ORCID Profile
0000-0003-0955-6307
Current Organisation
University Hospitals Sussex NHS Foundation Trust
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Publisher: SAGE Publications
Date: 16-12-2021
Abstract: HIV-1 transmitted drug resistance (TDR) is associated with transmission in men who have sex with men (MSM), non MSM clusters, sexually transmitted infections (STIs) and can lead to antiretroviral failure. UK guidelines recommend performing TDR testing in all newly-diagnosed people living with HIV. We audited performance of TDR in our large tertiary HIV department from 2014–2020. All new patients had TDR testing attempted in the study period. The rate of TDR was 8% and was associated with increasing age and having non-B subtype. Having non-B subtype was not associated with being non-UK born. Thirty-four percent of people were diagnosed with a bacterial STI at the time of HIV diagnosis, but STI diagnosis was not associated with TDR. There was no significant change in TDR over the 6-year audit period. TDR remains a small but significant problem. Identifying these populations and providing effective HIV prevention interventions will reduce HIV incidence and TDR.
Publisher: BMJ
Date: 11-09-2021
Publisher: Mark Allen Group
Date: 12-2006
DOI: 10.12968/HMED.2006.67.12.22443
Abstract: A 21-year-old woman was admitted to the authors' hospital with symptoms of breathlessness, pleuritic chest pain and haemoptysis having been unwell for 1 week with a flu-like illness. Clinical examination revealed a rapid respiratory rate (36/min), tachycardia (134 beats per minute), pyrexia (39°C), bibasal coarse crepitations and bronchial breathing. Investigations showed hypoxia (PO2 12.4 on 100% oxygen), raised inflammatory markers (C-reactive protein 324 mg/litre), thrombocytopenia (platelets 144 × 10 9 /litre), leucopenia (2 × 10 9 /litre) and neutropenia (0.88 × 10 9 /litre). Chest X-ray revealed bilateral air space shadowing (Figure 1). The patient was admitted to the high dependency unit and started on intravenous co-amoxiclav (1.2 g three times per day) and clarithromycin (500 mg twice daily). Blood cultures at 24 hours grew Staphylococcus aureus resistant to penicillin and fusidic acid. The patient was switched to intravenous flucloxacillin. Admission was complicated by the development of a small pleural effusion. The patient was managed with high flow oxygen therapy, did not require ventilatory support at any stage and was discharged home after 17 days. The patient received flucloxacillin for a total of 4 weeks. The S. aureus isolate carried enterotoxins G and I and the Panton-Valentine leucocidin gene. Throat swab was positive for influenza B by a molecular method.
Publisher: BMJ
Date: 20-08-2019
Publisher: BMJ
Date: 08-02-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2002
Publisher: BMJ
Date: 15-09-2020
Publisher: BMJ
Date: 17-10-2019
Publisher: Wiley
Date: 02-02-2022
DOI: 10.1111/JDV.17961
Publisher: Wiley
Date: 22-09-2022
DOI: 10.1111/HIV.13406
Abstract: We aimed to evaluate the usability and acceptability of a co-designed mobile health (mHealth) application (PrEP-EmERGE) within a digital health pathway to support HIV pre-exposure prophylaxis (PrEP). This was a cross-sectional study to evaluate the usability and acceptability of the PrEP-EmERGE app. Data were collected via an online survey sent to all PrEP EmERGE users in September 2021. Usability was assessed with a validated usability tool, the System Usability Scale (SUS). Acceptability was assessed using modified patient-reported experience measures (PREMs). Quantitative data were analysed using descriptive and/or inferential statistics and qualitative data (free text responses) using thematic analysis. In total, 81/133 (61%) active PrEP EmERGE users completed the online survey, which was available directly from their PrEP EmERGE app: 78/81 (96%) identified as cis-male, 74/81 (91%) reported their ethnicity as 'white', 69/81 (85%) reported daily PrEP use, 7/81 (9%) reported using an event-based dosing schedule, and 5/81 (6%) were switching between dosing schedules. Overall, the median SUS score was 78/100 (interquartile range: 70-92). There were no differences in median SUS scores by PrEP dosing schedules (p = 0.78) or months of experience of using the app (p = 0.31). Overall, 73/81 (90%) would recommend the PrEP EmERGE app to a friend and 78/81 (96%) rated their satisfaction of the app as excellent, good or satisfactory. The free text responses generated three key themes: accessibility (for results and information) autonomy [taking responsibility for their (sexual) health] and functionality (including technical recommendations for app development and the digital health pathway). Innovative, co-designed digital health pathways, such as PrEP EmERGE can help sexual health services to manage increasing numbers of people accessing PrEP - ensuring that they retain access for those who need to be seen face-to-face. We report high levels of acceptability and usability during the first 4 months of this novel pathway.
Publisher: Oxford University Press (OUP)
Date: 10-2000
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-12-2006
Publisher: BMJ
Date: 23-01-2019
Publisher: Informa Healthcare
Date: 06-10-2005
Publisher: CSIRO Publishing
Date: 16-06-2022
DOI: 10.1071/SH22061
Abstract: Hepatitis A is a sexually transmitted enteric infection in men who have sex with men (MSM). HIV pre-exposure prophylaxis (PrEP) has increased opportunities for sexual health interventions in MSM. 588 (372 in 2019, 216 in 2021) MSM attended for the first time in the study periods. MSM were significantly more likely to be screened for Hepatitis A susceptibility in 2021 than 2019 (93% vs 56%, P = 0.0001). Susceptibility (Hepatitis A IgG negative) to Hepatitis A did not change between in 2021 and 2019 (48% vs 47%, P = 0.921). De-medicalising PrEP is important as it will increase overall uptake. However, coupling PrEP with other sexual health interventions must not be lost.
Publisher: SAGE Publications
Date: 03-02-2021
Publisher: National Institute for Health and Care Research
Date: 03-2019
DOI: 10.3310/HTA23120
Abstract: Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. The study (Santé) had two main objectives – (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care. The project was a multistage, mixed-methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review, an analysis of national surveillance data, the development of a triage algorithm, and interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls in all clinics, participants would be consented to a 6-week follow-up STI screen. SH clinics in England. Young people (aged 16–25 years), and men who have sex with men. A three-part intervention package – (1) a triage tool to score patients as being at high or low risk of STI using routine data, (2) a study-designed web page with tailored SH information for all patients, regardless of risk and (3) a brief one-to-one session based on motivational interviewing for high-risk patients. The three outcomes were (1) the acceptability of the intervention to patients and SH providers, (2) the feasibility of delivering the interventions within existing resources and (3) the feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial). We identified 33 relevant trials from the systematic review, including videos, peer support, digital and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated that these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% vs. 46%). Fewer clinics were included in the pilot than planned, limiting the ability to make strong conclusions on the feasibility of the RCT. We were unable to conclude whether or not a definitive RCT would be feasible because of challenges in implementation of a pilot, but have laid the groundwork for future research in the area. Current Controlled Trials ISRCTN16738765. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 23, No. 12. See the NIHR Journals Library website for further project information.
