BackgroundThe introduction of social distancing in response to the COVID-19 pandemic led to reduced STI/HIV service provision in the UK. We investigated sexual risk behaviours among MSM and unmet need for sexual healthcare during the pandemic.MethodsA cross-sectional online survey (N=2,018) fielded via social media and dating apps (23/06–14/07/2020). We examined sexual behaviour and service use since lockdown (23/03/2020) and in the three previous months, and ‘unmet need for STI testing’ since lockdown (any new male partners and/or multiple condomless anal sex (CAS) partners without testing for STIs).We compared behaviours over the past three months between socio-demographically equivalent sub-samples recruited via Grindr into the present survey (N=956) and a 2017 survey (N=1,918).ResultsIn 2020, 36.7% of participants reported new male partners and 17.3% reported multiple CAS partners since lockdown. Comparing time since lockdown vs previous three months, HIV testers were less likely to test at sexual health clinics (22.3% vs 70.2%) and more likely to use free online self-sampling services (64.3% vs 17.1%), and PrEP users were less likely to report PrEP use (21.7% vs 65.7%).Since lockdown, 25.3% of participants had unmet need for STI testing. Unmet need was more likely among Asian vs White participants (aOR=1.76,[1.14–2.72],p=.01);living in Scotland (aOR=2.02,[1.40–2.91],p<.001) or Northern Ireland (aOR=1.93,[1.02–3.63],p=.04) vs England;and living with HIV (aOR=1.83,[1.32–2.53],p<.001).Compared to 2017, the 2020 sub-sample were less likely to report new male partners (46.8% vs 71.1%, p<.001), multiple CAS partners (20.3% vs 30.8%, p<.001) and unmet need (32.8% vs 42.5%, p<.001) in the past three months.ConclusionWe found ongoing potential STI/HIV transmission among MSM during the initial UK lockdown, despite a reduction in sexual activity, and potential inequalities in access to sexual healthcare. These findings will support public health planning to mitigate against health risks during and after the COVID-19 response.

Background Accelerated partner therapy (APT) is a partner notification (PN) method whereby healthcare professionals assess sex partners by telephone, then send or give the index patient antibiotics and self-sampling kits for them. We described characteristics and outcomes of people choosing APT in an RCT. Methods We did a cross-over cluster-randomised controlled trial comparing APT, additional to enhanced patient referral (2018–2019, ISRCTN Reference 15996256). Clusters were 17 UK clinics, assigned by random permutation. Each period lasted 6 months, with two-week washout. Participants were heterosexual women and men, ≥16 years with a positive C. trachomatis test and/or clinical PID, cervicitis, non-gonococcal urethritis or epididymo-orchitis, reporting ≥1 contactable sex partner in the past six months. Analysis is ‘per protocol’, using random effects logistic regression. Results 1536 index patients were offered APT. They described 2137 partners and selected APT for 305/2137(14.3%). Of these 166/305(54%) were Committed/steady, 85/305(29%) New, 45(15%) Occasional and 9(3%) One-off partners. Common index reasons for declining APT included: preference for face-to-face conversation 400/1832(21.8%), partner already in clinic 388/1832(21.2%), unwilling to engage with partner 206/1832(11.2%), preferring partner to attend clinic 202/1832(11.0%), partner overseas 150/1832(8.2%). Of 241 partners sent APT packs, 119/241(49%) returned chlamydia and gonorrhoea testing samples, of which 78/119(65.5%) were positive, but only 60/241(24.9%) HIV and syphilis samples (all negative). Of 106 index patients offered APT which was accepted ≥1 partners, and tested for chlamydia at 12–24 weeks, only 2(1.9%) were positive. This contrasts with 6.6% (53) in the control arm and 5.2%(29) in index patients not selecting APT or whose partners refused. Conclusion APT may improve PN outcomes but uptake is not universal and varies by partner type. Many index patients preferred face-to-face discussion and/or partners to attend clinic, while many were already attending. The role of APT in optimising PN, index patient care and STI control requires further clarification.

