STI/bbv session

11.00am - 11.10am ACCESS Analytics WA: Monitoring blood borne viruses and sexually transmissible infections in Western Australia

Jason Asselin (Burnet Institute), Victoria Polkinghorne (Burnet Institute), Nyssa Watson (Burnet Institute), Alison Carter (Kirby Institute), Rebecca Guy (Kirby Institute), Basil Donovan (Kirby Institute), Wayne Dimech (NRL Quality), Mark Stoove (Burnet Institute), Margaret Hellard (Burnet Institute) 

Background: The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Blood Borne Viruses (BBV) and Sexually Transmissible Infections (STI) (ACCESS)is a network of over 120, high caseload general practices, publicly funded sexual health clinics, community health centres and pathology laboratories that provide linked de-identified data on consultations, testing and treatment of BBV and STI. Funded by the Australian Government, it provides key data to monitor progress towards the targets of the National BBV and STI Strategies. Methods: With support of the Western Australian Department of Health, data from the 6 WA-based clinics participating in ACCESS have been used to compile a report on WA indicators related to BBV and STI testing, diagnosis and treatment, called ACCESS Analytics WA. Using data visualisation software, this report allows for easy disaggregation by priority populations and demographics. Results: The first iteration off dashboard reports has been finalised with data to December 31, 2023 and has released to SHABBVAC. It comprises of indicators related to clinic attendance, testing rate, proportion positive for chlamydia, gonorrhea, syphilis, HIV, hepatitis B and hepatitis C. Treatment indicators and cascades of care for HIV and hepatitis C are also included. Conclusion: Planning is underway to identify new sentinel sites to improve representativeness outside of metropolitan Perth. This presentation will provide an overview of estimates of the indicators and illustrate the strength and limitations of its use for system planning and monitoring progress towards targets of the WA BBV and STI strategies.

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11.10am - 11.20am Acceptability of doxy-PEP for STI prevention in a national sample of Australian gay and bisexual men and non-binary people

Martin Holt (Centre for Social Research in Health [CRSH]), James MacGibbon (CSRH), Benjamin Bavinton (Kirby Institute), Timothy Broady (CSRH) 

Background: There is growing interest in novel methods of preventing sexually transmissible infections (STIs), including the prophylactic use of antibiotics like doxycycline. Australia’s 2023 consensus statement on doxy-PEP asks who would want to use it, and suggests targeting to reduce STIs and limit antimicrobial resistance (AMR). Methods: In June-July 2023 we conducted a national online survey of gay and bisexual men and non-binary people. We compared the acceptability of STI-PEP (taking 1-2 pills after sex to prevent STIs), condoms, and STI-PrEP (taking daily low dose antibiotics). We assessed prior use of antibiotics for STI prophylaxis, and knowledge and concern about AMR. Factors associated with the acceptability of STI-PEP were identified with multivariate logistic regression. Results: There were 2,046 survey participants (median age 35 years, 81.7% gay-identified, 69.9% Australian born, 46.3% on HIV PrEP, and 6.8% living with HIV). 26.9% had been diagnosed with any STI in the previous year, and 7.5% had previously used antibiotics for STI prophylaxis. The acceptability of STI-PEP was 75.8%, condoms 45.1%, and STI-PrEP 54.0%. 37.9% knew nothing about AMR, and 47.3% of the whole sample were concerned about AMR. STI-PEP was more acceptable to participants who had previously used antibiotics to prevent STIs (AOR=3.09, 95%CI=1.78–5.35, p<0.001), and was less acceptable to those concerned about AMR (AOR=0.51, 95%CI=0.36–0.72, p<0.001). Future actions: To increase understanding of the potential risks and benefits of doxy-PEP, we recommend community discussion and debate about whether its use should be targeted to both prevent STIs and limit the chance of AMR. Conclusions: Doxy-PEP was highly acceptable to the gay and bisexual men and non-binary people we surveyed, and 8% had already used antibiotics for STI prophylaxis. Interest in STI-PEP was higher among participants who had previous used antibiotics to prevent STIs, and lower among those with AMR concerns.

