Charles F. Gilks

Alcohol use has been linked to sexual risk-taking behaviour, particularly among young people in Australia, who are also substantially represented in sexually transmissible infection (STI). While research on alcohol use and sexual risk-taking among university students in Australia exists, no studies outside recent Tertiary Students Sexual and Reproductive Health Survey (TSSHS) publications have distinguished between Australian-born and overseas-born domestic students, despite evidence that migrant populations may show different alcohol use and sexual behaviour patterns. Using data from the TSSHS and a cross-sectional anonymous online survey of university-enrolled students, this study is the first to compare sexually active Australian-born domestic, overseas-born domestic, and international students on alcohol use and sexual risk-taking. Findings align with past research, with Australian-born domestic students being more likely to consume alcohol at high-risk levels than international and overseas-born domestic students. Differences in sexual risk-taking behaviours between the three enrolment groups were fully mediated by harmful alcohol use, indicating an indirect effect between group membership and sexual risk-taking. Age moderated this mediation, with the association between harmful drinking and sexual risk-taking strongest among students aged 20–24, compared with younger and older groups.

We compared two widely used methods for Human Immunodeficiency Virus (HIV) molecular phylogenetic analysis (MPA) - Hypothesis testing using Phylogenetics (HyPhy) and Molecular Evolutionary Genetics Analysis (MEGA) – to consider which could strengthen surveillance and better target prevention interventions in Queensland, Australia. HIV pol sequences generated for drug resistance testing were linked to de-identified case reports in the state-wide register of notified HIV cases. The study used MEGA, 6.0 patristic distance ≤1.5% and HyPhy, patristic distance ≤2% to identify molecular transmission clusters. We compared time taken to perform each analysis; the effectiveness of identifying sequences that clustered; the efficiency of identifying clusters and their sizes; and the ability simply to illustrate cluster networks and their evolution over time. Of 1776 unique sequences identified 1,563 (88.5%) were linked to a notification record. Analysis with HyPhy (30 minutes) was 600 times faster than MEGA (324 hours). With HyPhy, 1084 (61.4%) sequences clustered compared to MEGA where 595 (33.7%) clustered making HyPhy 54% (595/1084) more effective. Overall, HyPhy identified 82 more transmission clusters than MEGA (266 versus 184) performing 45% (82/184) more efficiently. In size terms, HyPhy found 565 sequences clustered in 50 moderate or large clusters with MEGA finding 261 sequences in 21 moderate and 2 large clusters: of these clusters, 43 were identified by both methods but with MEGA nearly half (20; 47%) were small. HyPhy also more efficiently established cluster size. The HyPhy network cluster maps can more simply illustrate molecular transmission clusters, include patient characteristics, show their timelines and are easier to update than the cluttered MEGA circular phylogenetic trees. We are confident that HyPhy is better suited than MEGA to use in the Queensland context to generate comprehensive network transmission cluster maps for monitoring HIV transmission and to translate near real-time phylogeny data into action for targeted prevention interventions.

Background: Obesity was a risk factor for severe COVID-19 in children during early outbreaks of ancestral SARS-CoV-2 and the Delta variant. However, the relationship between obesity and COVID-19 severity during the Omicron wave remains unclear. Methods: This multicenter, observational study included polymerase chain r eaction-confirmed SARS-CoV-2-infected children and adolescents from Australia, Brazil, Italy, Portugal, Switzerland, Thailand, the United Kingdom and the United States hospitalized between January 1, 2020, and March 31, 2022. Data were collected across 3 time periods representing dominant SARS-CoV-2 variants: the ancestral strain (T1), pre-Omicron variants (Alpha and Delta; T2) and Omicron (T3). The primary outcome was the need for supplemental oxygen therapy and/or ventilatory support (respiratory support). Results: This study included 6176 hospitalized children and adolescents of 2 to <18 years of age. The median age was 11.0 (interquartile range, 6.0–14.0) years, and 2989 (48.4%) were female. Obesity status was available for 5460 (88.4%), of whom 213 (3.9%) met the criteria for having obesity. Obesity was positively associated with the need for respiratory support during T1 [risk ratio (RR), 3.45 (95% CI: 2.02–5.88)] and T2 [RR, 3.24 (95% CI: 1.57–6.67], but this association was lost during T3 [RR, 3.08 (95% CI: 0.85–11.15)]. These findings were similar for unvaccinated children. Conclusions: Obesity was associated with more severe COVID-19 during the ancestral and pre-Omicron waves but not during the Omicron wave. Importantly, the same phenomenon was observed in unvaccinated children, suggesting that differences in vaccination did not account for the observed changes in the need for respiratory support over time.