Publisher: SAGE Publications
Date: 28-05-2018
Publisher: BMJ
Date: 27-08-2021
DOI: 10.1136/SEXTRANS-2021-055169
Abstract: Rates of HIV, syphilis and gonorrhoea have increased over the past 20 years in men who have sex with men (MSM). Contact tracing strategies have increased the number of MSM attending clinics as sexual contacts. Understanding the outcomes of contact tracing could inform future public health policies to reduce the burden of STIs in MSM. We aimed to describe the contribution of MSM attending as notified sexual contacts of patients with HIV, syphilis and gonorrhoea to the overall diagnoses of HIV, syphilis and gonorrhoea in MSM in a cross-sectional study. We collected data on all MSM diagnosed with HIV, syphilis and gonorrhoea in 2019 and evaluated which of these MSM were tested due to attending as a sexual contact. Sexual contacts of HIV, syphilis and gonorrhoea contributed to 20% (95% CI=17.3% to 23.7%) of all diagnoses of HIV (3 of 30, 10%), syphilis (28 of 183, 15%) or gonorrhoea (98 of 420, 23%) in the study period. Asymptomatic sexual contacts contributed to 12% (95% CI=9.6% to 14.9%) of all diagnoses of HIV (3 of 30, 10%), syphilis (16 of 183, 9%) and gonorrhoea (57 of 420, 14%). The proportion of MSM diagnosed with gonorrhoea attending as sexual contacts of gonorrhoea (21%) was significantly greater than MSM diagnosed with HIV, attending as sexual contacts of HIV (3%) or MSM diagnosed with syphilis, attending as a sexual contact of syphilis (4%) (p .001). Furthermore, the proportion of MSM diagnosed with syphilis, attending as a sexual contact of another STI (11%) was significantly greater than MSM diagnosed with HIV, attending as a contact of another STI (7%) or MSM diagnosed with gonorrhoea, attending as a sexual contact of another STI (2%) (p .001). Contact tracing contributes significantly to the overall diagnoses of HIV, syphilis and gonorrhoea including asymptomatic sexual contacts in our population. Further efforts to increase the yield from contact tracing may continue to reduce the burden of HIV, syphilis and gonorrhoea within sexual networks of MSM.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-1999
Publisher: BMJ
Date: 24-09-2020
Publisher: BMJ
Date: 19-02-2021
Publisher: BMJ
Date: 17-07-2018
Publisher: BMJ
Date: 25-10-2022
DOI: 10.1136/SEXTRANS-2022-055583
Abstract: Outbreaks of sexually transmitted shigella have been reported in men who have sex with men (MSM) since the 1970s and present a major public health issue. Understanding the factors associated with the sexual transmission of shigella may inform future control strategies. We systematically searched four bibliographical databases (January 2000-February 2022) for manuscripts in English. We used a two-stage process to assess eligibility: the primary author conducted an initial screen and then three authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts that included MSM diagnosed with sexually transmitted shigella where specific factors associated with transmission were identified. Thirteen manuscripts met the inclusion criteria that included 547 in iduals. Sexually transmitted shigella in MSM was associated with: residing in a capital city/urban region, living with HIV (including engaging in seroadaptive sexual behaviour, having a low CD4 count, having a HIV viral load >100 000 and not engaging with HIV care), using HIV pre-exposure prophylaxis, use of geospatial mobile phone applications to meet sexual partners, visiting sex on premises venues, chemsex and recreational drug use, sexual behaviour (including multiple non-regular sexual partners and oral-anal sexual contact) and concomitant STIs. We have highlighted some important risk behaviours and factors that are associated with sexually transmitted shigella in MSM that can be used to target future shigella control interventions.
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.CLINTHERA.2005.11.002
Abstract: The purpose of this study was to evaluate the cost-effectiveness of sirolimus compared with cyclosporin for the postsurgical management of renal transplant recipients, from the perspective of the UK National Health Service and the Personal Social Service. A discrete event stochastic simulation model was developed to evaluate both cost-effectiveness and cost utility over 10 and 20 years after transplant using historical data on 937 renal transplant recipients from the University Hospital of Wales in Cardiff, United Kingdom. The simulation was designed to forecast the incidence of acute rejection events, graft failure, retransplant, frequency of hemodialysis (HD) and peritoneal dialysis (PD), and death. Cox proportional hazard models were derived from historical transplant data, in which 1-, 2-, and 3-year post-transplant serum creatinine levels were used as the key drivers for predicting graft success and survival. Costs were reported as year-2003 UK pounds sterling (1 UK pound = US $1.76). Probabilistic sensitivity analysis was conducted and results reported with particular attention to 2 threshold values, 30,000/QALY and 20,000/QALY RESULTS: Over a 10-year time horizon, treatment with sirolimus was projected to produce a gain of 0.60 discounted year of functioning graft with a cost savings of 276 UK pounds per patient. Over a 20-year time horizon these benefits increased to 1.59 discounted years of functioning graft and a cost savings of 7405 UK pounds per patient. Using sensitivity analysis of the 10-year model, the only factors found to cause the probability of exceeding a 30,000 ceiling to be >5% were the proportion of subjects maintaining continuous graft function and the use of low-dose cyclosporin. With the 20-year model, sirolimus maintained cost-effectiveness across most scenarios in sensitivity analysis. In this model analysis, sirolimus was cost-effective compared with cyclosporin for 10 to 20 years after renal transplantation in the United Kingdom, from the perspective of the UK National Health Service and Personal Social Service.
