Hepatitis C elimination among people living with HIV

Background: Hepatitis C virus (HCV) is a major cause of liver-related morbidity and mortality among people living with HIV globally. Aims: The broad aim of this research was to evaluate progress towards HCV elimination among people living with HIV in Australia. Specific aims included evaluating incidence and factors associated with HCV reinfection and patterns of drug use and sexual risk behaviours after treatment and characterizing the HCV cascade of care and factors associated with engagement in HCV care among people living with HIV in Australia. Methods: In Chapter Two, the risk of HCV reinfection following successful therapy among people living with HIV was evaluated in a global systematic review and meta-analysis, with factors associated with reinfection assessed using meta-regression. In Chapter Three, patterns of drug use and sexual risk behaviours and HCV reinfection incidence were assessed before and after direct-acting antiviral (DAA) scale-up in Australia among people with HIV/HCV coinfection enrolled in CEASE. In Chapter Four, the HCV cascade of care, including HCV testing and treatment, among people living with HIV was characterized in the pre (2010–2015) and post (2016–2018) DAA era in a population-based linkage study including all people living with HIV in New South Wales, Australia with an HCV notification. Factors associated with HCV testing and DAA treatment were assessed using logistic regression. Key Findings: Globally, HCV reinfection incidence following treatment among people living with HIV was similar following interferon-based and DAA therapy, with the highest risk among men who have sex with men and those with recent HCV infection. Following unrestricted DAA access and broad treatment uptake among people living with xviii HIV in Australia, HCV reinfection incidence was low despite stable pattens of risk behaviours before and after DAA treatment. The HCV care cascade among people living with HIV demonstrated high HCV RNA testing coverage (91%) and treatment uptake following DAA availability (7% pre DAA, 73% post DAA). Younger age, female gender, and rural region of residence were negatively associated with testing; no factors were associated with DAA treatment. Conclusion: To maintain progress towards HCV elimination, ongoing HCV screening and treatment of (re)infection among people living with HIV will be required. Enabling access to and ensuring broad coverage of HCV testing, treatment and prevention will be essential

How and Where Do We Ask Sensitive Questions: Self-reporting of STI-associated Symptoms Among the Iranian General Population

Background Reliable population-based data on sexually transmitted infections (STI) are limited in Iran and selfreporting remains the main source of indirect estimation of STI-associated symptoms in the country. However, where and how the questions are asked could influence the rate of self-reporting. In the present study, we aimed to assess what questionnaire delivery method (ie, face-to-face interview [FTFI], self-administered questionnaire [SAQ], or audio self-administered questionnaire [Audio-SAQ]) and setting (ie, street, household or hair salon) leads to more reliable estimates for the prevalence of self-reported STI-associated symptoms. Methods This cross-sectional study was conducted in winter 2014 on a gender-balanced (50.0% men) sample of 288 individuals aged 18–59 years old in Kerman, Iran. Respondents were recruited in (a) crowded public places and streets, (b) their households, and (c) hair salons. Data was collected on history of current and 6-month (ie, past 6 months) STI-associated symptoms. Three different methods including FTFI, SAQ and or Audio-SAQ were applied randomly in households and non randomly in streets and hair salons to collect data among the respondents. Generalized estimating equation (GEE) was used to compare the settings and methods separately. Results A total of 2.8% of men and 9.4% of women self-reported at least one STI-associated symptom. Respondents were significantly more likely to report STI-associated symptoms when completing questionnaires on the street compared to their household (P = .0001). While women were less likely to report symptoms in FTFI compared to SAQ (P = .036), no significant differences were found between men’s responses across different methods (P = .064). Conclusion Further research is needed to evaluate the effect of different combinations of methods and settings to find the optimal way to collect data on STI-associated symptoms

Patterns and correlates of hepatitis C virus phylogenetic clustering among people living with HIV in Australia in the direct-acting antiviral era: A molecular epidemiology study among participants in the CEASE cohort

Background and Aims: In moving towards the elimination of hepatitis C virus (HCV) infection among people living with HIV, understanding HCV transmission patterns may provide insights to guide and evaluate interventions. In this study, we evaluated patterns of, and factors associated with HCV phylogenetic clustering among people living with HIV/HCV co-infection in Australia in the direct-acting antiviral era. Methods: HCV RNA was extracted from dried blood spot (DBS) samples collected between 2014 and 2018 in the CEASE cohort study. The HCV Core-E2 region was amplified by a polymerase chain reaction and Sanger sequenced. Maximum likelihood phylogenetic trees (1000 bootstrap replicates) were used to identify patterns of clustering (3% genetic distance threshold). Mixed-effects logistic regression was used to determine correlates of phylogenetic clustering. Factors assessed were sexual risk behavior, education, injecting drug use, housing, employment, HIV viral load, age, sex, and sexuality. Results: Phylogenetic trees were reconstructed for HCV subtype 1a (n = 139) and 3a (n = 63) sequences, with 29% (58/202) in a pair or cluster. Overall (n = 202), phylogenetic clustering was positively associated with younger age (under 40; adjusted odds ratio [aOR] 2.52, 95% confidence interval [CI] 1.20–5.29), and among gay and bisexual men (n = 168), was positively associated with younger age (aOR 2.61, 95% CI 1.10–6.19), higher education (aOR 2.58, 95% CI 1.09–6.13), and reporting high-risk sexual behavior (aOR 3.94, 95% CI 1.31–11.84). During follow-up, five reinfections were observed, but none were in phylogenetic clusters. Conclusion: This study found a high proportion of phylogenetic relatedness, predominantly among younger people and gay and bisexual men reporting high-risk sexual behavior. Despite this, few reinfections were observed, and reinfections demonstrated little relationship with known clusters. These findings highlight the importance of rapid HCV treatment initiation, together with monitoring of the phylogeny

