Colette Smith

Objectives Doxycycline post-exposure prophylaxis (doxyPEP) has been shown to reduce syphilis and chlamydia incidence among gay, bisexual and other men who have sex with men (gbMSM) and transgender women (TGW). However, evidence among other populations remains limited. This study aimed to assess knowledge, attitudes, willingness and use of doxyPEP among sexual health clinic attendees and healthcare workers in Dublin. Methods Data were collected via two anonymous surveys in two sexual health services for service users and healthcare workers. Surveys were collected between January and March 2024. Logistic regression analyses explored factors associated with willingness to use doxyPEP. Results Among 378 clinic attendees (median age 32), 72% (272/378) identified as gbMSM, TGW, non-binary or gender fluid; 17% (64/378) cisgender women and 11% (42/378) heterosexual men. Overall, 62% (235/378) expressed willingness to use doxyPEP, with higher willingness observed in the gbMSM, TGW, non-binary and gender fluid group (70%, 190/272). This group also reported the highest level of knowledge of doxyPEP compared with other groups: 107/272 (39.3%). After adjustment, logistic regression analyses revealed that individuals with prior sexually transmitted infection (STI) diagnoses were more willing to use doxyPEP (adjusted OR (aOR) per number of STI diagnosed 2.00, 95% CI 1.28 to 3.03, p=0.002). 9% (35/378) reported doxyPEP use in the past 1 year. Among 52 healthcare workers, 81% (42/52) were aware of doxyPEP studies, 62% (32/52) believed it could reduce STIs, but 89% (46/52) had concerns, primarily around antimicrobial resistance. Conclusions This is the first study evaluating doxyPEP attitudes in Ireland. Willingness to use doxyPEP was high among individuals at greatest STI risk, supporting its potential for targeted implementation. There was also interest among cisgender women and heterosexual men. However, clinician concerns about antimicrobial resistance remain a barrier. These findings highlight the need for national guidelines, ongoing surveillance and research, including among heterosexual men and cisgender women, to inform equitable and safe doxyPEP prescription.

Objectives: We assessed the impact of COVID‐19, and the prevalence and factors associated with a history of COVID‐19 infection, long COVID and incomplete COVID‐19 vaccine uptake among people with HIV.Methods: Positive Voices 2022 is a questionnaire study of people accessing HIV care in the United Kingdom (March 2022–April 2023). Logistic regression assessed factors associated with a history of COVID‐19 (previous positive test), long COVID among those with a history of COVID‐19 (ongoing symptoms, with COVID‐19 onset >3 months previously) and incomplete COVID‐19 vaccine uptake (less than three doses of vaccine), adjusted for: age; gender; ethnicity; and year of HIV diagnosis.Results: In all, 4188 participants were included. Commonly reported negative impacts of the pandemic were on social contact (44% of participants), mental health (30%), healthcare access (26%) and financial security (25%). Overall, 2068 of 4188 (49.4%) participants had a history of COVID‐19. Of these, 10.8% met criteria for long COVID, associated with female gender, unemployment, financial hardship, earlier HIV diagnosis date, diabetes diagnosis, asthma/chronic obstructive pulmonary disease diagnosis, obesity and symptoms of depression and anxiety. Overall, 95.8% reported having at least one vaccine dose, but 649 (15.7%) participants had incomplete vaccine uptake, associated with younger age, female gender, Black African ethnicity, lower education, financial hardship, unemployment, multioccupancy household, more recent HIV diagnosis, detectable HIV viral load and symptoms of depression and anxiety.Conclusions: About half of participants had a history of COVID‐19, of whom 11% had persistent symptoms (long COVID). COVID‐19 vaccine uptake was high, but incomplete uptake was apparent for 16% of participants and was more common among women, younger people, Black African individuals and those with socio‐economic disadvantage.

[This corrects the article DOI: 10.2196/58531.].

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Background: Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socioeconomic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the United Kingdom. It monitors the physical, mental, and social health, well-being, and needs of this population so that they can be addressed. Objective: This paper aimed to describe the methodology, recruitment strategies, and key demographic features of participants recruited for the second national round of Positive Voices (PV2022). Methods: PV2022 was a national, cross-sectional questionnaire study that included people attending HIV care at 101 of the 178 clinics in the United Kingdom between April 2022 and March 2023. Data from the HIV and AIDS reporting system (HARS), a national surveillance database of people with HIV and attending care that is held at the UK Health Security Agency (UKHSA), was used as a sampling frame. The information collected in PV2022 included demographic and socioeconomic factors, HIV diagnoses and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors, and additional challenges experienced due to the COVID-19 pandemic. Data linkage to HARS enabled the extraction of clinical information on antiretroviral therapy (ART), HIV viral load, and CD4 lymphocyte counts. Probabilistic sampling was used to provide a randomly selected, representative sample of people attending HIV care who could be invited to complete a paper or online questionnaire. At the start of 2023, due to under-recruitment mainly due to the impact of the monkeypox (Mpox) outbreak, a separate sequential recruitment strategy was initiated in 14 of the largest clinics to increase participant numbers. Results: Of the 4622 participants who completed the questionnaire, 3692 were recruited through probabilistic recruitment and 930 through sequential recruitment. The overall response rate (measured as the number of people who completed a questionnaire of those who either accepted or declined) was 50%. Survey respondents represented approximately 1 in 20 people diagnosed with HIV in England, Wales, and Scotland. The median age of participants was 52 years, 3428 of participants were men, 2991 were White, and 1121 were Black. Conclusions: PV2022 is currently the largest survey of people with HIV in the United Kingdom (as of September 2024). The PV2022 findings will be used to explore the health and well-being of the HIV population and examine associations with demographic, socioeconomic, lifestyle, and other HIV-related factors. International Registered Report Identifier (IRRID): RR1-10.2196/58531

