Novel outreach settings to enhance sexually transmitted infection/HIV awareness, diagnosis and treatment in hard-to-reach populations

Abstract

Despite recent rises in the number of cases of sexually transmitted infections (STIs) such as syphilis and gonorrhoea in England and increasing rates of HIV diagnosis among several men who have sex with men populations, many individuals are still not engaging with sexual health services. The John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London set up outreach clinics at the two world's largest adult lifestyle exhibitions in 2013 and 2015. This was the first time that a sexual health screening and promotion service was available at these large-scale (over 10,000 attendees at each) adult lifestyle events. A total of 381 individuals underwent STI screening across the two events. Nineteen (5.0%) patients were diagnosed with an infection. Twelve (3.1%) patients with Chlamydia trachomatis, three (0.8%) patients with syphilis, one (0.3%) patient with Neisseria gonorrhoeae, one (0.3%) patient with HIV, one (0.3%) patient with hepatitis B and one (0.3%) patient with hepatitis C. All 19 patients were promptly contacted with their results and had arrangements made for treatment or were referred for specialist follow up. Where possible, contact tracing was also performed. Implementing such outreach-based projects is challenged by lack of on-site laboratory support, high staffing demands and potentially high costs. However, we achieved a total HIV screening uptake rate of 94.5% amongst our outreach clinic attendees (versus 67% nationally in conventional sexual health clinic attendees) with an HIV positivity rate of 0.3% (versus 0.2% nationally in high HIV prevalence band populations). Additionally, 30.7% had never been tested for HIV previously (versus 20.7% nationally). Our work demonstrates that these strategies can help to address issues related to lack of STI/HIV screening in hard-to-reach populations and promote risk reduction behaviour.

Continued Transmission of HIV Among Young Adults Who Inject Drugs in San Francisco: Still Room for Improvement

“…Even with a wide range of services and prevention programs offered to PWID in San Francisco (2), and increases in HIV prevention services in the U.S. and San Francisco, (31, 32), our data did not show a declining trend of the HIV incidence, but rather a stabilized and potentially low endemic or steady- state level. Further improvements upon prevention services such as multicomponent interventions (33), network-based interventions (34) to reduce risk at the community level, pre-exposure prophylaxis (35), and novel outreach programs to reach and serve hard-to-reach minorities (36) may have potential to further reduce HIV in young adult PWID. These results are also consistent with other studies in the U.S showing low HIV incidence rates among PWID, including in New York (0.4 per 100 PY, 95% CI: 0.0, 2.5) (37).…”

Laboratory Evaluation of the DPP Syphilis Screen & Confirm Assay

“…Same-day testing and results might also help to reduce mistreatment and/or overtreatment caused by syndromic management ( 10 ). Furthermore, it would be a great tool for providing care to hard-to reach populations ( 27 , 28 ). For the successful inclusion of new technologies ( 29 ), the performance characteristics of each assay and the capabilities of each health system must be taken into account so that the maximum benefit can be obtained with implementation ( 30 , 31 ).…”

Identification and treatment of viral hepatitis C in persons who use drugs: a prospective, multicenter outreach study in Flanders, Belgium

“…There are no good estimates of the size of these subgroups in Europe, which are often completely isolated from care. Nevertheless, outreach methods to contact vulnerable populations have been proven successful in different European countries and Australia [19][20][21][22][23]. We aimed to reach out to this specific and vulnerable PWUD community not reached within the OAT program of a community-based facility using a non-invasive screening method.…”