Publisher: Wiley
Date: 25-02-2022
DOI: 10.1111/JDV.18021
Publisher: BMJ
Date: 02-08-2023
Publisher: BMJ
Date: 31-03-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2003
Publisher: BMJ
Date: 04-12-2020
Publisher: Wiley
Date: 14-03-2019
DOI: 10.1111/HIV.12736
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH20013
Abstract: Abstract Background Transmitted human immunodeficiency virus type 1 (HIV-1) drug resistance (TDR) is an important contributor to antiretroviral treatment failure, and is associated with HIV-1 transmission among men who have sex with men (MSM), non-MSM clusters and in iduals diagnosed with concurrent sexually transmissible infections (STI). Western Sydney has a culturally erse population, with a high proportion of non-Australian-born in iduals. This study describes the prevalence of TDR and non-B HIV-1 subtypes in a clinic-based population. Methods: A clinic database was examined for all newly diagnosed treatment-naïve HIV-1 patients and information on their HIV-1 resistance and subtype, demographics including country of birth and diagnosis of a bacterial sexually transmissible infection was collected. Results: Data were available from 74/79 in iduals (62 cis-male, 16 cis-female and 1 transgender woman). Of the 74 genotypes, the prevalence of non-B subtypes and TDR was 43/74 (58% 95%CI = 46.9–69.3) and 14/74 (19% 95%CI = 10.0 to 27.8). It was also found that 30/79 (38%) had a concurrent bacterial STI. TDR was associated with subtype B infection (OR 3.53 95%CI = 1.41–8.82 P = 0.007) and being born in Australia (OR 12.0 95%CI = 2.45–58.86 P = 0.002). Conclusion: The relative prevalence of non-B HIV-1 subtypes and TDR is higher in Western Sydney than in the rest of Australia. TDR is associated with subtype B HIV-1 and being Australian born, suggesting ongoing local transmission. This highlights the ersity of the HIV epidemic locally and the need for interventions to prevent ongoing HIV transmission.
Publisher: CSIRO Publishing
Date: 27-04-2021
DOI: 10.1071/SH20218
Abstract: Unlike pharyngeal Neisseria gonorrhoeae, less is known about pharyngeal Chlamydia trachomatis in men who have sex with men (MSM). We reviewed cases of pharyngeal chlamydia in MSM from January to December 2019. The overall prevalence of pharyngeal chlamydia was 75/6613 (1.13% 95% confidence interval (CI) = 0.9–1.14). The median number of sexual partners was three, four (5%) reported throat symptoms and 20 (26%) were HIV positive. Multi-site and concomitant infection was common: rectal chlamydia [39 (52%)], urethral chlamydia [12 (16%)], early syphilis [2 (3%)] and gonorrhoea [14 (19%)]. HIV-positive MSM with pharyngeal chlamydia were older (P = 0.02) and more likely to have had previous syphilis (odds ratio = 4.9 95% CI = 1.6–14.7 P = 0.005). Further research is needed to explore the characteristics of pharyngeal chlamydia and benefits of increased screening for asymptomatic pharyngeal chlamydia in MSM.
Publisher: BMJ
Date: 06-08-2018
Publisher: BMJ
Date: 26-07-2019
DOI: 10.1136/SEXTRANS-2018-053903
Abstract: Behavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people ( years) and men who have sex with men (MSM) internationally, but evidence from England is limited. We aimed to explore service provider and user experiences and perspectives on behavioural interventions to reduce sexual behaviour risks, and the use of automated methods to triage in iduals to these services. We conducted a sequential mixed methods study with sexual health service providers and users in 2015/2016. Qualitative interviews with providers and service users (heterosexual young people and MSM) in London and Brighton allowed us to explore a range of experiences and expectations. A subsequent national web-survey of service providers measured the feasibility of delivery within existing resources and preferences for intervention attributes. We conducted 35 service user (15 heterosexual young people 20 MSM) and 26 provider interviews and had 100 web-survey responses. We found considerable heterogeneity in prevention services offered. Service users and providers were broadly supportive of tailoring interventions offered, but service users raised concerns about automated, data-driven triage, particularly around equity and fairness of service delivery. Digital technologies, including social media or apps, were appealing to providers, being less resource intensive. However, one-to-one talking interventions remained popular with both service users and providers, being familiar, trustworthy and personal. Key tensions between desirability of interventions and availability of resources to deliver them were acknowledged/recognised by providers and users. Overall, behavioural interventions to reduce sexual behaviour risks were viewed favourably by service providers and users, with key considerations including: privacy, personalisation and convenience. However, introducing desirable targeted interventions within heterogeneous sexual health settings will require resources to adapt interventions and research to fully understand the barriers and facilitators to use within routine services.
Publisher: Elsevier BV
Date: 06-1998
DOI: 10.1016/S0041-1345(98)00228-0
Abstract: [This corrects the article DOI: 10.1002/ece3.9417.].
Publisher: SAGE Publications
Date: 20-06-2023
Publisher: SAGE Publications
Date: 23-05-2020
Abstract: We aim to identify associations that may help support strategies to increase job satisfaction and reduce unscheduled time off work for nurses. Given current concerns regarding nursing workforce and retention, it is vital we identify strategies and factors which maintain job satisfaction, support staff retention and reduce unscheduled time off work. As part of a quality improvement project, we conducted and distributed an online anonymous survey. Likert scales were used to measure job satisfaction, perceived quality of care, wellbeing, and unscheduled time off work. We explored participation in project work of any kind in the preceding 12 months, and captured nursing experience and current area of practice (inpatient/outpatient). A total of 350 complete responses were analysed. Nurses engaged in research or Quality Improvement Projects (QIPs) were more likely to have higher perceived levels of patient care (p = 0.0001), wellbeing (p = 0.0001) and job satisfaction (p = 0.0001) and reported lower levels of unscheduled time off work (p = 0.0001). Nurses engaged in research or quality improvement projects reported higher levels of job satisfaction, wellbeing, perceived higher levels of care in their workplace, and had lower levels of unscheduled time off work. We suggest that involving nurses in research/QIPs may improve workforce instability and job satisfaction.
Publisher: SAGE Publications
Date: 03-02-2021
Abstract: Pharyngeal gonorrhoea is important in the transmission dynamics of gonorrhoea, and generation of antimicrobial resistance and the performing of culture remains vital. We reviewed the notes of men who have sex with men (MSM) presenting to our clinic with a positive pharyngeal NAAT for gonorrhoea between January and December 2019. There were 383 cases of NAAT-positive pharyngeal gonorrhoea, and 28 (7%, 95% CI = 5.11–10.36) reported sore throat at presentation. Pharyngeal cultures were taken from 270/383 (70%), and 73/270 (27%) were culture positive with available antimicrobial sensitivities. Overall, the presence of pharyngeal symptoms was not associated with pharyngeal chlamydia (OR = 1.6, CI = 0.19–13.32, p = 0.7), HIV status (OR = 1.1, CI = 0.47–2.57, p = 0.8), positive cultures (OR = 1.9, CI = 0.78–4.62, p = 0.2) or age ( p = 0.3). Routine screening of MSM for pharyngeal gonorrhoea is important to maintain surveillance and measures need to be taken to improve pharyngeal culture s ling from MSM.