Background Equitable implementation of HIV Pre-Exposure Prophylaxis (PrEP) is not well defined, particularly for populations already experiencing high levels of health inequity (e.g. people experiencing poverty or other social disadvantages). The five stages of the PrEP care-continuum (PCC) (awareness, acceptability, uptake, adherence, retention) can help evaluate PrEP implementation, but the extent to which key characteristics that are important for health equity are considered throughout the PCC has not been described. This systematic review aims to: 1) identify and collate outcome measure (OM) definitions for the PCC stages; 2) describe how key health equity characteristics are considered in these OM definitions. Methods Five databases were searched for quantitative studies published after January 1st, 2012. Data regarding study design, OM definitions, and health equity characteristics were extracted. Data were analysed using narrative synthesis. Results 11,264 papers were identified and screened; 227 were included. The majority of studies included >1 OM (67%). The most commonly reported OM was awareness (54%), followed by interest (51%) and uptake (50%). Relatively few studies reported on adherence (12%) or retention (17%). No studies described movement through the PCC from awareness to retention. The most commonly reported equity characteristics were age (86%) and race/ethnicity (80%); the least common were social capital (31%) and religion (1%). The majority of studies focused on cis-gender men who have sex with men (MSM) (48%), while other affected groups, such as cis-gender women and trans* people are less well represented (7% and 6%, respectively). Conclusion There is an unequal focus on the earlier stages of the PCC. Some key equity characteristics (e.g. age) are commonly considered, however, other important characteristics (e.g. social capital) are overlooked. These findings are relevant to healthcare professionals, policymakers and commissioners in informing how to best implement and evaluate PrEP programmes for potentially vulnerable and less advantaged populations.

Background Accelerated partner therapy (APT) is a partner notification (PN) method whereby healthcare professionals assess sex partners by telephone, then send or give the index patient antibiotics and self-sampling kits for their sex partner(s). APT was implemented within a cluster cross-over randomised control trial in 17 sexual health clinics in Britain (2018–2019, ISRCTN Reference 15996256). We conducted an integral process evaluation to help explain experiences of using APT. Methods Focus groups and telephone interviews with 34 healthcare professionals who delivered APT, and telephone interviews with 15 index patients and 17 sex partners who chose APT. Topic guides focussed on how APT was implemented and overall APT experiences. Data were analysed deductively using a bespoke framework derived from initial conceptualisations of APT, and key trial findings. Results Low uptake of APT was largely because index patients felt it was only suitable for certain types of sex partner. APT was considered best suited to established relationships and not appropriate for relationships with lower emotional connection. However, APT was not always offered by healthcare professionals and many sex partners attended clinic with index patients when they attended for treatment. Nevertheless, those who chose APT felt it worked better than existing options and helped partners overcome barriers to face-to-face care. Most sex partners received APT packs directly from the index patient within a day of consultation; some prioritised taking treatment over self-sampling. Some sex partners reported difficulties in blood sampling (finger-prick) resulting in fewer HIV and syphilis samples being returned than chlamydia and gonorrhoea (urine/vulvo-vaginal swab). Some sex partners did not value testing for infections other than chlamydia/gonorrhoea. Conclusions APT benefits established sexual partnerships with greater emotional connection, by providing treatment rapidly and overcoming barriers to face-to-face care. Targeting of APT combined with interventions to increase sex partner return of self-samples are needed.

