Sydney, Australia
Sydney, Australia

Time filter

Source Type

McManus H.,University of New South Wales | O'Connor C.C.,Royal Prince Alfred Hospital | O'Connor C.C.,University of New South Wales | O'Connor C.C.,University of Sydney | And 8 more authors.
PLoS ONE | Year: 2012

Background: Life expectancy has increased for newly diagnosed HIV patients since the inception of combination antiretroviral treatment (cART), but there remains a need to better understand the characteristics of long-term survival in HIV-positive patients. We examined long-term survival in HIV-positive patients receiving cART in the Australian HIV Observational Database (AHOD), to describe changes in mortality compared to the general population and to develop longer-term survival models. Methods: Data were examined from 2,675 HIV-positive participants in AHOD who started cART. Standardised mortality ratios (SMR) were calculated by age, sex and calendar year across prognostic characteristics using Australian Bureau of Statistics national data as reference. SMRs were examined by years of duration of cART by CD4 and similarly by viral load. Survival was analysed using Cox-proportional hazards and parametric survival models. Results: The overall SMR for all-cause mortality was 3.5 (95% CI: 3.0-4.0). SMRs by CD4 count were 8.6 (95% CI: 7.2-10.2) for CD4<350 cells/μl; 2.1 (95% CI: 1.5-2.9) for CD4 = 350-499 cells/μl; and 1.5 (95% CI: 1.1-2.0) for CD4≥500 cells/μl. SMRs for patients with CD4 counts <350 cells/μL were much higher than for patients with higher CD4 counts across all durations of cART. SMRs for patients with viral loads greater than 400 copies/ml were much higher across all durations of cART. Multivariate models demonstrated improved survival associated with increased recent CD4, reduced recent viral load, younger patients, absence of HBVsAg-positive ever, year of HIV diagnosis and incidence of ADI. Parametric models showed a fairly constant mortality risk by year of cART up to 15 years of treatment. Conclusion: Observed mortality remained fairly constant by duration of cART and was modelled accurately by accepted prognostic factors. These rates did not vary much by duration of treatment. Changes in mortality with age were similar to those in the Australian general population. © 2012 McManus et al.


Knight V.,Sydney Sexual Health Center | Knight V.,University of New South Wales | Ryder N.,Sexual Health and Blood Borne Virus Unit | Bourne C.,Sydney Sexual Health Center | And 4 more authors.
Sexually Transmitted Infections | Year: 2014

Objectives: To investigate the methods used by patients diagnosed with a sexually transmissible infection (STI) to inform their partners during contact tracing. Methods At a large Australian sexual health clinic between March and May 2010, we undertook a retrospective, cross sectional analysis of the methods used by patients diagnosed with a bacterial STI to inform their partners.Results: Of the 172 index patients contacted 1 week after treatment, 163 (95%) chose patient referral, 3 (2%) provider referral and 6 (3%) could not contact any partners. Index patients nominated 1010 sexual partners of whom 494 (49%) were reported as contactable. A total of 447/494 (91%) of these partners were successfully informed; telephone (37%) and face to face (22%) were the most used methods. After multivariate analysis, predictors of using face to face contact methods were age <30 years (AOR: 2.8; 95% CI 1.4 to 5.7), fewer than 2 sexual partners (AOR 3.6; 95% CI 1.7 to 7.6) and speaking a language other than English (adjusted OR (AOR) 3.1; 95% CI 1.3 to 7.2). The single predictor of using interactive contact methods (face to face+telephone) was reporting fewer than 2 sexual partners (AOR 2.7; 95% CI 1.3 to 5.5). People diagnosed with syphilis were significantly less likely to use an interactive contact tracing method (AOR 0.24; 95% CI 0.09 to 0.67).Conclusions: Most patients diagnosed with a bacterial STI at our sexual health clinic report informing their contactable partners directly either face to face or by telephone. Electronic communications methods were more popular for people with more sexual partners and those with syphilis. Effective contact tracing requires access to a range of methods for patients to inform their partners.


Read P.J.,Sydney Sexual Health Center | Read P.J.,University of New South Wales | Limnios E.A.,Prince of Wales Hospital | McNulty A.,Sydney Sexual Health Center | And 3 more authors.
Sexual Health | Year: 2013

Emerging antimicrobial resistance within Neisseria gonorrhoeae (NG) is a significant global public health threat. Detection and investigation of treatment failures is a crucial component of the World Health Organisation's response to this challenge. We report the cases of two homosexual men, both treated for pharyngeal NG with 500mg intramuscular ceftriaxone, in whom a test of cure 1 week after treatment showed persisting infection. Both men denied further sexual activity. In the first case, treatment failure was confirmed, since the isolates before and after treatment were identical by auxotype, antibiogram, multilocus sequence type (MLST) and multi-antigen sequence type (NG-MAST). In the second case, the MLSTs before and after treatment were identical, but NG-MAST results were similar but not indistinguishable. These cases underline the importance of test-of-cure and molecular investigations in identifying treatment failure, but also highlight the complexity of distinguishing treatment failure from reinfection when relying on highly variable molecular targets that may be subject to drug pressure. © 2013 CSIRO.