Publisher: Wiley
Date: 20-01-2022
DOI: 10.1111/HIV.13239
Abstract: Chemsex has been reported among men who have sex with men (MSM) living with HIV. There have been concerns about potentially harmful drug–drug interactions between chemsex drugs and antiretroviral therapy (ritonavir and cobicistat). We aimed to describe the prevalence and patterns of chemsex users in our HIV clinic population and to evaluate antiretroviral prescribing among chemsex users. We undertook a cross‐sectional study of patients attending our HIV clinic between January 2019 and December 2020. We collected data on patients who disclosed recent recreational drug use including chemsex in the previous 3 months. In all, 2202/2501 (88%) patients were asked about recreational drug use and 514 (23%) disclosed recreational drug use. Eighty‐two (4%) of these disclosed recent chemsex 73 (89%) used crystal meth hetamine, 51 (62%) used gamma‐hydroxybutyrate (GHB)/gamma‐butyrolactone (GBL), 55 (67%) reported poly‐drug use and 63 (76%) reported injecting drug use. The chemsex users were all cis‐male MSM and were significantly older (53 vs. 46 years, p 0.0001), and more likely to have had previous syphilis (73% vs. 28%, p 0.0001) than patients reporting non‐chemsex drug use. All chemsex users were prescribed antiretrovirals and 74 (90%) had an undetectable HIV viral load 31 (38%) patients were taking either ritonavir ( N = 12) or cobicistat ( N = 19) as part of their antiretroviral regimen and this was similar to other patients attending for HIV care [31/82 (38%) vs. 768/2419 (31%), p = 0.25]. The prevalence of chemsex users among our HIV clinic attendants is 4%, and 38% of these were prescribed either ritonavir or cobicistat. Chemsex use should be a factor in antiretroviral therapy decision‐making to avoid potential harm.
Publisher: Elsevier BV
Date: 02-2001
Abstract: The aim of the current study was to characterize the effects of prolonged hyperglycemia on renal structure and function using a model of non-insulin-dependent diabetes mellitus: the Goto Kakizaki (GK) rat, which does not have confounding variables, such as hyperlipidemia, obesity, or elevated blood pressure. The data show that hyperglycemia in this model was not associated with the development of significant proteinuria, but it was associated with the development of definitive age-dependent renal structural changes. These changes consisted of thickening of glomerular basement membrane at 35 weeks and tubular basement membrane. This thickening was accompanied by marked glomerular hypertrophy resulting from a parallel increase in total capillary luminal volume and mesangial volume, but fractional capillary and mesangial volumes remained unchanged. There was evidence of podocyte injury, as assessed by de novo expression of desmin. In contrast, there was no evidence of mesangial cell activation, as assessed by their de novo expression of alpha-SMA. Interstitial monocyte/macrophage influx increased significantly in GK rats at 12 weeks compared with Wistar controls. Glomerular macrophage infiltration was elevated significantly in 35-week GK rats. The structural changes described in the GK rat are similar to those described in prolonged non-insulin-dependent diabetes mellitus patients who have not developed overt renal disease. This model allows us to investigate further the mechanisms involved in the pathogenesis of the consequences of prolonged hyperglycemia.
Publisher: SAGE Publications
Date: 09-06-2018
Publisher: BMJ
Date: 29-10-2021
Publisher: CSIRO Publishing
Date: 30-01-2023
DOI: 10.1071/SH22192
Abstract: Event-based dosing (EBD) of HIV PrEP is as effective at preventing HIV transmission in MSM as daily dosing. There are limited data on the differences in STI testing frequency between MSM using EBD-PrEP and daily dosing. A total of 20% of 418 PrEP users were using EBD-PrEP and had a lower number of sexual partners (22 (27%) vs 142 (42%), P = 0.008), tested for STIs less frequently (115 (18%) vs 69 (50%), P 0.001), but were diagnosed with a similar number of STIs ((35% vs 34%, P = 0.54) compared to daily users. More research is needed to understand the optimal frequency for STI testing in MSM using EBD PrEP.
Publisher: Wiley
Date: 30-04-2021
DOI: 10.1111/HIV.13112
Publisher: BMJ
Date: 29-05-2023
Publisher: BMJ
Date: 22-06-2022
Publisher: BMJ
Date: 26-09-2022
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH19079
Abstract: Men who have sex with men (MSM) with symptomatic secondary syphilis present with characteristic symptoms of rash, fever and lymphadenopathy due to delays in microbiology results and some patients failing to return for treatment, empirical treatment is sometimes offered. We reviewed all patients presenting with secondary syphilis diagnosed on the basis of clinical symptoms and signs and reviewed treatment. Of the 36 patients, 16 MSM (44% 95% confidence interval (CI) 27.8–60.2%) were treated empirically, whereas treatment was delayed for 20 (56% 95% CI 39.8–72.2%) waiting for microbiology results. Treatment delays were longer for HIV-negative than HIV-positive MSM (10 vs 5 days respectively P = 0.01) the cumulative treatment delay was 143 days. Concerns over antimicrobial resistance and overuse of antimicrobials should drive the use of point-of-care testing for syphlis.
Publisher: CSIRO Publishing
Date: 29-11-2021
DOI: 10.1071/SH21196
Abstract: Anal examination and proctoscopy are important skills needed to facilitate the diagnoses of STIs and cancer. Clinician (25 doctors/15 nurses) confidence was higher for anal examination versus proctoscopy (median Likert scores 4/5 vs 5/5, P ≤ 0.05) and higher in doctors compared with nurses (median Likert scores 5/5 vs 4/5, P 0.008, 4/5 vs 2/5, P 0.005), and related to years of experience (5/5 vs 4/5, P 0.001, 3/5 vs 5/5, P = 0.007). Barriers included lack of opportunities for training, concerns about patient reluctance, and lack of available equipment. We need to be innovative when up-skilling the specialist sexual health workforce using online training and optimising opportunities for clinical assessment of MSM.
