BACKGROUND:HIV-specific broadly neutralising antibodies (bNAbs) can maintain viral control after interrupting antiretroviral therapy (ART). We investigated the duration and efficacy of Fc-engineered long-acting bNAbs (LS-bNAbs) in maintaining ART-free HIV control compared with placebo. METHODS:RIO is a double-blind, randomised, placebo-controlled trial. Eligibile participants were adults age 18-60 years, initiated on ART in early-stage HIV infection, virally suppressed on ART, and had no evidence of viral insensitivity to 10-1074. Participants were randomly assigned (1:1) to receive two LS-bNAbs (3BNC117-LS and 10-1074-LS) in arm A or saline placebo in arm B; participants and study staff were masked to assignment. Eligible participants interrupted ART after receiving blinded intravenous infusions of either bNAbs or placebo. A second optional infusion was offered after 20 weeks for participants who remained virally suppressed without ART. The primary outcome was time to viral rebound 20 weeks after ART interruption, defined as either the first of six consecutive plasma HIV RNA measurements greater than 1000 copies per mL, or two measurements greater than 100 000 copies per mL. All randomly assigned participants were included in the analyses. This study is registered with ClinicalTrials.gov, NCT04319367. FINDINGS:68 participants were randomly assigned, 34 to each arm. By week 20, viral rebound had occurred in eight participants in arm A and 30 in arm B; 75% (95% CI 61-92) of participants in arm A did not have viral rebound, compared with 11% (4-29) of participants in arm B. Participants in arm A were 91% less likely to rebound than were those in arm B (hazard ratio 0·09; 95% CI 0·04-0·21, p<0·0001). There were 326 adverse events in arm A and 260 in arm B, including 19 treatment-related or procedure-related adverse events in arm A and 41 in arm B. Of nine serious adverse events, none were treatment-related. The most commonly reported treatment-related or procedure-related adverse events were fatigue, lethargy, or somnolence: 11 in arm A and nine in arm B. There were two severe adverse events (anal abscesses) possibly related to the study protocol, both in the placebo arm. INTERPRETATION:Long-acting bNAbs can sustain extended ART-free viral control in people treated during early-stage HIV and represent a promising step towards achieving ART-free HIV remission. FUNDING:Gates Foundation.

Abstract Introduction To assess the effectiveness of novel HIV curative strategies, “cure” trials require periods of closely monitored antiretroviral therapy (ART) analytical treatment interruptions (ATIs). We performed a systematic review and meta‐analysis to identify the impact of ATI with or without novel therapeutics in cure‐related studies on the time to viral re‐suppression following ART restart. Methods Medline, Embase and Web of Science databases were searched for human studies involving ATIs from 1 January 2015 till 22 April 2024. The primary outcome was time to first viral re‐suppression (plasma HIV viral load [VL] <50 copies/ml) stratified by receipt of interventional drug with ATI (IA) or ATI‐only groups. Random‐effects proportional meta‐analysis and multivariable Cox proportional hazards analysis were performed using R. Results Of 1073 studies screened, 13 were included that met the inclusion criteria with VL data available after restarting ART (n = 213 participants). There was no difference between time to viral suppression in IA or ATI‐only cohorts (p = 0.22). For 87% of participants, viral suppression within 12 weeks of ART restart was achieved, and all eventually had at least one VL <50 copies/ml during follow‐up. After adjusting for covariables, while participants in the IA cohort were associated with less rapid suppression (adjusted hazard ratio [aHR] 0.61, 95% CI 0.40–0.94, p = 0.026), other factors include greater log VL at ART restart (aHR 0.56, 95% CI 0.46–0.68, p<0.001), duration since HIV diagnosis (aHR 0.93, 95% CI 0.89–0.96) and longer intervals between HIV VL monitoring (aHR 0.66, 95% CI 0.59–0.74, p<0.001). However, the use of integrase inhibitors was associated with more rapid viral suppression (aHR 1.74, 95% CI 1.16–2.59). Discussion When designing studies involving ATIs, information on time to viral re‐suppression after restarting ART is important to share with participants, and should be regularly monitored and reported, to assess the impact and safety of specific trial interventions in ATI studies. Conclusions The majority of participants achieved viral suppression after restarting ART in ATI studies. ART regimens containing integrase inhibitors and frequent VL monitoring should be offered for people restarting ART after ATI studies to ensure rapid re‐suppression.