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11.20am - 11.30am Risk factors for Sexually Transmitted Infections (STIs) among online sex worker advertisements in Perth, Western Australia

Joanne O'Dea (Metropolitan Communicable Disease Control), Anna Beswick (Metropolitan Communicable Disease Control), Ben Scalley (Metropolitan Communicable Disease Control)

Background: Sex workers have previously been considered a low-risk group for sexually transmitted infections (STIs). Research has demonstrated declining condom use among sex workers since the height of the HIV epidemic. As well as condomless sex, other risk factors may indirectly increase risk for STI transmission, such as sexual violence, group-based encounters, drug use and survival sex. Aims: In December 2023, Metropolitan Communicable Disease Control audited two websites commonly used by sex workers to advertise their services: Locanto and Escorts and Babes. The aim of this audit was to understand prevalence of direct and indirect risk factors for STIs among online sex worker advertisements. Methods: A total of 790 advertisements were included in this audit. Ads posted to Locanto (Massage and Escorts categories) and Escorts and Babes between 1-8 December, within the Perth metropolitan area, were downloaded and saved. Risk factors for STIs recorded included whether workers advertised protected or unprotected vaginal/anal sex and oral sex, sexual violence, group-based encounters, survival sex and drug use. Results: In only 20% of ads, protected vaginal and/or anal sex is required by the sex worker and only 9% require protection for oral sex. Over one quarter of ads promote acts of sexual violence and group-based sexual encounters. Drug use during sex or as payment for sex was promoted in 7% of the ads. Twelve ads contained words or phrases indicative of survival sex. Future actions: MCDC will meet with industry representatives and other stakeholders to discuss possible interventions. Opportunities for online outreach will be explored. Conclusions: This audit adds to the growing body of evidence that sex workers are becoming an increasingly higher-risk group for STIs.

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11.30am - 11.40am The sexual behaviours and practices of men who have sex with men and women (MSMW): A scoping review

Patricia Reid-Moore (Curtin University), Sharyn Burns (Curtin University), Jacqueline Hendriks (Curtin University), Gemma Crawford (Curtin University) 

Background: Whilst there is decades of research focusing on men who have sex with men (MSM), the majority has focused on homosexual and bisexual identifying men with limited research with heterosexual identifying men who have sex with both men and women (MSMW). In order to maintain their heterosexual identity, some MSMW do not disclose their same-sex behaviours to their female partners, friends and/or family. Anonymity and concealment of same-sex encounters is possible through use of geolocator apps and by attending clubs or parks where same-sex activity is known to occur. These encounters often involve unprotected sexual behaviour increasing the risk of STIs and BBVs. Studies have shown an increase in gonorrhoea and syphilis in heterosexual women in Australia and it has been suggested that MSMW may be one possible reason for this. The literature suggests that MSMW also experience barriers to accessing healthcare, and many describe a fear of disclosing their same-sex behaviours to their health-care providers. Consistent with the limited research focusing on MSMW, there is a lack of health interventions specific to this population. Method: A formalised scoping review, guided by the framework outlined by Arksey and O’Malley, is currently being conducted. The review focuses on the sexual health and safe-sex practices of MSMW and will include interviews with key stakeholders to gather additional information not accessible within the literature. Results: The scoping review is currently underway, and a revised abstract can be provided prior to the conference. Preliminary screening has resulted in 75 articles that are currently undergoing data extraction. Future actions: This research will provide a critical review of the current published and grey literature around sexual behaviours and practices of MSMW. This understanding will inform research to enable the development of public health interventions specific to this population, including safer-sex practices and STI/BBV prevention.

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11.40am - 11.50am HealthySexual – designing, implementing and evaluating a statewide sex positive sexual health campaign to increasing STI testing across WA 

Sharelle Tulloh (WA Dept of Health), Matthew Bacon (WA Dept of Health)

Background: The WA Department of Health’s (DoH) HealthySexual aimed to create an overarching sexual health campaign that targets all priority populations whilst encouraging open conversations to destigmatise sexual health and illustrate that is a part of general health and wellbeing. Over the past three years, the campaign has evolved to address epidemiological trends and incorporate consumer and key stakeholder feedback. Methods: The initial creative concepts were codesigned with 303 Creative, key stakeholders and consumers. Assets were designed with the DoH Communications team and Initiative Media provided analytics for the best media buy for the campaign. Assets include: social media; banners for GP newsletters; airport; condom wallets with QR code to online testing; posters; venues; bus stops; back of buses. Results: Initial campaign burst April 2021 to June 2021 had the following investment and estimated impressions:

