OBJECTIVES:The objective of the Immediate Staging Pilot Project (ISPP) was to improve linkage to human immunodeficiency virus (HIV) care by increasing the number of referrals made to HIV care, and to decrease the time between diagnosis and linkage to care for newly diagnosed HIV clients. This pilot had the potential to decrease HIV transmission at a population level by engaging clients in treatment earlier. OUTCOMES: Comparing linkage to care outcomes between a group that received the standard of care (SOC) and an intervention group that received immediate staging, the median linkage to care time decreased from 21.5 to 14.0 days respectively (p = 0.053). The referral rates to HIV care were 56.1% in the SOC group and 94.1% in the intervention group (p < 0.001). CONCLUSION:Creating best practices that include offering CD4 and viral load testing at the time of diagnosis, enhanced nursing support and standardized referral processes has facilitated an improvement in the quality of HIV services provided to MSM clients attending low-threshold clinics.KEY WORDS: Linkage to care; continuum of care; HIV; men who have sex with men; low-threshold sites; outcome assessment (health care) La traduction du résumé se trouve à la fin de l'article.

Background Infectious syphilis has increased substantially over the past decade. Targeting limited public health resources toward subpopulations with multiple reinfections may have a large impact in reducing onward transmission within a community. Methods A chart review was conducted for individuals with 4 or more infectious syphilis diagnoses between 2005 and 2014 (the top 1% of all syphilis diagnoses in British Columbia, Canada). We characterized the sociodemographics, partner notification outcomes and social network. Results Between 2005 and 2014, there were 30 individuals with 4 or more syphilis diagnoses, accounting for 139 diagnoses. All were men who have sex with men and 29 (96%) were human immunodeficiency virus–positive. Of the 139 diagnoses, 65% occurred in the early latent stage of infection, 22% in the secondary stage, and 14% in the primary stage. The median number of sexual partners per diagnosis was 5 (range, 1–50). Among the 838 partners reported, 79% were notifiable, 53% were notified, and 23% were reported to be tested or treated. Sexual network mapping showed that almost half of the members of this group could be linked to one another either directly or indirectly via partners over 10 years. Social network mapping demonstrated high connectivity, with 4 venues associated with almost two thirds of the study population. Conclusions The connectivity and recurrent diagnoses in this study population suggest potential benefits of targeted interventions to individuals with multiple diagnoses and their partners. Our study highlights the need for enhanced care, increased syphilis testing frequency, and exploring alternative preventative methods among individuals with syphilis rediagnoses to reduce syphilis incidence.

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Background Exosomes are small vesicles containing a wide range of functional proteins, DNA and RNA. Exosomal RNAs have been implicated in many exosome-mediated biological functions. These cell-derived Exosomes contain numerous miR-NAs, which can work locally or can enter the circulation to act at distal sites. Accumulating evidences indicate that exosomal miRNA is linked to the host immune response to infection. In this study, we focused on how Treponema pallidum evade immune clearance via exosome-mediated transfer of microRNAs. Methods We first performed a comprehensive miRNA profiling in exosomes using microarray analysis. Thereafter, RT-PCR was performed to validate the expression of miR-146a-5p in exosome derived from macrophage stimulated by Treponema pallidum and syphilis patients. Laser confocal microscopy was used to trace exosomal miR-146a-5p secreted by macrophage into HUVECs. The effect of exosomal miR-146a-5p on monocytes cells transendothelial migration of HUVEC by using migration assay. Luciferase reporter assay were utilized to confirm the binding of exosomal miR-146a-5p to the 3'untranslated region of JAM-C. Results MicroRNA array was performed and 65 miRNAs were identified. Among the identified miRNAs, miR-146a-5p was one of the most significantly changed miRNAs which high expression in Treponema pallidum derived exosomes. We also confirmed that miR-146a-5p was enriched in serum exosomes of syphilis patients. Exosomal miR-146a-5p of macrophages could be transferred into HUVEC and reduce monocyte transendothelial migration by directly targeting the promoter of JAM-C. Conclusion Our date show that exosomes derived from macrophage stimulated by Treponema pallidum expressed high levels of miR-146a-5p which could be delivered to endothelial cells, and decreases monocyte transendothelial migration by targeting JAM-C in endothelial cells, which may enable Treponema pallidum evade the host immune clearance. Disclosure No significant relationships.

IntroductionFrom 2010 to 2015, the incidence of infectious syphilis (primary, secondary, and early-latent) has increased 5-fold in British Columbia (BC). In response, the BC Centre for Disease Control (BCCDC) enhanced surveillance for syphilis to characterise sexual/social networks driving the epidemic, and to monitor the risk of HIV transmission. Here we communicate indicators developed from the provincial enhanced surveillance system.MethodsIn BC, management of syphilis – including partner notification – is centralised, and coordinated by the BCCDC. In January 2016, a new workflow was implemented to systematically collect and analyse data on HIV co-infection, viral-load and partners. New indicators were developed along a cascade-of-care framework for case and partner care.ResultsFrom January to September 2016, 581 syphilis cases were diagnosed in BC; 491 (84%) were among men who have sex with men (MSM). Of these, 201 (41%) were HIV-positive and 268 (55%) were HIV-negative. Three-quarters of HIV-positive MSM had undetectable viral loads. 149 (74%) of HIV-positive MSM and 137 (51%) of HIV-negative MSM were diagnosed during the early-latent stage. For both groups, 96% of cases were treated within 30 days of syphilis testing. Of the 201 HIV-positive MSM, 141 (70%) discussed partners with public health nurses and together reported 1270 partners (65% anonymous, 35% notifiable) or 9.0 partners/case (range:0–214). Of the 268 HIV-negative MSM, 215 (80%) discussed partners and reported 1806 partners (51% anonymous, 49% notifiable), or 8.4 partners/case (range:1–200).ConclusionA greater proportion of HIV-positive MSM were diagnosed with syphilis during the asymptomatic early-latent stage, which may be due to routine syphilis screening. However, a lower proportion of HIV-positive MSM with syphilis co-infection were engaged with public health for partner notification, and report a lower proportion of notifiable partners, compared to MSM with syphilis only. Strategies to engage HIV-positive MSM in partner care would strengthen the public health response to syphilis.