University attendance can lead to changes in sexual behaviour that place people at increased risk of negative sexual and reproductive health (SRH) experiences; however, relatively few studies have explored access to and use of SRH services by university students in Australia. A convenience sample of students (N = 4291) from five universities completed an online survey to examine barriers and facilitators to accessing SRH services. Descriptive statistics were used to analyse variations by gender, sexuality, and enrolment status. Content analyses were conducted on responses to two open-ended questions. Over half (59%, 2934) had never spoken to a health professional about SRH issues. Of the 41% (1357) who had, female, non-binary/gender diverse, and Australian-born students were significantly more likely to have done so than students identifying as male, heterosexual, or as an international student. Frequently reported barriers to use of SRH services were 'feeling embarrassed', 'being judged' and 'not knowing where to go'. LGBTQIA+ students along with international and overseas-born domestic students faced specific access barriers. Recommendations targeting student-identified barriers to access are offered, calling for universities to support student wellbeing by providing supportive, non-judgemental, and inclusive SRH promotion and health services that cater to needs of diverse student cohorts.

Intersectionality pinpoints intersecting factors that empower or oppress people with multiple (dis)advantageous conditions. This study examined intersectional inequity in knowledge, attitudes, and testing related to HIV among adults aged 15 to 49 years in Ethiopia. This study used nationally representative 2016 Ethiopian Demographic Health Survey data. The sample size was 27,261 for knowledge about HIV/AIDS and 25,542 for attitude towards people living with HIV and HIV testing. Triple (dis)advantage groups were based on wealth status, education status, and residence. The triple advantages variables specifically are urban residents, the educated, and those who belong to households of high wealth status, while the triple disadvantages are rural residents, the uneducated, and those who live in poor household wealth rank. A multilevel logistic regression analysis was employed. Adjusted odds ratios (aOR) and confidence intervals (CI) with a P-value ≤ 0.05 were considered statistically significant. Based on descriptive analysis, 27.9% (95% CI: 26.5%, 29.3%) of adults had comprehensive knowledge about HIV/AIDS, 39.8% (95% CI: 37.6, 41.9%) exhibited accepting attitude towards people living with HIV, and 20.4% (95% CI: 19.1%, 21.8%) undergo HIV testing. Comprehensive knowledge about HIV/AIDS, accepting attitude towards people living with HIV, and HIV testing was 47.0%, 75.7%, and 36.1% among those with triple advantages, and 13.9%, 16.0% and 8.7% among those with triple non-advantages, respectively. The odds of having comprehensive knowledge about HIV/AIDS, accepting attitude towards people living with HIV, and HIV testing were about three (aOR = 3.4; 95% CI: 2.76 to 4.21), seven (aOR = 7.3; 95% CI = 5.79 to 9.24) and five (aOR = 4.7; 95% CI:3.60 to 6.10) times higher for triple forms of advantage than triple disadvantages, respectively. The findings of this study imply that Ethiopia will not achieve the proposed targets for HIV/AIDS services unless it prioritises individuals who live under multiple disadvantaged conditions.

Universal health coverage is essential for the progress to end threats of the acquired immunodeficiency syndrome epidemic. The current review assesses the publication rate, strategies and barriers for antiretroviral therapy (ART) coverage, equity, quality of care, and financial protection. We searched Web of Science, PubMed, and Google Scholar. Of the available articles, 43.13% were on ART coverage, 40.28% were on financial protection, 10.43% were on quality of care, and 6.16% were on equity. A lack of ART, fear of unwanted disclosure, lack of transportation, unaffordable health care costs, long waiting time to receive care, and poverty were barriers to ART coverage. Catastrophic health care costs were higher among individuals who were living in rural settings, walked greater distances to reach health care institutions, had a lower socioeconomic status, and were immunocompromised. There were challenges to the provision of quality of care, including health care providers’ inadequate salary, high workload and inadequate health workforce, inappropriate infrastructure, lack of training opportunities, unclear division of responsibility, and the presence of strict auditing. In conclusion, ART coverage was below the global average, and key populations were disproportionally less covered with ART in most countries. Huge catastrophic health expenditures were observed. UHC contexts of ART will be improved by reaching people with poor socioeconomic status, delivering appropriate services, establishing a proper health workforce and service stewardship.

