Marjo Taal & Hanna Bos 26 juli 2018 - Soa Aids Nederland
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Marjo Taal & Hanna Bos 26 juli 2018
Synergie in de soa-bestrijding Wat gaat er goed in de NL soa- bestrijding en waar ben jij trots op?
Syndemics….. synergie!
https://www.rivm.nl/en/Topics/S/Sexually_transmitted_infecti
ons_STIs/Video/Video_STI_s.std?ext=.mp4
Programma
1. Start-up
2. Syfilis
3. Soa en PrEP?
4. Soa kliniek in the
future
Synergie
Disease Concentration
Disease interaction
Large scale social forces
6 Gonorrhea in the U.S - 2016
HIV and STI Synergy
Inflammation and/or
ulceration
BEHAVIOR Condomless sex ↑HIV
STI PrEP and
Multiple partners transmission
TasP and/or acquisition
Higher risk partners, ↑ risk
of HIV-infected partner
HIV and STI Synergy
Inflammation and/or
ulceration
↑HIV
BEHAVIOR Condomless sex transmission
STI PrEP and
Multiple partners and/or acquisition
TasP
Higher risk partners, ↑ risk
of HIV-infected partner
• it‘s the mucosa/microbioom! • DGI: gedissimineerde gonorroe go vaccin & China • MSM migrants: prioriteit PrEP • HCV eliminatie: gedragsverandering!
Syfilis
Congenital Syphilis Cases by Year of Birth and rates of Primary and Secondary Syphilis among Women, United States, 2007–2016 Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
Decline in the number of penicillin API manufacturers
over the past decade, 1995-2018
Pre-1995 1995-2000
1995- 2001-2005
2001- 2006-2010
2006- 2011-2015
2011- 2016
Pre-1995 Current
2000 2005 2010 2015
• CSPC China
• NCPC China
• Jiangxi Dongfeng China
• Sandoz Germany Closed plant
Acquired by
• Wyeth India Pfizer
Acquired by
• King USA Pfizer
Ended
• Pfizer USA production
Ended
• Alembic India production
Ended
• Bristol Europe UK production
Ended
• Aventis France production
Acquired by
• GIST Brocades Netherlands DSM*
Source: Melanie Taylor, RHR/STI, WHO Geneva.A Vicious Cycle: STDs predict future HIV Risk
Rectal GC
or CT
1 in 15 MSM were diagnosed with HIV within 1 year.*
Primary or
Secondary
Syphilis 1 in 18 MSM were diagnosed with HIV within 1 year.**
No rectal STD
or syphilis
infection
1 in 53 MSM were diagnosed with HIV within 1 year.*
*STD Clinic Patients, New York City. Pathela, CID 2013:57;
**Matched STD/HIV Surveillance Data, New York City. Pathela, CID 2015:61Syfilis Toepassing in jouw werk? Vragen aan experts? Vragen aan andere disciplines?
PrEP en soa
Risk Compensation adjustment of behaviour in response to a
perceived reduction in risk.
•Critical issue in the public health implementation of biomedical interventions: Could increased risky
sexual behavior counteract the biological efficacy against HIV?
