THE PREP CLINIC IN CHECK POINTS - DR. LORENZO BADIA INFECTIOUS DISEASES UNIT, S.ORSOLA-MALPIGHI HOSPITAL, BOLOGNA, ITALY - ICAR 2019
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The PrEP clinic in check points
Dr. Lorenzo Badia
Infectious Diseases Unit, S.Orsola-Malpighi Hospital, Bologna, Italy
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Disclosures • Advisory board: Gilead, Abbvie • Speaker: Gilead, Merck • Research grant: Gilead • Travel grant: Gilead, Bristol-Meyers-Squibb, Abbvie
BLQ Checkpoint: the first Italian experience
• Established in June 2015
• Activity started in September 2015
• Made possible thanks to an
agreement with the Municipality of
Bologna, Health Authority of Bologna
and Plus which is the implementing
body
• With the support of Emilia-Romagna
region
3
Testing activities at the BLQ Checkpoint
• Rapid HIV test (Alere Determine ™ HIV-
1/2 Ag/Ab Combo – capillary blood
sampling – nurse)
• Rapid HCV test (OraQuick® HCV Rapid
Antibody Test – saliva – nurse)
• Results: 20 minutes
• Free access: Tue + Thu 18-21 (phone
bookings)
• Free, anonymous, confidential
• Peer counselling (pre e post test)
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Testing activities at the BLQ Checkpoint
People with HIV/HCV reactive test:
• Couselling
• Confirmatory test at the Clinical
Center
• Self-help group
• Workshops for MSM HIV+ (HIVoices)
People tested negative
• Couselling (safer sex, stigma against PLWHIV )
• Retesting (3/6/12 months) – Recall service
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PrEP at BLQ Checkpoint
• In March 2018, after generic Emtricitabine/Tenofovir
disoproxil became available, the first Italian
community-based PrEP Clinic was set up
• A cooperation between:
- UO Malattie Infettive - AZOU Bologna
- UO Dermatologia - AZOU Bologna
- PLUS Onlus
• Monday and Wednesday from 6 to 9 PM
• Informal and friendly environment
PrEP at BLQ Checkpoint
Screening blood tests:
- HIV/HBV/HCV/Syphilis UO Dermatologia
- Creatinine Ambulatorio MTS
- CT/NG on urine/pharynx/rectum
3 days
Peer counseling
Visit with ID specialist
PrEP prescription, condom and
BLQ Checkpoint
lube dispensation
1 month, then every 3 months
Peer counseling
Visit with ID specialist
PrEP prescription, condom and
BLQ Checkpoint
lube dispensation, STIs POC tests
PrEP at BLQ Checkpoint
Cepheid Genexpert™ CT/NG Creatinine on
on urine/rectum/pharynx capillary blood
(results in 75 minutes) (result in 10 sec)
Non è possibile visualizzare l'immagine.
InCepheid
caso diGenexpert™
reattività HCV
di 1 VL
o più test, presa in
su sangue capillare
carico “fast
(risultato track”
in 45 minuti)(1 giorno) presso
ambulatori MTS (Chlamydia, gonorrea,
Non è possibile visualizzare l'immagine.
sifilide) o Malattie
Alere Determine™ Infettive
HIV-1/2 Ag/Ab (HIV,
ComboHCV)
su sangue capillare
Non è possibile visualizzare l'immagine.
(risultato in 15 minuti)
Alere Determine™ Syphilis
su sangue capillare
(risultato in 15 minuti)
SEX-CHECK Study
• Prospective, observational study enrolling cis-men
and trans-women who have sex with men
Non è possibile visualizzare l'immagine.
• PrEP users or non-PrEP users
• Conducted at the "BLQ Checkpoint"
Aim of the study • Todescribe prevalence and incidence of STIs in the HIV-negative MSM population • To describe baseline risk factors for HIV and HCV acquisition and if they change after counseling/frequent testing • To evaluate correlations between baseline characteristics and future HIV acquisition
Methods
Each subject undergoes
• Rapid tests for HIV (Ag/Ab), HCV (Ab and RNA), syphilis
(Ab), Chlamydia trachomatis/Neisseria gonhorroeae (PCR
on rectal/oral swab and urine) at baseline
• Questionnaire about sexual habits and risk factors
The whole evaluation is repeated every 3 month for 1 year
Study period 1 year
3 months 3 months 3 months 3 monthsBaseline characteristics PrEP users Non PrEP
(n=42) users (n=38)
Cis-gender men, n (%) 41 (97.6) 37 (97.4)
Age, median (range) 40 (24-57) 37.5 (19-59)
Sexual orientation, n (%)
•Gay 41 (97.6) 35 (92.1)
•Bisexual 0 (0) 2 (5.3)
•Heterosexual 1 (2.4) 1 (2.6)
Level of education, n (%)
•Primary school 2 (4.8) 0 (0)
•Secondary school 21 (50.0) 15 (39.5)
•University 15 (35.6) 15 (39.5)
•Post-university 4 (9.6) 8 (21.0)
White/caucasian, n (%) 39 (92.9) 36 (94.7)
Male partners in last 6 months, n (%)
•1-5 4 (9.6) 8 (21.0)
•6-10 3 (7.2) 4 (10.6)
•>10 35 (83.2) 26 (68.4)Condom use and
serosorting
Percentage of patients reporting at least 1
condomless sexual intercourseSexual Ways to meet practices partners
Substance use
15% of subjects reported
sharing of straws or
needlesHistory of STIs and access
to test
STIs history
Time of last HIV testSTIs prevalence
1 active HCV infection
21.4% previous syphilisWhat happened next?
P73 - Malosso P. et al.
Poster exhibition
OC32 - Maccaro A. et al.
06/06 h 15:43Summary and conclusions
• High prevalence of risk factors for HIV and other STIs.
• Peer leading, together with flexible schedule is the key for
success of checkpoints
• Close cooperation with clinics (“fast tracks”) to treat immediately
incident STIs
• The prevalence of CT and NG infections, together with the
absence of symptoms in all cases, confirms the need to screen
for these infections in MSM population, especially before and
during PrEP.
• The low prevalence of HCV infection requires further evaluation.You can also read
