Philip Cunningham

Background and Aims: To achieve hepatitis C (HCV) elimination by 2030, testing and treatment must reach people most at risk. Dried blood spot (DBS) testing offers an alternative to venepuncture, suitable for community and prison settings. This study evaluated HCV infection prevalence and treatment initiation among people receiving DBS testing in New South Wales (NSW), Australia. Methods: The NSW DBS Pilot was an observational study of people testing for HCV RNA from DBS samples collected across 36 community sites (including drug treatment clinics and needle and syringe programmes) and 21 prisons. Logistic regression identified factors associated with current HCV infection (detectable HCV RNA) and treatment initiation within 6 months. Results: Between September 2019 and December 2023, 13 940 participants were tested for HCV (25% female, 33% Aboriginal and/or Torres Strait Islander, 36% injected drugs in the last month). Overall, 11% (1310/13940) had current infection, higher in community (12%) than prison (9%), and declining from 14% in 2019–2021 to 9% in 2022–2023. Among those with current infection, treatment initiation within 6 months was higher in prison settings (64%) compared to community (37%). In community settings, Aboriginal and/or Torres Strait Islander people had lower odds of treatment initiation (aOR 0.69, 95% CI: 0.51–0.92). In prison, treatment declined in 2022–2023 compared with 2019–2021 (aOR 0.64, 95% CI: 0.43–0.94). Conclusions: The NSW DBS Pilot provided broad access to HCV testing, but treatment initiation remained suboptimal, particularly in community settings. Declining prevalence indicates progress towards elimination; however, further efforts are needed to close remaining gaps along the care cascade.

Background: People living with HIV are at the highest risk of anal cancer. Screening people living with HIV and treatment of identified anal high‐grade squamous intraepithelial lesions (HSIL) are now recommended to reduce cancer incidence. We investigated the implementation of such a programme in a large HIV clinic in Sydney, Australia. Methods: Men who have sex with men (MSM) living with HIV aged 35+ were invited to participate in an anal screening programme. Following informed consent, participants underwent digital anorectal examination (DARE) and anal swabs (self‐ and clinician‐collected) for HPV genotyping and cytological testing. Swab collection order was randomized. Positive results for HPV16, atypical squamous cells—cannot exclude HSIL (ASC‐H), HSIL or abnormal DARE suspicious of anal cancer led to immediate referral for high‐resolution anoscopy (HRA). The rest returned in 6 months for repeat tests. Screening logs captured reasons for declining screening. Results: Of the 225 people invited to participate, 23.1% declined, 49.8% did not respond to repeated contact and 27.1% consented (median age 57.5 years). Of those who consented, 66.1% had high‐risk HPV and 78.7% had cytological abnormalities of which 48.6% were HSIL or ASC‐H. No differences in swab positivity were found between self‐ and clinician‐collected specimens. Thirty‐eight participants were referred for HRA with 100% attendance. Of these, 42.1% had histological HSIL. One had anal cancer. Conclusions: Uptake of the screening programme was poor, with only a quarter agreeing to participate. Those who underwent screening had excellent adherence (100% HRA attendance) with substantial quantities of HSIL found. Further research is required to understand and address barriers to initial screening programme uptake.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibody neutralization response and its evasion by emerging viral variants and variant of concern (VOC) are unknown, but critical to understand reinfection risk and breakthrough infection following vaccination. Antibody immunoreactivity against SARS-CoV-2 antigens and Spike variants, inhibition of Spike-driven virus–cell fusion, and infectious SARS-CoV-2 neutralization were characterized in 807 serial samples from 233 reverse transcription polymerase chain reaction (RT-PCR)–confirmed Coronavirus Disease 2019 (COVID-19) individuals with detailed demographics and followed up to 7 months. A broad and sustained polyantigenic immunoreactivity against SARS-CoV-2 Spike, Membrane, and Nucleocapsid proteins, along with high viral neutralization, was associated with COVID-19 severity. A subgroup of “high responders” maintained high neutralizing responses over time, representing ideal convalescent plasma donors. Antibodies generated against SARS-CoV-2 during the first COVID-19 wave had reduced immunoreactivity and neutralization potency to emerging Spike variants and VOC. Accurate monitoring of SARS-CoV-2 antibody responses would be essential for selection of optimal responders and vaccine monitoring and design.

The SARS-CoV-2 antibody neutralization response and its evasion by emerging viral variants are unknown. Antibody immunoreactivity against SARS-CoV-2 antigens and Spike variants, inhibition of Spike-driven virus-cell fusion, and infectious SARS-CoV-2 neutralization were characterized in 807 serial samples from 233 RT-PCR-confirmed COVID-19 individuals with detailed demographics and followed up to seven months. A broad and sustained polyantigenic immunoreactivity against SARS-CoV-2 Spike, Membrane, and Nucleocapsid proteins, along with high viral neutralization were associated with COVID-19 severity. A subgroup of ‘high responders’ maintained high neutralizing responses over time, representing ideal convalescent plasma therapy donors. Antibodies generated against SARS-CoV-2 during the first COVID-19 wave had reduced immunoreactivity and neutralization potency to emerging Spike variants. Accurate monitoring of SARS-CoV-2 antibody responses would be essential for selection of optimal plasma donors and vaccine monitoring and design. One Sentence Summary Neutralizing antibody responses to SARS-CoV-2 are sustained, associated with COVID19 severity, and evaded by emerging viral variants

Background: Rapid HIV testing was introduced at 12 clinics in New South Wales (NSW) for routine testing and promoted with social marketing. The effect of the availability of rapid HIV testing on testing frequency among gay and bisexual men (GBM) was evaluated. Methods: An observational design using patient data from 12 clinics was used. The primary outcome was the mean number of HIV tests in 12 months. The intervention group comprised GBM who had one or more rapid tests from October 2013 to September 2014 and this was compared with two control groups; a concurrent group (no rapid test in the same period) and a historical group (attended between July 2011 and June 2012). Independent sample t-tests were conducted to compare mean number of tests among men in the intervention, concurrent and historical groups. Multivariate logistic regression was used to assess the association between rapid HIV testing and testing frequency. Results: Men in the intervention group (n = 3934) had a mean of 1.8 HIV tests in 12 months, compared with 1.4 in the concurrent group (n = 5063; P < 0.001) and 1.4 in the historical group (n = 5904; P < 0.001); testing frequency was higher among men at increased risk of HIV in the intervention group compared with the other two groups (mean 2.2, 1.6 and 1.5 respectively; P < 0.001). Membership of the intervention group was associated with increased odds of having two or more HIV tests in 12 months (AOR = 2.5, 95%CI 2.2–2.8; P < 0.001) compared with the concurrent group, after controlling for demographic and behavioural factors. Conclusion: Introducing and promoting rapid HIV testing in clinics in NSW was associated with increased HIV testing frequency among GBM.