Publisher: CSIRO Publishing
Date: 11-11-2022
DOI: 10.1071/SH22120
Abstract: Objective Hepatitis B is sexually transmitted among men who have sex with men (MSM) and has previously been endemic in some populations of MSM. Presence of anti-hepatitis B core (anti-HBc) determines previous or ongoing infection. We aimed to establish the prevalence and associations of anti-HBc in our clinic population of MSM. Method A cross-sectional study of newly attending MSM to determine the prevalence and associations of testing positive for anti-HBc using our clinic database from 2012 to 2019. We used crude odds ratios to identify any associations. Results There were 3342/5842 (58%) newly attending MSM who were tested for anti-HBc between 2012 and 2019. Of the 3342 MSM tested for anti-HBc, the median age was 30 years (interquartile range 23–43), 442 (13%) were living with HIV, 10 (0.3%) were HBsAg positive, 62 (1.9%) had past/current hepatitis C, 401 (12%) had a positive syphilis enzyme immunoassay (EIA), 455 (14%) were diagnosed with either gonorrhoea or chlamydia and 1080 (32%) were non-UK born. A total of 331 (10%, 95% confidence interval (CI) = 8.9–11.0) tested positive for anti-HBc and the proportion testing positive reduced significantly throughout the study period (P 0.004). Testing positive for anti-HBc was associated with age years (OR = 8.2, 95% CI = 5.9–11.4, P 0.0001), having past/current hepatitis C (odds ratio (OR) = 5.0, 95% CI = 3.0–8.6, P 0.0001), having a positive syphilis EIA (OR = 5.9, 95% CI = 4.4–7.3, P 0.0001) and being non-UK born (OR = 1.4, 95% CI = 1.1–1.8, P 0.006). There were no associations with HIV status or having a diagnosis of gonorrhoea or chlamydia. Conclusion Although reducing, the prevalence of anti-HBc remains endemic in MSM locally and further efforts are needed to enhance hepatitis B prevention strategies.
Publisher: SAGE Publications
Date: 30-09-2020
Abstract: The characteristics and serological responses of primary syphilis are not completely understood. We aimed to describe the characteristics, the serological responses and presumptive treatment of primary syphilis in HIV-positive and -negative men who have sex with men (MSM). We conducted a retrospective review of microbiological and demographic information from MSM presenting with primary syphilis. There were 111 cases of primary syphilis in MSM, the median age was 46 (IQR = 37–53years) and 40 (36%) were living with HIV. Fifty percent of MSM presented with painful lesions and 14% with extra-genital lesions. Extra-genital lesions were significantly more likely to be painful than non-genital lesions (OR 4.72 95%CI = 1.25–17.83, p = 0.02). Overall, a reactive serological response demonstrated a sensitivity of 80% (57/71) compared with Treponema pallidum PCR. Serology was more sensitive in MSM with no previous syphilis (OR = 3.38, 95%CI = 1.00–11.43, p 0.05). MSM presenting with painless lesions were more likely to be treated presumptively (OR = 3.39, 95%CI = 1.38–8.33, p 0.002). There were no differences in the characteristics, serological responses or management according to HIV status. Fifty percent of MSM with primary syphilis presented with painful lesions extra-genital lesions are more likely to be painful than genital lesions, serology is positive in 80% and there were no differences between HIV-positive and -negative MSM. Understanding the characteristics of primary syphilis will underpin public health c aigns.
Publisher: SAGE Publications
Date: 26-04-2023
Publisher: CSIRO Publishing
Date: 16-07-2021
DOI: 10.1071/SH20189
Abstract: Background Eleven percent of people living with HIV in Australia remain unaware of their diagnosis, and there are missed opportunities for HIV testing in priority settings in New South Wales. HIV testing remains low outside of sexual health clinics with the exception of antenatal settings where HIV testing is routine. To understand why HIV testing rates are low, we sought to identify health worker-related barriers to HIV testing. Methods: We conducted an anonymous online survey to health workers in Western Sydney Local Health District (WSLHD) in September 2019. Tick-box, Likert scale responses were analysed using Chi-square and Kruskal–Wallis statistical tests, and free text responses were analysed with thematic analysis. Results: Three percent (n = 420) of WSLHD’s estimated 14 000 health workers responded. These included 317 clinicians (171 nurses, 65 doctors, 56 allied health professionals (AHPs), 25 midwives, and 103 health workers in non-clinical roles). Health workers were from a variety of in-patient/out-patient settings. Many health workers (291/420, 69% 95%CI = 64.9–73.7%) were unaware that HIV testing is offered in their areas doctors (82%) and midwives (80%) were more aware than nurses (23%) and AHPs (11%) (P 0.0001). Doctors (Likert score = 3.62 3.45/5) and midwives (2.84 2.76) were significantly more comfortable discussing and confidently offering HIV testing than nurses (2.42 1.81) or AHPs (1.83 0.91) (P 0.0001 for both). The top five barriers to HIV testing were (1) procedural knowledge, (2) identification of at-risk patients, (3) HIV knowledge, (4) positive result management, and (5) privacy concerns. Free text responses highlighted perceived stigma, testing/result responsibilities and resource challenges as barriers to HIV testing. Conclusions: Clinicians working in priority settings and with priority populations require more education and support to increase targeted HIV testing.
Publisher: Elsevier BV
Date: 07-2003
DOI: 10.1034/J.1600-6143.2003.00133.X
Abstract: The TRansplant European Survey on Anemia Management (TRESAM) documented the prevalence and management of anemia in kidney transplant recipients. Data from 72 transplant centers in 16 countries were screened, involving 4263 patients who had received transplants 6 months, 1, 3 or 5 years earlier. The mean age of transplant recipients was 45.5 years at transplantation. The most common etiology was chronic glomerulonephritis. The most common comorbidities were coronary artery disease, hepatitis B/C, and type 2 diabetes. The mean hemoglobin levels before transplantation were significantly higher in the more recently transplanted recipients. At enrollment, 38.6% of patients were found to be anemic. Of the 8.5% of patients who were considered severely anemic, only 17.8% were treated with epoetin. There was a strong association between hemoglobin and graft function of the 904 patients with serum creatinine > 2 mg/dL, 60.1% were anemic, vs. 29.0% of those with serum creatinine <or= 2 mg/dL (p < 0.01). Therapy with angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, mycophenolate mofetil (MMF) or azathioprine was also associated with a higher likelihood of anemia. The prevalence of anemia in the transplant recipients was remarkably high and appeared to be associated with impaired renal function and with ACE inhibitors and angiotensin II receptor antagonist use. Further studies should be carried out to interpret whether appropriate management of anemia after kidney transplantation may improve long-term outcome.