Patient satisfaction is a critical component of quality of care assessment in the pursuit of universal health coverage to end the tuberculosis epidemic and other diseases. This study aimed to review the level of satisfaction of tuberculosis patients and related factors. Articles were accessed from Web of Science, EMBASE, PubMed and Google Scholar. Twenty-six papers fulfilled the eligibility criteria from 13 countries. The percentage of satisfied tuberculosis patients ranged from 53.5% to 97.0% in the five African countries, 67.8 to 97.2% in India, South-East Asia, 82.0% in Pakistan, East-Mediterranean and 92.9% in Armenia, the European region. Accessibility, healthcare cost, treatment duration and taking supervised-directly observed treatment were healthcare service-related determinants. Technical competency, interpersonal relationships, confidentiality, time spent with healthcare providers, time spent waiting for care and counselling and health education were health worker-related determinants. Patient-related variables that determine satisfaction were gender, age, ethnicity, place of residence, marital status, educational status, income and health status. Developing and/or approaching an internationally-agreed tool to measure tuberculosis patient satisfaction in healthcare settings will improve the availability of high-quality and comparable data to verify actual variation across and within a country. A multidimensional approach considering clients, health workers and healthcare settings is required to holistically address satisfaction issues of tuberculosis patients to gradually realise universal health coverage.

Background: The pandemic of Coronavirus Disease 2019 (COVID-19) is a timely reminder of the nature and impact of Public Health Emergencies of International Concern. As of 12 January 2022, there were over 314 million cases and over 5.5 million deaths notified since the start of the pandemic. The COVID-19 pandemic takes variable shapes and forms, in terms of cases and deaths, in different regions and countries of the world. The objective of this study is to analyse the variable expression of COVID-19 pandemic so that lessons can be learned towards an effective public health emergency response. Methods: We conducted a mixed-methods study to understand the heterogeneity of cases and deaths due to the COVID-19 pandemic. Correlation analysis and scatter plot were employed for the quantitative data. We used Spearman’s correlation analysis to determine relationship strength between cases and deaths and socio-economic and health systems. We organized qualitative information from the literature and conducted a thematic analysis to recognize patterns of cases and deaths and explain the findings from the quantitative data. Results: We have found that regions and countries with high human development index have higher cases and deaths per million population due to COVID-19. This is due to international connectedness and mobility of their population related to trade and tourism, and their vulnerability related to older populations and higher rates of non-communicable diseases. We have also identified that the burden of the pandemic is also variable among high- and middle-income countries due to differences in the governance of the pandemic, fragmentation of health systems, and socio-economic inequities. Conclusion: The COVID-19 pandemic demonstrates that every country remains vulnerable to public health emergencies. The aspiration towards a healthier and safer society requires that countries develop and implement a coherent and context-specific national strategy, improve governance of public health emergencies, build the capacity of their (public) health systems, minimize fragmentation, and tackle upstream structural issues, including socio-economic inequities. This is possible through a primary health care approach, which ensures provision of universal and equitable promotive, preventive and curative services, through whole-of-government and whole-of-society approaches.

HIV self-testing (HIVST) introduces opportunities for screening in non-conventional settings, and addresses known testing barriers. This study involved the development and evaluation of a free online HIVST dissemination service hosted by a peer-led, community-based organisation with on-site, peer-facilitated HIV testing, and established referral and support programs for people newly diagnosed with HIV to determine whether this model was feasible and acceptable for engaging MSM, particularly among infrequent and naive HIV-testers, or those living in remote and rural areas. Between December 2016 and April 2018, 927 kits were ordered by 794 individuals, the majority of whom were men who have sex with men (MSM) (62%; 494), having condomless sex (50%; 392), or living outside a major city (38%; 305). Very few (5%; 39) sought the available pre-test peer contact, despite 45% (353) being naive HIV-testers. This study demonstrates that online HIVST dissemination is acceptable and feasible for engaging at-risk suboptimal testers, including those unwilling to test elsewhere (19%; 47/225). With half (50%; 403) unwilling to buy a kit, our study suggests that HIVST will need to be subsidized (cost-neutral to users) to enhance population coverage and access.

The role of children in the spread of SARS-CoV-2 remains highly controversial. To address this issue, we performed a meta-analysis of the published literature on household SARS-CoV-2 transmission clusters (n=213 from 12 countries). Only 8 (3.8%) transmission clusters were identified as having a paediatric index case. Asymptomatic index cases were associated with a lower secondary attack in contacts than symptomatic index cases (estimate risk ratio [RR], 0.17; 95% confidence interval [CI], 0.09-0.29). To determine the susceptibility of children to household infections the secondary attack rate (SAR) in paediatric household contacts was assessed. The secondary attack rate in paediatric household contacts was lower than in adult household contacts (RR, 0.62; 95% CI, 0.42-0.91). These data have important implications for the ongoing management of the COVID-19 pandemic, including potential vaccine prioritization strategies. 40-word summary: In household transmission clusters of SARS-CoV-2 children are unlikely to be the index case. Children are also less likely than adults to be infected with SARS-CoV-2 from a family member.