Background: To test efficacy, HIV cure-related trials often require a period of intensively monitored interruption of antiretroviral therapy (ART) (analytical treatment interruption or ATI). As individuals who started ART during primary HIV-1 infection (PHI) are often recruited, we have asked people already enrolled into an observational PHI study about their willingness and concerns around participating in cure-related studies involving ATIs. Methods: People who were diagnosed with PHI and started ART, attending two London HIV clinics, provided informed consent to complete a digital survey in clinic between 21/07/21 to October 31, 2023. Questions comprised sociodemographics, motivations, concerns and practical considerations influencing willingness to participate in studies involving ATIs. Hierarchical clustering of responses was performed using the ‘pheatmap’ R statistical package and ranked from most to least concerned. Responses were cross-referenced with enrolment into an ATI study which recruited from this cohort. Results: Of 352 eligible participants, 75 completed the survey. The majority were white, cisgender men who have sex with men, 34/75 (45 %) were born outside the UK. 29 (39 %) expressed interest in joining ATI studies. Participants who were interested or unsure in joining ATI studies were primarily motivated (53/65, 82 % very or moderately interested) by an altruistic desire to help scientific research. Across all participants, onward HIV transmission was the predominant concern (67/75, 89 % very or moderately concerned), and similar levels of concerns reported if the HIV-1 viral load threshold to restarting ART was increased from 500 to 50 000 copies/mL. Most participants preferred weekly (23/65, 35 %) or fortnightly (11/65, 17 %) viral load monitoring during an ATI. Before taking part in a study involving an ATI, participants stated they would prefer to discuss this with their HIV doctor (55/65, 85 %). Conclusion: In this small survey, 39 % of respondents expressed interest in joining studies involving ATIs, primarily for altruistic reasons. Participants were more interested in joining a potential ATI study if a novel intervention was included than simply an ATI alone. The main concern expressed was risk of viral transmission. To inform practical and study design considerations for future ATI studies, unrestricted access for mitigation of transmission risk should be included, and regular, frequent viral load monitoring is preferred.

Purpose of review Despite improvements in the effectiveness of antiretroviral therapy (ART), there are still unmet needs for people living with HIV which drive the search for a cure for HIV infection. The goal of this review is to discuss the challenges and recent immunotherapeutic advances towards developing a safe, effective and durable cure strategy for HIV. Recent findings In recent years, advances have been made in uncovering the mechanisms of persistence of latent HIV and in developing more accurate assays to measure the intact proviral reservoir. Broadly neutralising antibodies and modern techniques to enhance antibody responses have shown promising results. Other strategies including therapeutic vaccination, latency reversal agents, and immunomodulatory agents have shown limited success, but newer interventions including engineered T cells and other immunotherapies may be a potent and flexible strategy for achieving HIV cure. Summary Although progress with newer cure strategies may be encouraging, challenges remain and it is essential to achieve a high threshold of safety and effectiveness in the era of safe and effective ART. It is likely that to achieve sustained HIV remission or cure, a multipronged approach involving a combination of enhancing both adaptive and innate immunity is required.