How and Where Do We Ask Sensitive Questions: Selfreporting of STI-associated Symptoms Among the Iranian General Population

Abstract Background: Reliable population-based data on sexually transmitted infections (STI) are limited in Iran and selfreporting remains the main source of indirect estimation of STI-associated symptoms in the country. However, where and how the questions are asked could influence the rate of self-reporting. In the present study, we aimed to assess what questionnaire delivery method (ie, face-to-face interview [FTFI], self-administered questionnaire [SAQ], or audio self-administered questionnaire [Audio-SAQ]) and setting (ie, street, household or hair salon) leads to more reliable estimates for the prevalence of self-reported STI-associated symptoms. Methods: This cross-sectional study was conducted in winter 2014 on a gender-balanced (50.0% men) sample of 288 individuals aged 18–59 years old in Kerman, Iran. Respondents were recruited in (a) crowded public places and streets, (b) their households, and (c) hair salons. Data was collected on history of current and 6-month (ie, past 6 months) STI-associated symptoms. Three different methods including FTFI, SAQ and or Audio-SAQ were applied randomly in households and non-randomly in streets and hair salons to collect data among the respondents. Generalized estimating equation (GEE) was used to compare the settings and methods separately. Results: A total of 2.8% of men and 9.4% of women self-reported at least one STI-associated symptom. Respondents were significantly more likely to report STI-associated symptoms when completing questionnaires on the street compared to their household (P=.0001). While women were less likely to report symptoms in FTFI compared to SAQ (P=.036), no significant differences were found between men’s responses across different methods (P=.064). Conclusion: Further research is needed to evaluate the effect of different combinations of methods and settings to find the optimal way to collect data on STI-associated symptoms

Condom Use and its Associated Factors Among Iranian Youth: Results From a Population-Based Study

Abstract Background: Given the young structure of Iran’s population and the fact that extramarital sexual relationships are both prohibited by legislation and shunned by society and religion, examining condom use practices among Iranian youth is highly important. The aim of this study was to explore condom use and its correlates among Iranian young adults. Methods: In a sample of 3,045 individuals aged 19-29 who were recruited from a nation-wide study, we analyzed data from 633 participants who reported a history of extramarital sex. Subjects were asked about their condom use practices during their last penetrative sex. Data were collected through a self-administered questionnaire where the respondents completed the survey on their own and passed it to trained gender-matched interviewers. Multivariable regression models were constructed to report adjusted odds ratios (AOR) along with 95% CI. Results: Of the 633 participants, 222 (35.1%) reported condom use at last sex. Men reported significantly higher condom use than women (38.5% vs. 25.7%). Having a stable job (AOR = 1.86, 95% CI: 1.01, 3.43), higher knowledge of condom use (AOR = 1.57, 95% CI: 1.03, 2.37) and sexual transmission of HIV (AOR = 1.83, 95% CI: 1.18, 2.85) were positively associated with condom use at last sex. Conversely, experience of sex under the influence of substances (AOR = 0.66, 95% CI: 0.45, 0.94) was significantly associated with reduced odds of condom use at last sex. Conclusion: This study shows that only one out of every three young adults reported using condoms at last sex. While educational programs are helpful, multi-sectoral approaches (eg, individual-, community-, and structural-level interventions) are required to change sexual behaviours towards safe sex practices and reinforce negotiating condom use among youth

Feasibiity analysis of MBMS deployment with the introduction of LTE

Multimedia Broadcast Multicast service (MBMS) proposed by 3GPP for efficient use of network resources in broadcast and multicast services, provides the operator a delivery mechanism to simultaneously send to multiple recipients at high speed. Although MBMS was introduced in 3GPP Release 6 at the time of 3G networks, the MBMS feature did not find much attention from the 3G network operators. This thesis studies the technical and market feasibility for a successful MBMS deployment today at the time of commercial LTE deployment. UE and RAN advancements that make MBMS technologically feasible are studied together with the market feasibility factors such as user demand on media streaming and the impending data explosion. The thesis concludes that today at the time of LTE, it is more feasible from both technology and market perspectives to deploy MBMS in comparison to the time of 3G. As a future work, the thesis provides some suggestions that the operators should take care of before deploying MBMS

Feasibiity analysis of MBMS deployment with the introduction of LTE

Multimedia Broadcast Multicast service (MBMS) proposed by 3GPP for efficient use of network resources in broadcast and multicast services, provides the operator a delivery mechanism to simultaneously send to multiple recipients at high speed. Although MBMS was introduced in 3GPP Release 6 at the time of 3G networks, the MBMS feature did not find much attention from the 3G network operators. This thesis studies the technical and market feasibility for a successful MBMS deployment today at the time of commercial LTE deployment. UE and RAN advancements that make MBMS technologically feasible are studied together with the market feasibility factors such as user demand on media streaming and the impending data explosion. The thesis concludes that today at the time of LTE, it is more feasible from both technology and market perspectives to deploy MBMS in comparison to the time of 3G. As a future work, the thesis provides some suggestions that the operators should take care of before deploying MBMS