• Screens $82k – 4M

• Audio $42k – 300k

• Outdoor $50k – 795k

• Display and digital $36k – 1.6M

• Socials $13k – 1M

Updated metrics for 2022-2023 bursts will be included in presentation. The HealthySexual website had 79k WA users since launch (61k acquired via organic social). The online testing users doubled in 2023 possibly due to new condom dispensers and campaigns QR codes directing to the testing page. Future actions: The campaign will continue to be evaluated, improved and adapted to meet emerging trends (e.g. targeting areas with increased HIV and syphilis rates). DoH will continue to: explore novel places to advertise (e.g. state handheld pregnancy record); collaborate with funded services to complement campaigns; monitor epidemiology and target advertising responses (e.g. antibiotic resistant gonorrhoea cases). Conclusions: Lessons learned:

• social media is the best value for money

• images are a challenge!

• simple designs have the most impact (e.g. ‘syphilis’ on back of bus)

• tag line ‘Talk. Test. Protect’ had more impact than ‘healthysexual’.

• a balance of health promotion versus brand recognition is required in public health.

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11.50am - 12.00pm Outbreak of Burkholderia cepacia complex infections in correctional centres in Queensland and Western Australia: a new opportunity for NSP advocacy

Candice Holland (West Moreton and Metro North Health Services, Queensland Dept of Health), Lisa Bastian (Sexual Health and Blood-borne Virus Program, WA Dept of Health), Donna Mak (Communicable Disease Control Directorate), John Dyer (Fiona Stanley Hospital), Gabriela Willis (Boorloo Public Health Unit), Ben Scalley (Boorloo Public Health Unit)

Background: Burkholderia cepacia  complex are environmental organisms found in soil and water and pose minimal medical risk to healthy people.  In 2018, six cases of invasive Burkholderia cenocepacia infection were identified in prisoners who attended a Queensland public hospital; injecting drug use was noted in some cases. In 2019, another outbreak was identified across two Queensland prisons and a resurgence of cases was noted in 2021.  In 2024, a tertiary hospital in Western Australia reported hospital admissions of inmates from a correction centre with Burkholderia cenocepacia infection and who had reported injecting drug use. Method: The Queensland Department of Health established an outbreak management team to investigate the outbreak.  The investigation included case interviews, environmental health investigation, analysis of prisoner movement and hospital related cost analysis associated with in-patient care. Results:

• Queensland epidemiological summary to 30 January 2024

  •  64 cases to date

  • All male

  • Mean age 33 (range 21-56) years

  • Incubation period – unknown

  • Deaths – 1

  • Site of infection: bloodstream, bone and joint, skin and soft tissue, infective endocarditis

  • Hospitalisation costs – significant

  • Environmental investigation did not yield a conclusive finding.

• Small cluster of prisoners were admitted to a tertiary hospital in Western Australia in 2024

  • All cases reported injecting drug use as a risk factor

  • Associated in-patient costs were significant due to prolonged length of stay, including intensive care admissions.

Public health investigations did not identify epidemiological links indicating person to person transmission or a common environmental point source. During the same time periods, Burkholderia cenocepacia infections had not been observed among people who inject drugs outside of prison in either jurisdictions. Conclusions: Given that Burkholderia cenocepacia is commonly found in soil and water, the most likely cause of the outbreaks/cluster is lack of access to sterile injecting equipment in custodial settings.  These infections represent significant preventable harm to prisoners’ health and cost burden to the health and custodial sectors. As Burkholderia cenocepacia is not a notifiable infectious disease in Western Australia or Queensland, it is not routinely reported to the Departments of Health making it difficult describe, measure and monitor the problem. It is possible that other non-notifiable infections in prisoners due to lack of access to sterile injecting equipment are going unnoticed. The outbreak in Qld and cluster in WA provide an new opportunityto advocate for access to harm minimisation therapies and needle and syringe programs for prisoners in custodial settings. 

 

12.00pm - 12.30pm Q&A session