BackgroundEffectiveness of HIV postexposure prophylaxis (PEPSE) correlates with speed of uptake following HIV exposure. Time to first dose has not improved in the UK for over 10 years. On-demand pre-exposure prophylaxis (PrEP) has shown that people can self-start medication for HIV prevention.We hypothesised that advanced provision of PEPSE (HOME PEPSE) for men who have sex with men (MSM) to self- initiate would reduce time to first dose following HIV exposure.MethodsPhase IV, randomised, prospective, 48-week, open-label study was carried out. MSM at medium risk of acquiring HIV were randomised (1:1) to immediate or deferred standard of care (SOC) HOME PEPSE. Every 12 weeks, participants self-completed mental health/risk behaviour surveys and had HIV/sexually transmitted infection (STI) testing.HOME PEPSE comprised a 5-day pack of emtricitabine/tenofovir disoproxil fumarate/maraviroc 600 mg once daily initiated following potential exposure to HIV. If taken, participants completed a risk survey; PEPSE continuation was physician directed. Primary outcome was time from potential exposure to HIV to first PEPSE dose.Findings139 participants randomised 1:1; 69 to immediate HOME PEPSE and 70 to deferred HOME PEPSE. Median age 30 years (IQR 26–39), 75% white, 55% UK born and 72% university educated. 31 in HOME PEPSE and 15 in SOC arm initiated PEPSE. Uptake of HOME PEPSE was appropriate in 27/31 cases (87%, 95% CI: 71% to 95%). Median time from exposure to first dose was 7.3 hours (3.0, 20.9) for HOME PEPSE and 28.5 hours (17.3, 34.0) for SOC (p<0.01). HOME PEPSE was well tolerated with no discontinuations.No significant differences in missed opportunities for PEPSE uptake, sexual behaviour or bacterial STI infections between treatment arms.InterpretationHOME PEPSE reduced the time from exposure to first-dose PEPSE by 21+ hours, with no impact on safety. This significantly improves the efficacy of PEPSE and provides an option for people declining PrEP.

We thank Kow et al. [1] for their response to the findings of the RECEDEC19 study on clinical outcomes between people living with and without HIV hospitalized with coronavirus disease 2019 (COVID19) [2]. The authors suggest the inclusion of antiretroviral therapy (ART) in the multivariable model, particularly those who received tenofovirbased ART, to investigate the effectiveness of these medications in patients with COVID19. As only five (7.4%) people living with HIV not receiving ART were included, this study was not powered to compare the effect of ART on clinical outcomes in hospitalized patients. Tenofovir disoproxil fumarate (TDF) is associated with renal and bone densityrelated adverse effects, and UK national guidelines [3] recommend avoiding TDF in people with impaired renal function or osteoporosis. As a result, the population receiving TDF is biased, and its inclusion in the multivariable model risks multicollinearity with the comorbidities, frailty and age factors that were already included. The small sample size and lack of a suitable denominator for people living with HIV across all clinics receiving tenofovirbased ART were other limitations in evaluating the effectiveness of tenofovir in the prevention of severe COVID19 hospitalisation outcomes. Therefore, we considered that inclusion of tenofovirbased ART in the multivariable model would be of limited value, and the antiretroviral data were presented descriptively to avoid overinterpretation in this paper. As the authors have summarized, tenofovir has been hypothesized to be potentially effective against severe acute respiratory syndrome coronavirus 2 (SARSCoV2); however, evidence to support the use of tenofovirbased strategies for the treatment or prevention of COVID19 remains sparse. Evidence from two openlabelled randomized trials have provided mixed results. Participants randomized to TDF/emtricitabine following a recent diagnosis (<7 days) of nonsevere COVID19 showed a mean realtime polymerase chain reaction cycle threshold difference of 2.9 (95% confidence interval [CI] 0.1– 5.2, p = 0.044) but no difference in time to symptom recovery, and the study was not powered to collect other clinical outcomes [4]. Although a larger pragmatic randomized trial of TDF/emtricitabine, rosuvastatin plus colchicine, or a combination of the four medications showed lower mortality in participants receiving all four medications (hazard ratio [HR] 0.53; 95% CI 0.29– 0.96; p = 0.038), TDF/emtricitabine alone was not associated with a reduction in 28day mortality in the TDF/emtricitabine arm compared with standard of care (HR 0.69; 95% CI 0.39– 1.20; p = 0.187) [5]. Two ongoing randomized controlled trials investigating TDF/emtricitabine as treatment for COVID19 are registered in the clinicaltrials.gov database at the time of writing (NCT04712357, NCT04890626). Effective treatments for COVID19 are available, but the search continues for effective, lower cost, alternative treatments and remains relevant, particularly for settings with limited resources and/or access to vaccines. However, we advise caution in the interpretation of the effectiveness of ART including tenofovir for the treatment of COVID19 from retrospective cohorts because of the contribution of confounding overlapping factors that may not be possible to adequately adjust for. The findings of the ongoing suitably powered and blinded randomized controlled trials are anticipated to provide more robust answers as to whether tenofovir is effective in the treatment of COVID19.