Background Partner notification (PN) is a key strategy for sexually transmitted infection (STI) management to reduce transmission and improve population health. It involves contacting sexual partners of people diagnosed with an STI and encouraging testing and treatment to prevent onward transmission, and re-infection. Current UK PN practice tends to conceptualise sexual partner types as 'regular' or 'casual'. However these terms do not sufficiently capture diverse sexual behavioural patterns or STI transmission risk. Given this context, we explored the social relevance, understandings and meanings of contemporary sexual partner types, as a first step in aligning lived realities with clinical practice to improve PN outcomes. Methods We conducted eleven semi-structured focus groups (November 2016-August 2017), with members of the public (n=38) and sexual health clinic attendees diagnosed with an STI in the past six months (n=19) in England and Scotland. We recruited participants aged 18–65 years who identified as heterosexual or men who have sex with men (MSM), using purposive and convenience sampling. Data were digitally recorded, transcribed and analysed using thematic analysis in NVivo V.10. Results Findings from the 57 participants (male n=34; female n=23), suggested two key themes in understanding sexual partner types: 1) nature of emotional involvement with the partner(s) and 2) time/continuity of the relationship. Both tapped into participants' relationship perspectives and shaped their understandings and use of partner terms. Interrelated subthemes involved: the different contexts, such as clinical consultations or everyday social interactions, which shaped the use of the terms 'regular' and 'casual' and associated interpretations; and the polysemy and ambiguity of the terms when they were used in combination with other words (e.g. casual sex; casual partner; casual regular) and alternate terms (e.g. random, one-off, serious relationship). There were no differences in the understandings of the terms between heterosexual and MSM participants. Conclusion This is the first empirical evidence that challenges and provides insight into the dichotomy of sexual partner types in contemporary clinical practice. There is a need for a new socially informed, interdisciplinary classification of sexual partner types to enable better recording and communication between patients, sex partners and healthcare professionals. Improved understanding of partner types will help healthcare professionals develop and tailor PN approaches which address social and cultural influences on the way people form sexual relationships and talk about sex. This will enable targeting of resources to achieve greatest benefit to individual and population health by detecting and preventing STI transmission.

Current UK National Guidelines for HIV Testing recommend universal HIV testing for all medical admissions where the local diagnosed HIV prevalence exceeds 2 per 1000 population and that those with indicator diseases should always be offered testing in any setting.1 The Royal London Hospital serves a population with a high local HIV prevalence of 6.2/1000,2 four times that of the national prevalence and, therefore, a highly relevant setting for universal HIV testing in the medical admissions unit (MAU). Bacterial pneumonia is a very common clinical indicator condition for HIV, so we used an International Classification of Diseases-10 diagnosis of ‘lobar …

Background UK National Guidelines for HIV Testing recommend that an HIV test should be considered in all general medical admissions where diagnosed HIV prevalence in the local population exceeds two in 1000 population as well as for all patients presenting with certain indicator diseases. The aim of this audit was to determine if HIV testing rates of patients admitted with pneumonia improved after the implementation of opt-out testing for all acute medical admissions. Methods HIV testing rates were compared for patients admitted with pneumonia before (September 2011) and after (September 2012) implementing opt-out testing for acute medical admissions. Patients were identified from hospital coding data for pneumonia during their inpatient stay. Electronic patient records were used to determine which patients had received a test for HIV during their admission. Results Seventy-nine patients were admitted with pneumonia in September 2011 and 86 in September 2012. Before opt-out HIV testing, 4/79 (5.1%) patients were tested for HIV during their admission (mean age 63.5 years), with no positive tests. Following the implementation of opt-out testing, 22/86 (25%) patients admitted with pneumonia were tested for HIV (mean age 62.5 years), with no patients testing positive. Since implementing opt-out HIV testing for acute medical admissions the rate of HIV testing in patients admitted with pneumonia increased from 5.1% to 25% (p = 0.0002). Conclusion Following the implementation of opt-out HIV testing for acute medical admissions, the rate of testing in patients with a diagnosis of pneumonia has significantly increased. However, despite national guidelines and regional opt-out testing for acute medical admissions, a test was only performed in a quarter of eligible patients. Further work needs to be done in all areas of the hospital to increase awareness of HIV testing and to ensure rates of testing continue to rise.