•Behavioral adaptation: Behavioral changes triggered by a safety measure: reduction in condom use
•Behavioral disinhibition: Lack of restraint with more risk taking behaviors: increasing nr of partners,
nr of sexual acts, chemsex…
•STIs: Best objective measure of risk compensation and most feared consequence of risk compensation
•Individual vs. population impact of biomedical interventions: risk compensation among people not
using PrEP/TASP
•Risk management plan: Assess the public health impact of PrEP
Cassell BMJ 2006Figure 10
New diagnoses of HIV and STIs from 1996
to 2015 in MSM in England
Unemo M et al. Lancet Infect Dis 2017Unemo M et al. Lancet Infect Dis 2017
Community-Level Changes in11Condom use with
Figure
Casual Partners Among MSM
30%
1%
46%
The Lancet Infectious Diseases 2017 17, e235-e279DOI: (10.1016/S1473-3099(17)30310-9)
Copyright Holt M. et al . Lancet HIV 2018Meta-analyis of effect of PrEP on STIs diagnosis among MSM Significant increase in any rectal STI diagnosis (OR: 1.39, 95% CI: 1.03-1.87) Significant increase in rectal chlamydia (OR: 1.59, 95% CI: 1.19-2.13) Increase in STIs rates in more recent studies (OR: 1.47, 95% CI: 1.05-2.05) Traeger MW et al. CID 2018
Partners, not condom use drive STIs rates
• SPARK: Community-based PrEP demonstration project in NYC
• 261 MSM followed until M12 after PrEP intitiation
• Decrease in condom use: 61% to 46%
Predicting Factors of STIs aOR 95% CI p
Age < 25 years old 3.67 1.11-12.25 < 0.05
> 5 casual partners at BL 2.80 1.43-5.50 < 0.01
STIs in 6 months pre-PrEP 2.22 1.07-4.59PrEP en soa Toepassing in jouw werk? Vragen aan experts? Vragen aan andere disciplines?
STI clinic in the future Dean Street Express, London
Time to treatment
Pre Express Post Express
Time attendance to informed
of result (hours) 183 3.8
Time attendance to
treatment 238 48
(hours)
Byrne et al, BASHH oral presentation 2015
Whitlock et al, Int J STD&AIDS 2018CT/GC in HIV negative MSM
15.000 Chlamydia any site 1.000
Diagnoses
800
Tests
10.000
600
400
5.000
200
- -
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3
2012
Chlamydia
2013
diagnoses
2014
Chlamydia
2015
tests
2016 2017
Gonorrhoea any site
15.000 2.000
Diagnoses
1.500
Tests
10.000
1.000
5.000
500
- -
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3
2012 Gonorrhoea
2013 diagnoses
2014 Gonorrhoea2016
2015 tests 2017
HIV and STI test and diagnosis trends in MSM attending Dean Street Clinic, 2012 to 2016 (GUMCAD)STI models of care Private Public Pro’s Pro’s • High coverage • Serve high-risk populations • Can easily provide basic STI screening • Diagnose and treat large numbers of services STIs Contra’s • High level of expertise • Most patients not at high risk Contra’s • STIs not a priority • Low coverage • Lack of expertise • Stigma Public Health Impact Public Health Impact • Generalized epidemics • Concentrated epidemics
Concentrated Epidemics
Most of these infections are
HIV overlapping epidemics among
populations that STD clinics have
Syphilis access to:
Gonorrhea •
•
MSM
Sex workers
LGV •
•
injection drug users
other high-risk populations
Hepatitis COnline services: SH24
Mobile friendly and onlineDigital vending machine
BioSURE HIV self-tests: 3rd generation
Wall mounted at eye level
Touch screen
Robust - liquid proof – secure (>300 machines,
no incidents)
Lifespan ‘hundreds of thousands’ of vends
Little maintenance, can be done remotely
Access website for live monitoring of sales,
issues and epidemiological data Installed Brighton Sauna
June 2017GPS to predict the next event You probably met gonorroea at ….. Your nearest STI care that is open now is…….
STI clinic in the future
∞ Social media
campaigns Branded services
tailored to diverse
Tailored risk reduction needs
advice online
Outreach in hot spots
Links to community and/or to support
organisations local community needs
Wellbeing programme
Self-sampling
Self-testingBarriers
Funding constraints
• a small pot for prevention
• complacency amongst policy-makers/funders/…
Provider constraints
slow to adopt new technologies, resistant to change,
paternalistic
not knowing/connecting with users
negative attitudes persist
Population constraints
fear and stigma have not gone awaySolutions
Funding constraints
• tackle the cost of tests – a global issue
• make throughput efficient for lab (upscale) and clinic
(differentiate)
Provider constraints
top-down, bottom-up – create the team that gets the
technology
keep it lively – refresh campaigns, start new ones, reward
staff, trust the users
Population constraints
work with community champions on positive messages –
be inclusive, celebrate diversitySTI clinic in the future Toepassing in jouw werk? Vragen aan experts? Vragen aan andere disciplines?
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