Background Antiretroviral therapy (ART) has led to dramatic improvements in survival for people living with HIV, but is unable to cure infection, or induce viral control off therapy. Designing intervention trials with novel agents with the potential to confer a period of HIV remission without ART remains a key scientific and community goal. We detail the rationale, design, and outcomes of a randomised, placebo-controlled trial of two HIV-specific long-acting broadly neutralising antibodies (bNAbs): 3BNC117-LS and 10-1074-LS, which target CD4 binding site and V3 loop respectively, on post-treatment viral control. Methods RIO is a randomised, placebo-controlled, double-blinded prospective phase II study. Eligible individuals will have started ART within 3 months of primary HIV infection and have viral sequences that appear to be sensitive to both bNAbs. It will randomise 72 eligible participants 1:1 to the following arms via a two-stage design. In Stage 1, arm A participants are given dual long-acting (LS-variants) bNAbs infusions, followed by intensively monitored Analytical Treatment Interruption (ATI) ( n = 36); in arm B, participants receive placebo infusions followed by ATI. The primary endpoint will be time to viral rebound within 36 weeks after ATI. Upon viral rebound, the participant and researcher are unblinded. Participants in arm A recommence ART and complete the study. Participants in arm B are invited to restart ART and enroll into Stage 2 where they will receive open-label LS bNAbs, followed by a second ATI 24 weeks after. Secondary and exploratory endpoints include adverse events, time to undetectable viraemia after restarting ART, immunological markers, HIV proviral DNA, serum bNAb concentrations in blood, bNAb resistance at viral rebound, and quality of life measures. Discussion The two-stage design was determined in collaboration with community involvement. This design allows all participants the option to receive bNAbs. It also tests the hypothesis that bNAbs may drive sustained HIV control beyond the duration of detectable bNAb concentrations. Community representatives were involved at all stages. This included the two-stage design, discussion on the criteria to restart ART, frequency of monitoring visits off ART, and reducing the risk of onward transmission to HIV-negative partners. It also included responding to the challenges of COVID-19. Trial registration The protocol is registered on Clinical.trials.gov and EudraCT and has approval from UK Ethics and MHRA.

BACKGROUND:Neuropathic pain negatively affects quality of life among people living with HIV (PLWH). This study examined the feasibility of conducting a full-scale randomized-controlled trial of online acceptance and commitment therapy ("ACT OPEN") for neuropathic pain in PLWH.METHODS:Using a parallel-groups design, thirty-eight participants were randomized to ACT OPEN or a waitlist control (2:1). Participants completed standard self-report outcome measures at baseline, and two- and five-months post-randomization. Participants were aware of their allocation, but assessment was blinded.RESULTS:Twenty-five participants were randomized to ACT OPEN and 13 to the control (of 133 referrals). ACT OPEN completion was 69% and two-month trial retention was 82%. Treatment credibility and satisfaction scores for ACT OPEN were comparable to scores reported in previous trials of cognitive-behavioural treatments for pain. Four adverse events were reported during the study, including one serious adverse event; all of these were unrelated to the research procedures. Small to moderate effects and 95% confidence intervals suggest that the true effect may favour ACT OPEN for improvements in pain intensity/interference and depression.CONCLUSIONS:A full-scale RCT of online ACT for pain management in PLWH may be feasible with refinements to trial design to facilitate recruitment.SIGNIFICANCE:Research on pain management in people living with HIV has primarily focused on pharmacological treatments with limited success. This is the first study to show the potential feasibility of a psychological treatment based on acceptance and commitment therapy delivered online and tailored for pain management in people with HIV ("ACT OPEN"). ACT OPEN may be a promising treatment in this population and further evaluation in a full-scale randomized-controlled trial appears warranted.TRIAL REGISTRATION:The trial was registered (clinicaltrials.gov; NCT03584412).

