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Los modelos de Unidades de ITS en LondresChemsex y PrEP
Dean Street services - location
Dean Street Express Attendees8454
2968
62% MSM; 34% heterosexual
Median age 26 (IQR 22-38yrs)
Prevalence of any STI: 11.5% (CT/NG: 10%)
526 new HIV diagnoses in 2015
56 Dean Street & DSE: HIV diagnoses 2015New HIV infections
Challenges: HIV risk reduction
Chemsex support
PrEP
PEPOnline resources
Education
Test-and-treat
(Treatment-as-prevention)
Challenges: HIV risk reduction
Chemsex support
PrEP
PEPOnline resources
Education
Test-and-treat
(Treatment-as-prevention)
Hornet/ECDC PrEP survey
• Hornet/ECDC survey on PrEP
Hornet survey respondents
8543 persons responded between 23 – 25 April
Where did you obtain PrEP?n= 528 persons on PrEP responding to this question
Pe
rce
nta
ge
Results
1 February – 11 October 2016
•377 individuals
•Virtually 100% MSM
•80% White
•Median age 38 years
•Median follow-up 88 days (2-589 days)
•Baseline urinalysis abnormal in 4
– No significant deterioration during follow-up
Results (2)
Regimen:
• 224/377 (59%) on daily PrEP
•153/377 (42%) on event driven PrEP
•TDM performed in 194 individuals
•Where sample taken at wrong time of
inadequate information; normal at repeat
Details of source
www.unitedpharmacies-uk.md 32.3 % (52/161)
www.alldaychemist.com 14.3 % (23/161)
www.iwantprepnow.co.uk 6.2 % % (10/161)
www.alldaypharmacy.co.uk 6.2 % (10/161)
www.aids-drugs-online.com 1.2 % (2/161)
Hospital 0.6 % (1/161)
www.callchemist.com 0.6 % (1/161)
www.buylowdrugs.com 0.6 % (1/161)
Not stated/unknown 37.9% (61/161)
Source of PrEPSource of PrEPSource of PrEPSource of PrEP
Challenges: risk reduction
Chemsex support
PrEP
PEPOnline resources
Education
Test-and-treat
(Treatment-as-prevention)
Chemsex support
CODE clinic
Staffing
Substance use workers
HIV/GUM physicians
Nurses
Health Advisers
Psychosexual
Acute services
-A&E
-Liaison psychiatry
-C&W inpatient
Other
-Clinical psychology
-Psychiatry
-GP
1. ChemSex support
2. ChemSex support
Chemsex support service, Feb – Dec 2014
874 MSM using G/crystal/meph brief intervention
• 45% reported 5-10 partners per episode
• 70% reported NO ‘chem-free’ or ‘sober’ sex in previous 6/12
• 29% were injecting drug users
• 52% HIV negative
• 55% had 1 or more courses of PEP
• 10% reported zero condom use for intercourse
• 40% reported using condoms for intercourse less than 50% of the time
Stuart et al. EACS poster (2015)
Chemsex support service: 56 Dean Street56 Dean Street: ChemSex support
Challenges: HIV risk reduction
Chemsex support
PrEP
PEPOnline resources
Education
Test-and-treat
(Treatment-as-prevention)
Is immediate ART feasible?
• UK seroconverters, 1998 -2011 (Parson et al. 2014)
• Earlier cART from 3.7y to 1.4y in 2011
• From 1st July 2016
• Create capacity for 1st appt within 48h
• Preliminary results (upto 2nd Sep 2016)
• 53 new HIV diagnoses
• 47 followed-up
• 2 DNA; 4 moved away
• All offered ART at first appt
• 12 did not start ART
• 35 started: 10 within 48h
Characteristic Within 48 hours
N=10
> 48 hours
N=25
P-value
Age (mean) 32.7 34.3 0.62
Baseline CD4 (mean)
cells/mm3
359 521 0.06
Baseline VL
(mean) cpm log10
6.07
(1.17 million)
5.22
(167,000)
0.08
Recent infection (RITA)
%
56% (5/9*) 42% (10/24*) 0.48
Mean days to start
(range)
1 (0-2) 9 (3-20) <0.001
ART regimen initiated
INSTI
PI
NNRTI
0
10 (100%)
0
9
13
3
0.026
56DS Rapid Start pilot
*RITA not sent in one patient from each group
Challenges: HIV risk reduction
Chemsex support
PrEP
PEPOnline resources
Education
Test-and-treat
(Treatment-as-prevention)
Who are MSM at high-risk?
• PEPSE, Jan-Jun 2013 1
• 530 MSM
• HIV incidence: 7.6 per 100 pyfu
• MSM with early syphilis, Jan – Jun 2014 2
• 206 MSM (110 HIV-; 96 HIV+)
• HIV: 8.3 per 100pyfu
1. Whitlock et al STI 2016
2. Girometti et al STI 2016
Dean Street Prime
Dean Street Prime
Dean Street Prime
Dean Street Prime
Challenges: HIV risk reduction
Chemsex support
PrEP
PEPOnline resources
Education
Test-and-treat
(Treatment-as-prevention)
Thanks