Knight V.,Sydney Sexual Health Center | Ryder N.,Sexual Health and Blood Borne Virus Unit | Guy R.,University of New South Wales | Lu H.,Sydney Sexual Health Center | And 3 more authors.
Sexually Transmitted Diseases | Year: 2013

INTRODUCTION: In December 2010, a new "express" testing service (Xpress) was implemented alongside routine clinics at a large sexual health clinic. Xpress involved a computer-assisted self-interview, self-collected samples and enrolled nurse staffing. We evaluated the impact of the service on patient journey, staff costs, and clinical capacity. METHODS: In the first 5 months of Xpress, we calculated the median waiting time and length of stay, staff hours and costs, and utilization. We compared these attributes to the same months in the previous year. RESULTS: In the Xpress period, 5335 patients were seen (705 in the Xpress clinic, 4630 in routine clinic), 11% more than the 4804 in the before period. Staff hours were 13% greater in the Xpress period compared with the before period (3567 vs. 3151). The cost per patient seen in the Xpress period was lower compared with the before period ($26.79 compared with $28.48). The median waiting time in the Xpress period was 19 minutes (interquartile range, 8-36; 10 in Xpress clinic and 17 in routine clinics) compared with 23 in the before period (P < 0.01). The median length of stay in the Xpress period was 40 minutes (interquartile range, 27-58; 21 in Xpress clinic and 40 in routine clinics) compared with 43 in the before period (P < 0.01). The utilization rates were 67% in the Xpress period (40% in the Xpress clinic and 74% in routine clinics) compared with 76% in the before period (P < 0.01). CONCLUSION: The Xpress clinic improved the patient journey, and although not fully used, more patients were seen overall in the clinic with minimal additional costs. Marketing of the Xpress clinic is underway. Copyright © 2012 American Sexually Transmitted Diseases Association.


Guy R.,University of New South Wales | Wand H.,University of New South Wales | Knight V.,Sydney Sexual Health Center | Kenigsberg A.,Sydney Sexual Health Center | And 3 more authors.
Sexually Transmitted Infections | Year: 2013

Background In 2009, Sydney Sexual Health Centre implemented a short message service (SMS) reminder system to improve re-screening after chlamydia infection. SMS reminders were sent at 3 months recommending the patient make an appointment for a re-screen. Methods Using a before-and-after study, the authors compared the proportion re-screened within 1e4 months of chlamydia infection in women and heterosexual men who were sent an SMS in January to December 2009 (intervention period) with a 18-month period before the SMS was introduced (before period). The authors used a c2 test and multivariate regression. Visitors and sex workers were excluded. Results In the intervention period, 141 of 343 (41%) patients were diagnosed with chlamydia and sent the SMS reminder. In the before period, 338 patients were diagnosed as having chlamydia and none received a reminder. The following baseline characteristics were significantly different between those sent the SMS in the intervention period and the before period: new patients (82% vs 72%, p1/40.02), aged <25 years (51% vs 33% p<0.01), three or more sexual partners in the last 3 months (31% vs 27%, p<0.01) and anogenital symptoms (52% vs 38%, p<0.01). The proportion rescreened 1e4 months after chlamydia infection was significantly higher in people sent the SMS (30%) than the before period (21%), p1/40.04, and after adjusting for baseline differences, the OR was 1.57 (95% CI 1.01 to 2.46). Conclusions SMS reminders increased re-screening in patients diagnosed as having chlamydia at a sexual health clinic. The clinic now plans to introduce electronic prompts to maximise the uptake of the initiative and consider strategies to further increase re-screening.


Bourne C.,Sydney Sexual Health Center | Zablotska I.,University of New South Wales | Williamson A.,Sydney Sexual Health Center | Calmette Y.,AIDS Council of New South Wales | Guy R.,University of New South Wales
Sexual Health | Year: 2012