The contribution of HIV to COVID‐19 outcomes in hospitalized inpatients remains unclear. We conducted a multi‐centre, retrospective matched cohort study of SARS‐CoV‐2 PCR‐positive hospital inpatients analysed by HIV status.

COVID-19 and Pneumocystis jirovecii pneumonia: a diagnostic dilemma in HIV Coleman H1*, Snell LB2, Simons R1, Douthwaite ST3, Lee MJ1. Affiliations: 1. Harrison Wing, Department of HIV, Guys’ and St Thomas’ NHS Foundation Trust, London, UK 2. Centre for Clinical Infection & Diagnostics Research, King’s College London, London, UK 3. Department of Virology, Guys’ and St Thomas’ NHS Foundation Trust, London, UK

Liver toxicity is a frequent adverse event following antiretroviral therapy for HIV, ranging from asymptomatic increases in liver enzymes to fulminant liver failure.1 2 Rilpivirine is a second-generation non-nucleoside reverse transcriptase inhibitor with low rates of liver enzyme elevations.3 We report a case of acute hepatitis secondary to rilpivirine with histological documentation. A 27-year-old Mediterranean man was diagnosed with HIV, with a baseline CD4 count of 0.359 ×109/L and an HIV-1 viral load of 21 525 copies/mL. His last negative HIV test was 2 years prior. His medical history included depression, G6PD deficiency and a beta thalassaemia carrier status. He reported minimal alcohol intake. His baseline liver markers were normal. Abacavir/lamivudine 600/300 mg once daily and raltegravir 400 mg two times per day were started on week 4 following diagnosis. Raltegravir was switched to rilpivirine 25 mg once …