Publisher: BMJ
Date: 16-08-2021
Publisher: SAGE Publications
Date: 12-07-2023
DOI: 10.1177/09564624231188752
Abstract: A broad range of stakeholders commission and provide harm reduction support for people who engage in chemsex, including public health, sexual health, mental health, HIV services and substance misuse services. Understanding the experiences of stakeholders could provide important insights and suggest ways to improve outcomes. We aimed to explore the experiences of stakeholders providing harm reduction support to people who engage in chemsex in Brighton, UK. We conducted semi structured interviews with chemsex harm reduction stakeholders who provide support for people in Brighton, UK. The semi-structured interviews were recorded, transcribed, and analysed thematically using NVivo 1.6.2: Braun & Clarke framework. We recruited ten stakeholders with at least 6 months of experience in providing commissioning, managing or providing harm reduction services to people who engage in chemsex. Five themes emerged from the stakeholders: stakeholder perception of client pathways (inefficiency in client pathways, inequitable access to services, unmet client mental health needs) and stakeholder experiences (having to use an ‘empathy’, ‘non judgement’ and ‘guiding hand’ approach), and experiencing emotional burnout as a result of the chemsex harm reduction work. This pilot study of stakeholders suggests that to improve chemsex harm reduction outcomes, a more integrated approach between providers with clear client pathways and a broader reach including services tailored towards non-MSM, and offering services outside of typical business hours is needed. Furthermore, the sustainability of services requires increased workplace support for chemsex service providers to prevent burnout and maintain service quality.
Publisher: BMJ
Date: 20-08-2019
Publisher: Wiley
Date: 31-07-2019
DOI: 10.1111/HIV.12774
Publisher: Yonsei University College of Medicine
Date: 2004
Publisher: Wiley
Date: 22-08-2021
DOI: 10.1111/JDV.17589
Publisher: Wiley
Date: 07-10-2023
DOI: 10.1111/JDV.18627
Publisher: BMJ
Date: 10-09-2021
DOI: 10.1136/SEXTRANS-2020-054529
Abstract: International guidelines recommend Mycoplasma genitalium testing, preferably using an assay to detect macrolide resistance-associated mutations, for men presenting with non-gonococcal urethritis, but there is no specific guidance on such testing for men with gonococcal urethritis. This study aimed to estimate the proportion of men with gonococcal urethritis who have coinfection with M. genitalium through a retrospective analysis of cases of symptomatic urethral gonorrhoea at Western Sydney Sexual Health Centre in 2017 and 2018. Fourteen of 184 (7.6%, 95% CI 3.7 to 11.5) men with gonococcal urethritis had M. genitalium detected in the urine at the time of presentation. No demographic or behavioural factors predicted M. genitalium coinfection. Coinfection with urethral Chlamydia trachomatis was detected in 29 of 184 (15.8%, 95% CI 10.5 to 21.1). All five men with macrolide-resistant M. genitalium detected returned for treatment with moxifloxacin at a median of 8 days (range 5–16 days) after presentation and treatment of gonorrhoea three of five were documented to remain symptomatic at this visit. Although M. genitalium coinfection is less common than chlamydia among men with symptomatic gonococcal urethritis, M. genitalium testing, using an assay to detect macrolide resistance, will potentially reduce symptom duration particularly for men with macrolide-resistant infections, but may not be justifiable on cost-benefit analysis.
Publisher: Wiley
Date: 07-2001
DOI: 10.1034/J.1600-051X.2001.028007706.X
Abstract: Severe gingival hyperplasia (GH) is one of the most frequent side-effects associated with the prescription of Cyclosporine-A (CsA). This study statistically modeled the medical and dental risk factors for the development of GH following CsA administration to determine whether renal function post-transplantation was related to the incidence or extent of GH in 236 consecutive renal transplant patients. All patients were at least 6 months post-transplant and medicated with both traditional oral CsA (n=220 in iduals) and the new microemulsion form CsA-Me (n=229 in iduals). Patients had either received CsA alone (n=45 in iduals) or cyclosporine and nifedipine (n=191 in iduals). Gingival overgrowth was assessed and computerized data, available for all patients included pre- and post-transplant medical history and post-transplant renal function, i.e., serum creatinine levels, documented rejection episodes and glomerular filtration rates (GFR). These data together with CsA serum levels and last-recorded dose of CsA, CsA-Me, nifedipine, azathioprine and prednisolone, were analysed by multivariate regression analysis using SPSS. The extent and severity of hyperplasia was significantly correlated with the dosage and serum level of CsA at 3, 6 and 12 months post-transplantation last recorded dosage, however (p<0.0001), was the most accurate predictor of hyperplasia. Gingivitis (p<0.0001) and plaque (p<0.002), were associated with hyperplasia. Duration of renal replacement therapy, age at transplantation, post-transplant interval serum creatinine levels and documented rejection episodes were unrelated with the extent and severity of GH. Of all the renal variables only the correlation of GFR with last recorded doses of CsA and CsA-Me, approached significance this was then considered for inclusion in the model. In a multiple regression analysis including GFR, however, only last CsA (and CsA-Me) doses and gingivitis score were selected for inclusion in the final model. These data demonstrate that inter-patient variation in the extent and severity of GH and renal function post-transplantation are unrelated and are mediated independently.
Publisher: Elsevier BV
Date: 02-2002
DOI: 10.1046/J.1523-1755.2002.00149.X
Abstract: Chronic allograft nephropathy is an important cause of graft failure. Many donor and recipient factors contribute to its development. Prospective analysis of these factors has been hindered by the lack of sensitive and specific indicators of renal injury. As a consequence protocol biopsies have been increasingly used in the assessment of renal allograft injury. We performed protocol renal allograft biopsies to prospectively examine the role of important determinants and mediators of chronic allograft nephropathy. A total of 51 consecutive cadaveric renal transplant recipients entered a randomized prospective study of tacrolimus (Tac) versus cyclosporine (CsA) microemulsion based immunosuppression. Study patients underwent protocol renal allograft biopsies at the time of engraftment and at 3, 6 and 12 months post-transplantation. Biopsies were analyzed by quantitative polymerase chain reaction (PCR) for mRNA for transforming growth factor-beta (TGF-beta), thrombospondin, and fibronectin. Measurements of renal structural injury were estimated by quantitative assessment of interstitial fibrosis and glomerulosclerosis. Changes in profibrotic growth factors and renal structural injury were related to donor and recipient determinants by stepwise regression analysis. Longitudinal assessment of renal injury demonstrated an early and progressive increase in mRNA for TGF-beta, thrombospondin (TSP) and fibronectin (FBN): TGF-beta baseline, 1.9 +/- 0.2 log copies TGF-beta 6 months, 2.5 +/- 0.2 log copies, P < 0.05 6 months vs. baseline TSP baseline, 1.9 +/- 0.2 log copies TSP 6 months, 2.4 +/- 0.2 log copies, P < 0.05 6 months vs. baseline FBN baseline, 2.0 +/- 0.2 log copies FBN 12 months, 2.3 +/- 0.2 log copies, P < 0.05 12 months vs. baseline. This increase in profibrotic growth factors within the allograft was associated with a significant increase in interstitial fibrosis (Vvi) on renal biopsies: Vvi baseline, 13 +/- 1% Vvi 3 months, 18 +/- 1% Vvi 6 months, 28 +/- 2% Vvi 12 months, 34 +/- 2% P < 0.05 3, 6, and 12 months vs. baseline. Histological analysis demonstrated chronic allograft nephropathy in 4% biopsies at 3 months, 12% at 6 months and in 49% at 12 months. These changes in renal structure were not associated with any change in creatinine clearance (CCr): CCr 3 months, 56 +/- 2 mL/min, CCr 24 months, 56 +/- 2 mL/min P=NS. Stepwise regression analysis of key donor and recipient determinants of chronic renal injury identified calcineurin inhibitors and acute rejection episodes as important factors involved in the development of chronic renal injury. In particular, the use of cyclosporine compared to tacrolimus was associated with a tenfold increase in TGF-beta mRNA (TGF-beta mRNA at 6 months, CsA vs. Tac, 3 +/- 0.3 vs. 2 +/- 0.3 log copies, P < 0.05), interstitial fibrosis (Vvi at 6 months, CsA vs. Tac, 33 +/- 4% vs. 24 +/- 2%, P < 0.05). Changes in growth factors and renal structure predicted impaired renal function (CCr at 12 months, CsA vs. Tac, 53 +/- 4 mL/min vs. 62 +/- 2 mL/min, P < 0.05). Similarly, acute rejection episodes were associated with an accelerated development of interstitial fibrosis (Vvi at 6 months, acute rejection vs. no rejection, 34 +/- 3% vs. 25 +/- 2% P < 0.05), but not with changes in TGF-beta, thrombospondin or fibronectin expression. Our results suggest that structural injury develops early in the natural history of the renal allograft and is mediated, in part, by the early up-regulation of profibrotic growth factors. We have determined that calcineurin inhibitors, in particular cyclosporine, and acute rejection episodes are key factors in the development of renal structural injury.
