV for currently experiencing CT and/or NG symptoms were 33.3% and 84.4%, respectively.ConclusionsAmong Kenyan men engaged in transactional sex and alcohol use, STI prevalence was high. These data fill an important gap about STI prevalence and risk factors in African men highlighting the risk of ongoing transmission and the need for targeted prevention programmes and expanded access to testing and treatment.
doi: 10.1136/sextrans-2024-056142pmid: 39773988