During the rapidly evolving novel coronavirus disease 2019 (COVID-19) outbreak, more than a million cases have been diagnosed worldwide; however, there have been limited reports of HIV and COVID-19 coinfection at the time of writing. We report a case highlighting the challenge of diagnosing COVID-19 and Pneumocystis jirovecii pneumonia (PJP) in an individual with HIV. A 55-year-old male presented with a 7-day history of fevers, cough, and hypoxia. Comorbidities include well controlled HIV infection (diagnosed 2006, current CD4+ cell count 422 cells/μl (35.6%), HIV-1 viral load <20 copies/ml), on emtricitabine/tenofovir disoproxil 200/245 mg and raltegravir 1200 mg once daily; and mild asthma. He had no prior history of PJP, was an ex-smoker, lived with his partner, and neither had recent travel histories nor contact with confirmed COVID-19 cases. Chest computed tomography (CT) (Fig. 1) showed extensive subpleural and para-mediastinal cystic changes, subpleural ground-glass changes bilaterally, most prominent in the upper lobes with relative sparing of the lung bases; consistent with PJP. Incidental interstitial lung fibrosis and paraseptal emphysema was also reported.Fig. 1: Chest computer tomography image slice showing extensive subpleural and para-mediastinal cystic changes, subpleural ground-glass changes bilaterally.A lower respiratory tract-induced sputum was tested for respiratory pathogens using multiplex PCR and P. jirovecii DNA was detected. SARS-CoV-2 RNA was not detected by real-time PCR (RT-PCR) of an initial combined nose and throat swab (day 2). Investigations for other respiratory pathogens were negative. PJP treatment was commenced with intravenous cotrimoxazole (120 mg/kg/24 h) and oral prednisolone 40 mg twice daily. He deteriorated 3 days into treatment and required critical care. A repeat throat swab (day 7) detected SARS-CoV-2 by RT-PCR. He improved with high-flow oxygen not requiring intubation or ventilation. He was discharged (day 14) to complete 21 days oral treatment followed by long-term PJP prophylaxis. We report the first case of P. jirovecii and SARS-CoV-2 detection in an individual with well controlled HIV. At the time of writing, only one other HIV/COVID-19 coinfection case has been published, with limited details of the individual's HIV status [1], and an European regional database of HIV/COVID-19 cases is currently under way [2]. We recommend further epidemiological data from HIV/COVID-19 cases to be collected and reported to understand the relationship between COVID-19, HIV, and antiretroviral therapy. Sensitivity of RT-PCR from throat swabs to detect SARS-CoV-2 RNA has been reported as 95% [3]. However, retrospective studies comparing RT-PCR against combined clinical and radiographic criteria to diagnose COVID-19 in an epidemic setting reported lower sensitivities of RT-PCR at 70–80% [4]. Lower detection rates are associated with time from symptom onset, dropping from 100% to 40% if taken after day 5 of symptoms [5]. Retrospective testing of this patient's-induced sputum, taken within 26 h of the negative throat swab, confirmed the presence of SARS-CoV-2. Lower respiratory samples by induced sputum may aid diagnosis in the presence of negative upper respiratory samples [6]. The detection of P. jirovecii DNA in the induced sputum and an initial negative SARS-CoV-2 result in the presence of characteristic features of PJP formed the basis of the PJP diagnosis. The significance of detected P. jirovecii DNA using PCR alone remains uncertain and may represent colonization of the respiratory tract. Immunofluorescence microscopy was not available in this case. The prevalence of detectable P. jirovecii DNA in healthy immunocompetent adults has been reported between 0% and 20% [7,8]. However, in 100% of lung autopsy samples from immunocompetent individuals with detectable P. jirovecii DNA, detailed immunofluorescence microscopy revealed both cyst and trofozoite forms suggestive of actively replicating P. jirovecii[9], suggesting mild PJP infection may be present even in immunocompetent adults with detectable P. jirovecii. Clinically COVID-19 and PJP may present with similar features of dry cough, exercise desaturation, and relatively normal chest auscultation. Common chest CT findings for both conditions include ground-glass pattern with interlobular septal thickening [10,11]. Implications of missed COVID-19 diagnoses include missed opportunities for contact tracing and prevention of onward transmission in an epidemic setting. Clinical management of PJP and COVID-19 also differs, particularly high-dose corticosteroid therapy is recommended in severe PJP [12]; however, there is no evidence for corticosteroid therapy in COVID-19, and observational data suggest increased mortality and secondary infection rates in influenza, and impaired clearance of the closely related SARS-CoV and MERS-CoV viral infections [13]. In conclusion, we report the first case of an individual living with HIV diagnosed and treated for both COVID-19 and PJP. Diagnosis of either conditions in the presence of both pathogens is challenging due to overlapping clinical and radiological features and limitations of current diagnostic assays, with clinical and public health implications in the current COVID-19 pandemic. Acknowledgements We would like to acknowledge the person described in the case report for their consent and contributions to this article. Ethics and consent: Ethics committee approval was not required, nor funding requested. Patient consent was granted for this article and images to be used. Author contributions: H.C., L.B.S., M.J.L.: cowritten. R.S., S.T.D.: review. Conflicts of interest M.J.L. has received grants and honoraria by Gilead Sciences not related to this work. H.C., L.B.S., R.S., S.T.D. have no disclosures to make.

