Estimating the syphilis epidemic among gay, bisexual and other men who have sex with men in Australia following changes in HIV care and prevention

Wilkinson, Anna L.; Scott, Nick; Tidhar, Tom; Luong, Phillip; El-Hayek, Carol; Wilson, David; Fairley, Christopher K; Zhang, Lei; Leslie, David; Roth, Norman; Tee, Ban Kiem; Hellard, Margaret; Stoové, Mark

doi:10.1071/sh18215

Cited by 4 publications

(5 citation statements)

References 34 publications

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“…Our findings concur with previous modelling studies that showed the preventive effect of scaling up syphilis testing. 40 , 41 Increasing syphilis testing frequency among high-risk MSM can vastly reduce the duration of infectiousness and the number of infectious MSM. Even though higher testing frequency means that more syphilis-infected individuals will be diagnosed, treated, and become susceptible to reinfection, the estimated number of treated MSM each year was much smaller than the susceptible population, and its impact on increasing the number of infections was negligible.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, we accounted for the fast expansion of HIV-PrEP uptake in BC since 2018, unlike other studies that did not consider HIV-PrEP or considered a hypothetical scenario with HIV-PrEP. 40 , 41 We estimated that the current HIV-PrEP program significantly reduced the syphilis rate compared to a scenario with no HIV-PrEP implementation. In addition, we stratified the MSM population by HIV-PrEP eligibility, HIV-PrEP use, and HIV status, accounting for the heterogeneity of the MSM population in HIV/syphilis risk and healthcare access.…”

Section: Discussionmentioning

confidence: 99%

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Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

Zhu,

Takeh,

David

et al. 2024

The Lancet Regional Health - Americas

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

Zhu,

Takeh,

David

et al. 2024

The Lancet Regional Health - Americas

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“…Furthermore, there is emerging evidence from open‐label and demonstration studies and implementation sites among gay, bisexual and other men who have sex with men (MSM) that condom use decreases among some men on PrEP, particularly among those already engaging in condomless sex or other high‐risk behaviours . However, modelling among MSM suggest that if PrEP is accompanied by regular STI services, increased detection and treatment may mitigate increases in STI transmission . While there is no current evidence among FSWs of decreasing condom use or other behaviours increasing vulnerability to STIs and unintended pregnancy , implementation data are too limited to discount this possibility.…”

Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

et al. 2020

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Introduction Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre‐exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. Discussion FSWs have high unmet need for effective contraception and unintended pregnancy is common in low‐ and middle‐income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk‐taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single‐focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real‐life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two‐fold increase in condomless sex among FSWs on PrEP, which, given low use of non‐barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW‐focused community‐based HIV services is likely to be the most effective model for improving access to non‐barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. Conclusions As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women’s rights.

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“…In many developed countries, the advent of effective ART making HIV untransmissible, and the widespread availability of PrEP, has led to increasing levels of comfort with condomless sex [36] and an associate decrease in condom use among MSM [37][38][39]. In the context of these biomedical HIV prevention approaches, modelling studies of syphilis transmission have emphasised the importance of syphilis control strategies that focus on increased testing among MSM [40].…”

Section: The Need For Rapid Point-of-care Test To Improve Frequent Te...mentioning

confidence: 99%

Point-of-Care Diagnostics for Diagnosis of Active Syphilis Infection: Needs, Challenges and the Way Forward

Pham

Ong

Anderson

et al. 2022

IJERPH

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Syphilis, a curable sexually transmitted infection, has re-emerged as a global public health threat with an estimated 5.6 million new cases every year. Pregnant women and men who have sex with men are key target populations for syphilis control and prevention programs. Frequent syphilis testing for timely and accurate diagnosis of active infections for appropriate clinical management is a key strategy to effectively prevent disease transmission. However, there are persistent challenges in the diagnostic landscape and service delivery/testing models that hinder global syphilis control efforts. In this commentary, we summarise the current trends and challenges in diagnosis of active syphilis infection and identify the data gaps and key areas for research and development of novel point-of-care diagnostics which could help to overcome the present technological, individual and structural barriers in access to syphilis testing. We present expert opinion on future research which will be required to accelerate the validation and implementation of new point-of-care diagnostics in real-world settings.

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Estimating the syphilis epidemic among gay, bisexual and other men who have sex with men in Australia following changes in HIV care and prevention

Cited by 4 publications

References 34 publications

Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

Point-of-Care Diagnostics for Diagnosis of Active Syphilis Infection: Needs, Challenges and the Way Forward

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