BACKGROUND Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socioeconomic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the United Kingdom. It monitors the physical, mental, and social health, well-being, and needs of this population so that they can be addressed. OBJECTIVE This paper aimed to describe the methodology, recruitment strategies, and key sociodemographic features of participants recruited for the second national round of Positive Voices (PV2022). METHODS PV2022 was a national, cross-sectional questionnaire study that included people attending HIV care at 101 of the 178 clinics in the United Kingdom between April 2022 and March 2023. Data from the HIV and AIDS reporting system (HARS), a national surveillance database of people with HIV and attending care that is held at the UK Health Security Agency (UKHSA), was used as a sampling frame. The information collected in PV2022 included demographic and socioeconomic factors, HIV diagnoses and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors, and additional challenges experienced due to the COVID-19 pandemic. Data linkage to HARS enabled the extraction of clinical information on antiretroviral therapy (ART), HIV viral load, and CD4 lymphocyte counts. Probabilistic sampling was used to provide a randomly selected, representative sample of people attending HIV care who could be invited to complete a paper or online questionnaire 'on the web' to online. At the start of 2023, the study was underrecruiting, mainly due to the mpox outbreak, and a separate sequential recruitment strategy was initiated in 14 of the largest and most demographically diverse clinics to increase participant numbers. RESULTS Of the 4622 participants who completed the questionnaire, 3692 were recruited through probabilistic recruitment and 930 through sequential recruitment. The overall response rate (measured as the number of people who completed a questionnaire of those who either accepted or declined) was 50%. Survey respondents represented approximately 1 in 20 people diagnosed with HIV in England, Wales, and Scotland. The median age of participants was 52 years, 3428 of participants were male, 2991 were of White ethnicity, and 1121 were of Black ethnicity. CONCLUSIONS PV2022 is currently the largest survey of people with HIV in the United Kingdom (as of September 2024). The PV2022 findings will be used to explore the health and well-being of the HIV population and examine associations with demographic, socioeconomic, lifestyle, and other HIV-related factors. INTERNATIONAL REGISTERED REPORT RR1-10.2196/58531

Objective: To investigate the association of age at antiretroviral therapy (ART) initiation with CD4⁺ : CD8⁺ T-cell ratio in virally suppressed people with HIV on long-term ART, and to characterize potential CD4⁺ : CD8⁺ ratio recovery in this population by age. Design: A longitudinal study of people attending an HIV clinic at the Royal Free Hospital NHS Trust, London, who initiated ART between 2001 and 2015, and achieved and maintained HIV-1 viral suppression (viral load + : CD8⁺ ratio at 5 and 10 years was assessed. Methods: Multivariable linear regression was used to investigate the relationship between age at ART initiation and log CD4⁺ : CD8⁺ ratio, adjusting for demographic factors (gender/HIV transmission route, ethnicity), baseline CD4⁺ count and calendar year. Results: The sample included 1859 people aged 20–78 (75% men, 56% white ethnicity). Overall, median CD4⁺ : CD8⁺ T-cell ratio increased from 0.24 at baseline to 0.77 at year 5 and 0.88 at year 10. Ratios increased among all age groups in unadjusted and adjusted models but increased less among older ages (baseline ages 60–69 and 70–79). Median ratios at year 5 were 0.85, 0.80, 0.72, 0.76, 0.6, and 0.44, respectively, among people aged 20–29, 30–39, 40–49, 50–59, 60–69 and 70–79 years at baseline. Conclusion: In a virally suppressed London population, age had a substantial impact on CD4⁺ : CD8⁺ ratio recovery, especially for those starting ART after age 60 years. Results may indicate the level of CD4⁺ : CD8⁺ ratio recovery possible in an HIV-positive, virally suppressed, aging population.

: Determination of previous SARS-COV-2 infection is hampered by the absence of a standardized test. The marker used to assess previous exposure is IgG antibody to the nucleocapsid (IgG anti-N), although it is known to wane quickly from peripheral blood. The accuracies of seven antibody tests (virus neutralization test, IgG anti-N, IgG anti-spike [anti-S], IgG anti–receptor binding domain [anti-RBD], IgG anti-N + anti-RBD, IgG anti-N + anti-S, and IgG anti-S + anti-RBD), either singly or in combination, were evaluated on 502 cryopreserved serum samples collected before the COVID-19 vaccination rollout in Kumasi, Ghana. The accuracy of each index test was measured using a composite reference standard based on a combination of neutralization test and IgG anti-N antibody tests. According to the composite reference, 262 participants were previously exposed; the most sensitive test was the virus neutralization test, with 95.4% sensitivity (95% CI: 93.6–97.3), followed by 79.0% for IgG anti-N + anti-S (95% CI: 76.3–83.3). The most specific tests were virus neutralization and IgG anti-N, both with 100% specificity. Viral neutralization and IgG anti-N + anti-S were the overall most accurate tests, with specificity/sensitivity of 100/95.2% and 79.0/92.1%, respectively. Our findings indicate that IgG anti-N alone is an inadequate marker of prior exposure to SARS COV-2 in this population. Virus neutralization assay appears to be the most accurate assay in discerning prior infection. A combination of IgG anti-N and IgG anti-S is also accurate and suited for assessment of SARS COV-2 exposure in low-resource settings.