Late HIV diagnosis is associated with significant mortality in people living with HIV (PLWH) and high numbers of missed opportunities (MO) for earlier testing have been identified. A pilot of a national late diagnosis review process (LDRP) was undertaken in 15 HIV services evaluating the feasibility of LDRP implementation, as a patient safety initiative. All newly diagnosed PLWH with CD4 counts <200 cells/mm3 were included, and healthcare episodes within 5 years of presentation reviewed. Of 127 patients identified, 40 (31.5%) had MO and were more often white, UK-born and suffered more serious harm around diagnosis. Of these, four were designated serious incidents (undergoing root cause analysis) and eight were serious learning events. Engagement with services where MO occurred was challenging, however 75% of services found the LDRP sustainable. Widespread implementation of the LDRP should enable progress with training and policy changes within external services, enabling earlier HIV diagnosis and preventing deaths.

Following changes in national antiretroviral therapy (ART) guidelines removing the CD4 threshold for initiation of ART, we evaluated the time to ART initiation and reasons for delayed or non-initiation. A retrospective notes review of 292 newly diagnosed HIV-positive individuals attending two London clinics between August 2015 and December 2016 was performed. Two hundred and fifty-four of 292 (87%) individuals started ART. Median time to ART initiation was 29 days (range: 0-514). Thirty of 292 (13%) did not start ART. Rates of virological suppression at six months were similar regardless of time to ART initiation. People who inject drugs (16.7% vs. 3.6%) (p = 0.009), having a higher median baseline CD4 cell count (500 vs. 388 cells/mm(3), p = 0.001), and having gastrointestinal/liver co-morbidities (23% vs. 9%, p = 0.001) were associated with delayed ART initiation. The cohort not on ART had a higher median baseline CD4 cell count (500 vs. 388 cells/mm(3), p < 0.001). Documented reasons for delayed or ART non-initiation included patient's choice, prolonged adjustment periods, and difficulty leaving work. We conclude that delayed or non-initiation of ART was associated with injecting drug use and prolonged adjustment to a new HIV diagnosis. Clinician factors may include lack of urgency with higher baseline CD4 cell counts. Improved linkage to care and drug services pathways may encourage timely ART initiation.

The use of digital vending machines (VMs) to delivery HIV self-testing (HIVST) could expand HIV testing in priority populations. We surveyed primarily Black African (BA) participants and other minority ethnicities, to identify acceptability, preferences, and concerns of using VMs for HIVST dispensing. A structured survey was developed with Black African and Caribbean, Latin American and other Minorities (BLAM) communities, and distributed between September 2018 and January 2019. Participants were recruited using mobile tablet surveys distributed by outreach volunteers, and online through BLAM communities' websites, workshops, and language-specific messages on social media. Descriptive analyses were undertaken stratified by ethnic groups. One hundred and twenty-eight (67.0%) participants identified as BAs, 31 (16.2%) Black Caribbeans (BCs), 22 (11.5%) Latin Americans (LAs), and 10 (5.2%) other non-white ethnicities (ONWEs). Rates of willingness to use the HIVST were high in all groups except BCs (BAs 77.9%, BCs 53.6%, LAs 81.8%, ONWEs 80.0%). Most participants favoured healthcare-associated venues for VM placement, but there were differences in community venues favoured by different ethnic groups and concerns reported. HIVST is acceptable in many BLAM communities and increases understanding of the concerns and how to address them in the design of VMs for HIVST, to expand HIV testing in these priority communities.

Sexually transmitted infections (STIs) can manifest as urethritis, proctitis, pharyngitis or cervicitis, depending on the site of infection, although asymptomatic infections are frequent particularly at extragenital sites. Classical STIs such as gonorrhoea and chlamydia are well-recognized causes, but many other STIs such as trichomoniasis, lymphogranuloma venereum, syphilis and herpes simplex can infect these mucosal sites. In the UK, there is a high burden of infection in specific populations, including young people, men who have sex with men and individuals from black and minority ethnic populations. Symptoms are often similar regardless of the underlying aetiology, and non-infectious inflammatory conditions also occur. A structured history, appropriate examination and investigations are necessary to make a specific STI diagnosis. Management is best guided by the organisms detected, but treatment is often given syndromically to cover common causative organisms before results are available. Partner notification is an integral component of STI treatment strategies.