Publisher: SAGE Publications
Date: 18-12-2021
Abstract: Within the UK, the majority of hepatitis A occurs in high risk groups such as men who have sex with men (MSM). It has been estimated that 70% of MSM need immunity to provide adequate herd immunity. We aimed to estimate the proportion of hepatitis A susceptibility in MSM throughout a 10-year period (2010–2019), and explore associated demographic factors. Using our Electronic Patient Record system, we extracted anonymous clinical data between for MSM at their first attendance including hepatitis A IgG result, age, country of birth and diagnosis of an STI. Overall, 1401/6884(20%) were tested for hepatitis A IgG at their first attendance, with 626/1401 (45%, 95% CI = 42%–47%) showing susceptibility. Testing rates increased between 2010–2019 (OR = 67.79, 95%CI = 39.09–117.60, p = .0001) however, susceptibility remained similar (OR = 0.98, 95%CI = 0.33–2.89, p = 0.98). MSM aged 35 and under had significantly higher susceptibility vs MSM aged over 35 (OR 3.4176, 95%CI = 2.71–4.31, p = .0001). UK-born had significantly higher susceptibility vs non-UK born (OR 1.5, 95%CI = 1.2147–1.8618, p = 0.0002). Susceptibility of hepatitis A in MSM may be higher than necessary to control future outbreaks. It is important that effective targeting of MSM, particularly young MSM, occur at all levels of healthcare and not solely rely on opportunistic presentation at a sexual health clinic.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-1999
Publisher: SAGE Publications
Date: 10-2019
Publisher: BMJ
Date: 07-01-2020
Publisher: BMJ
Date: 10-12-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-1999
Publisher: BMJ
Date: 13-10-2023
Publisher: BMJ
Date: 04-02-2021
Publisher: SAGE Publications
Date: 29-05-2023
DOI: 10.1177/09564624231168217
Abstract: This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics however, it may also be applicable to other settings such as primary care or other hospital departments where in iduals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.
Publisher: SAGE Publications
Date: 24-09-2019
Publisher: BMJ
Date: 23-02-2023
Publisher: BMJ
Date: 19-04-2022
DOI: 10.1136/SEXTRANS-2020-054878
Abstract: There has been a significant increase in syphilis in men who have sex with men (MSM) in the UK over the past 20 years. Partner notification strategies have increased the number of MSM attending STI clinics as sexual contacts of syphilis. Current guidelines suggest testing and consideration of presumptive antimicrobial treatment. Syphilis treatment with benzathine penicillin requires clinic resources, is painful and is associated with complications. It is important we consider strategies to rationalise presumptive antimicrobial use and promote antimicrobial stewardship. We aimed to determine if there are any factors associated with having syphilis among MSM attending as sexual contacts of syphilis in a cross-sectional study. We examined the clinical records of MSM attending as sexual contacts of syphilis from January to December 2019. Of the 6613 MSM who attended for STI testing, 142 of 6613 (2.1%) presented as sexual contacts of syphilis. The median age was 40 years (IQR=31–51), 43 of 142 (30%) were HIV positive, 38 of 142 (27%) had been diagnosed and treated for syphilis in the past, and 11 of 142 (8%) presented with symptoms (possible lesions of primary or secondary syphilis). Thirteen (9%, 95% CI=4.4 to 13.9) tested positive for syphilis on the day of presentation. MSM who were symptomatic (genital ulcer or body rash), HIV positive or had a history of syphilis were significantly more likely to test positive for syphilis (OR=51.88, 95% CI: 3.01 to 893.14, p=0.007). We have shown that in our clinic-based population of MSM who presented as sexual contacts of syphilis, the factors associated with testing positive for syphilis were: having HIV, having a history of syphilis or presenting with symptoms (possible lesions of primary or secondary syphilis). These factors could be used to rationalise antibiotic treatment among MSM presenting as sexual contacts of syphilis. Further research is needed to validate this finding in other populations of MSM and people affected by syphilis.
Publisher: Frontiers Media SA
Date: 23-08-1999
Abstract: To evaluate the role of tacrolimus in the treatment of Chronic Graft Nephropathy (CGN), a pilot cross-sectional study was performed on 14 patients with deteriorating renal function and biopsy-proven CGN. Maintenance therapy was switched from cyclosporin to tacrolimus, and results of conversion on allograft function were assessed by estimated glomerular filtration rate (GFR) and clinical outcome. Minimum follow-up was 15 months. Two distinctive response patterns emerged: (i) continuing deterioration of renal function with no apparent benefit over the projected trend of GFR (nine patients), and (ii) unequivocal change in the GFR trend line equation with reduced rate of deterioration in one patient and sustained improvement of GFR in four patients (reversal of downward trend). Five out of 14 patients (36 %) benefited from replacing Neoral with Prograf. All five patients exceeded their estimated time of return to dialysis by a median of 41 weeks (range: 29-52) and their grafts continue to function.
