The ‘Antiretrovirals, Sexual Transmission Risk and Attitudes’ (ASTRA) Study. Design, Methods and Participant Characteristics

Abstract

Life expectancy for people diagnosed with HIV has improved dramatically however the number of new infections in the UK remains high. Understanding patterns of sexual behaviour among people living with diagnosed HIV, and the factors associated with having condom-less sex, is important for informing HIV prevention strategies and clinical care. In addition, in view of the current interest in a policy of early antiretroviral treatment (ART) for all people diagnosed with HIV in the UK, it is of particular importance to assess whether ART use is associated with increased levels of condom-less sex. In this context the ASTRA study was designed to investigate current sexual activity, and attitudes to HIV transmission risk, in a large unselected sample of HIV-infected patients under care in the UK. The study also gathered background information on demographic, socio-economic, lifestyle and disease-related characteristics, and physical and psychological symptoms, in order to identify other key factors impacting on HIV patients and the behaviours which underpin transmission. In this paper we describe the study rationale, design, methods, response rate and the demographic characteristics of the participants. People diagnosed with HIV infection attending 8 UK HIV out-patient clinics in 2011-2012 were invited to participate in the study. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire, and their latest CD4 count and viral load test results were recorded. During the study period, 5112 eligible patients were invited to take part in the study and 3258 completed questionnaires were obtained, representing a response rate of 64% of eligible patients. The study includes 2248 men who have sex with men (MSM), 373 heterosexual men and 637 women. Future results from ASTRA will be a key resource for understanding HIV transmission within the UK, targeting prevention efforts, and informing clinical care of individuals living with HIV.

Non-Disclosure of HIV Status and Associations with Psychological Factors, ART Non-Adherence, and Viral Load Non-Suppression Among People Living with HIV in the UK

“…During the study period 5112 HIV-diagnosed men and women were invited to participate in ASTRA, of whom 3258 completed the questionnaire (response rate 64 %) [22.] The mean age was 45.2 years (SD 9.6).…”

“…The Antiretrovirals Sexual Transmission Risks and Attitudes (ASTRA) study recruited men and women with diagnosed HIV infection attending one of eight UK HIV outpatient clinics during 2011–2012 [22]. Participants completed a confidential, gender-specific questionnaire that included socio-demographic information (gender, sexual orientation, age, ethnicity, education, employment, religion, stable partner, social support), HIV-related factors (date of HIV diagnosis, ART use, ART adherence), mental health symptoms (anxiety, depression).…”

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

“…The Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study T his work has been adapted from Speakmen et al 22 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproductions in any medium, provided the original author and source are credited. The text below includes minor additions and formatting changes to the original text.…”

“…This section describes the ASTRA study, a cross-sectional questionnaire study of 3258 people with a diagnosed HIV infection, recruited from eight HIV outpatient clinics in the UK from February 2011 to December 2012, with a response rate of 64% (see Speakman et al 22 ). The questionnaire was self-completed and confidential, and included sections on demographic factors, socioeconomic circumstances, HIV-related factors (including self-reported VL status), lifestyle factors, health and symptoms, and a detailed section on recent sexual behaviour.…”

Clinical roundup

“…However, this survey can only account for around half of all the individuals actually engaging in these behaviours; those of negative or unknown status are not represented in the data, but also have a role to play in transmission risk. In the UK, the Antiretrovirals, Sexual Transmission Risk and Attitudes study surveyed over 3000 HIV-positive people at eight clinical sites4 and asked similar questions. Full results are unpublished but the associations reported in a conference abstract in 2012 were broadly the same as the Medical Monitoring Project 5…”