Publisher: CSIRO Publishing
Date: 31-12-2021
DOI: 10.1071/SH21203
Abstract: There are few data on the length of time clinicians should take s ling the pharynx to optimise the sensitivity of gonorrhoea culture specimens and we aimed to gain a consensus on s ling time. The estimated mean time clinicians reported that they spent s ling the pharynx for gonorrhoea culture specimens was 4.63 s (s.d. ± 2.04). There was no significant difference in s ling times between clinicians who had worked in sexual health for over and under 10 years, (4.7 (s.d. ±2.02) vs 4.6 (s.d. ± 2.3) P = 0.45). We are now using these findings to design an educational tool with the aim of improving pharyngeal gonorrhoea culture sensitivity.
Publisher: Wiley
Date: 24-07-2021
DOI: 10.1111/JDV.17503
Publisher: BMJ
Date: 18-11-2016
Publisher: Wiley
Date: 14-10-2019
DOI: 10.1111/HIV.12684
Publisher: Wiley
Date: 29-03-2019
DOI: 10.1111/HIV.12723
Publisher: SAGE Publications
Date: 14-02-2023
DOI: 10.1177/09564624231154942
Abstract: Outbreaks of sexually transmitted Shigella flexneri and Shigella sonnei in men who have sex with men (MSM) are a major public health issue. While most cases can be managed conservatively, a minority require antimicrobial treatment. Recent reports have highlighted increasing antimicrobial resistant (AMR) strains of Shigella spp. in men who have sex with men. We aimed to systematically review antimicrobial resistance (and decreased antimicrobial sensitivity) in sexually transmitted shigella in men who have sex with men, focussing on macrolides, quinolones, and third generation cephalosporins. We systematically searched 4 bibliographical databases (EMBASE, medline, EMCARE and CINAHL) from January 2011 to November 2021. We used a 2-stage process to assess eligibility: the primary author conducted an initial screen and then 3 authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts in English which included men who have sex with men with sexually transmitted shigella where data on antimicrobial resistance was available. Thirty-nine manuscripts met the inclusion criteria. A majority of the manuscripts ( N = 34) described reduced susceptibility or antimicrobial resistant to macrolides, quinolones and third generation cephalosporins in circulating strains of shigella within sexual networks of men who have sex with men. Extensively drug resistant outbreaks of shigella in men who have sex with men have been reported containing genetic markers of ceftriaxone resistance (e.g. BlaCTX-M27) where isolates also contained markers of reduced susceptibility, and antimicrobial resistant to macrolides and quinolones. There is little role for macrolides, quinolones or third generation cephalosporins in the management of sexually transmitted shigella in men who have sex with men. More research is needed to develop novel strategies for shigella control in men who have sex with men, as antimicrobial options are diminishing.
Publisher: Wiley
Date: 07-09-2022
DOI: 10.1111/J.1399-0012.2006.00565.X
Abstract: The clinical impact of new-onset diabetes mellitus (NODM) is frequently underestimated by clinicians. NODM occurs in approximately 15-20% of renal transplant patients and 15% of liver transplant recipients. Diabetes after transplantation is a leading risk factor for cardiovascular events, with a higher prognostic value than in the non-transplant population. NODM also appears to have a negative influence on graft function, and graft survival rates after renal transplantation are significantly lower in patients who develop diabetes than in controls. Patient mortality following renal transplantation is generally found to be higher in patients with NODM, due to increased cardiovascular and peripheral vascular disease, accelerated graft deterioration and diabetes-related complications, notably infection. A renal registry analysis has reported an increase of 87% in risk of death following onset of NODM. There is also limited evidence that NODM is associated with increased risk of death in liver transplant patients. The relative incidence and severity of diabetic complications in transplant recipients have not been assessed rigorously in a clinical trial but registry data indicate that 20% of renal transplant patients with NODM experience at least one clinically significant diabetic complication within three years. Financially, the additional healthcare costs incurred over the first two years following onset of NODM amount to 21,500 dollars. Routine pre-transplant assessment of diabetic risk, with requisite modification of lifestyle, glycaemic monitoring and immunosuppressive regimens, and coupled with standardized, aggressive hypoglycaemic management as necessary, offers an important opportunity to alleviate the burden of NODM for transplant patients.
Publisher: Springer Science and Business Media LLC
Date: 2006
DOI: 10.2165/00019053-200624010-00006
Abstract: Immunosuppressive therapy is required to prevent graft rejection. Calcineurin inhibitors such as tacrolimus are paradoxically toxic to the kidney, whereas sirolimus (rapamycin Rapamune) is not generally associated with the nephrotoxicity of CNIs. The purpose of this study was to evaluate the relative cost utility of sirolimus versus tacrolimus for the primary prevention of graft rejection in renal transplant recipients in the UK. A stochastic simulation model was constructed using clinical trial and observational data comparing the two treatments. Time duration was up to 20 years. Costs were from a UK NHS perspective, valued at 2003 prices and discounted at 6%. Benefits were discounted at 1.5%. Simulated events included patient and graft survival, haemodialysis, peritoneal dialysis, re-transplants and acute rejection. Costs were summed for events and various maintenance therapies. Utility was differentially accredited depending upon survival and using the alternative renal replacement therapies. Outcome was predicted using post-transplant creatinine levels up to 3 years. Extensive statistical economic and sensitivity analyses were undertaken. Over the 10-year horizon, sirolimus gained 0.72 years (discounted) of functioning graft over tacrolimus, resulting in an incremental cost per year of functioning graft that was dominant. Over a 20-year time horizon, the cost effectiveness of sirolimus over tacrolimus further improved with an average discounted gain in years of a functioning graft of 1.8 years, resulting in an incremental cost-utility ratio that was also dominant. The number of haemodialysis events was 48,243 for sirolimus recipients versus 127,829 for those receiving tacrolimus and peritoneal dialysis events 40,872 versus 105,249, respectively. Similar values were obtained when real-life observational data on tacrolimus use in Cardiff, Wales were entered into the model. Using data from Cardiff, sirolimus remained dominant over tacrolimus under all scenarios. Our study suggests that sirolimus may be more cost effective than tacrolimus for the primary prevention of graft rejection in renal transplant recipients in the UK. Sirolimus was economically 'dominant' under almost all scenarios investigated. This finding was robust using statistical economic analysis and univariate sensitivity analysis.
Publisher: SAGE Publications
Date: 21-02-2023
Publisher: Wiley
Date: 08-2020
DOI: 10.1002/JIA2.25579
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for daniel richardson.