Background: In 2006, two new innovative features were added to a website called WhyTest which provided HIV/sexually transmissable infection (STI) information for gay men. The features were the 'Tell them' service allowing visitors to forward anonymous e-postcard or short message services (SMS) to sexual partners who may have been exposed to an STI, and the 'Remind me' service allowing visitors to register for a 3-, 6- or 12-monthly SMS reminder for a sexual health check. We describe the uptake of the new website functionality, and recognition of a health promotion campaign conducted in January-June 2007 to promote these new features. Methods: We used Poisson regression to assess trends in monthly partner notification messages and STI testing reminders sent in August 2007-June 2010. We also analysed 2007 Sydney Gay Community Periodic Survey data to measure recall of the campaign. Results: A total of 7923 partner notification messages were sent in the period August 2007-June 2010, with a significant increasing trend in monthly messages sent (P<0001). Of the total messages sent, 7581 (96%) were by SMS and 342 (4%) by e-postcards. A total of 1023 STI testing reminders were sent in the same period, with a significant increasing trend in monthly reminders sent (P<0.001); 516 reminders were by SMS (50.4%) and 507 by email (49.6%). The 2007 Sydney Gay Community Periodic Survey showed that 55% of the 2342 participants recognised the WhyTest image in the campaign. Conclusion: There was high awareness of WhyTest campaign images and the SMS partner notification service was more popular than the e-postcard feature. © 2012 CSIRO.


Gundevia Z.,Sydney Sexual Health Center | Gundevia Z.,Sydney Sydney Eye Hospital | Foster R.,Sydney Sexual Health Center | Foster R.,University of New South Wales | And 3 more authors.
Sexually Transmitted Infections | Year: 2015

Objectives: To describe antibiotic use for treatment of Mycoplasma genitalium (MG) at an urban sexual health centre in Australia. To describe MG positivity rates in those returning for 1 month test of cure (TOC) following first-line antibiotic treatment for MG. Methods: Retrospective cross-sectional case-note review for all patients diagnosed with MG at Sydney Sexual Health Centre from 2009 to 2013. Results: Two hundred and eighteen MG cases were identified; 66% were male and 90% were symptomatic at presentation. Four people did not return for treatment. Azithromycin containing regimens were prescribed as first-line treatment in 88% of cases; azithromycin 1 g stat in 75% of cases and a course of extended azithromycin 1 g stat plus 500 mg daily for 4 days in 14% of cases. TOC was performed in 53% (95% CI 46% to 60%) of cases and 28% (95% CI 20% to 38%) of these cases were MG-positive at TOC. Of those having a MG-positive result at TOC, 26% received azithromycin 1 g stat and 33% received extended azithromycin. Accounting for cases lost to follow-up in azithromycin containing regimens, the positive MG TOC rate was estimated to be between 15% and 61%. Conclusions: High rates of MG positivity were found in those attending TOC following first-line treatment of MG with azithromycin containing regimens.


Martin L.,Sydney Sexual Health Center | Knight V.,Sydney Sexual Health Center | Read P.J.,Sydney Sexual Health Center | Read P.J.,Kirby Institute | And 2 more authors.
Sexually Transmitted Diseases | Year: 2013

BACKGROUND: Sydney Sexual Health Centre (SSHC) Xpress clinic has significantly reduced the length of stay and waiting time for clients at SSHC but is currently only available to clients who can read and understand a high level of English. This reduces access for culturally and linguistically diverse (CALD) clients. This study sought to determine the acceptability of 4 proposed components of an express clinic model among CALD clients: computer-assisted self-interview (CASI), self-collection of swabs/urine specimens, not having a physical examination, and consultation with a health promotion officer rather than with a clinician. Differences in acceptability based on language group, new or return client status, sex worker status, clinic visited status, and age were analyzed. METHODS: A cross-sectional, anonymous questionnaire was offered to all female Chinese, Thai, and Korean clients attending SSHC between March and November 2012. Multivariate regression and Pearson χ statistical analyses were conducted using STATA 12 software. RESULTS: A total of 366 questionnaires were returned from 149 Thai, 145 Chinese, and 72 Korean participants. After multivariate analysis, the only predictor of willingness to use an express model of service provision was language group: overall, 67% Thai (odds ratio, 3.74: confidence interval [CI], 2.03-6.89; P < 0.01) and 64% Korean (odds ratio, 3.58; CI, 1.77-7.25, P < 0.01) said that they would use it compared with 35% Chinese. Age, history of sex work, new or returning clients, and general or language clinic attendance did not impact on choices. Within the preference for individual components of the model, more Thai women were happy with using a health promotion officer (43.2%) than Chinese (14.1%) or Korean (8.5%) (P < 0.001); no groups were happy with forfeiting a physical examination; Thai (48.6%) and Korean (40.9%) were happier with self-swabbing than Chinese women (23.9%, P < 0.001); and more Thai were happy to use a CASI (44.2%) than Chinese (12%) or Korean (11.1%; P < 0.001). CONCLUSIONS: This research shows that the components of an express model used at SSHC are not favorable to our CALD client base. Despite a CALD express clinic having the potential to reduce waiting times, most clients did not favor reduced waiting time over being physically examined or using a CASI. Copyright © 2013 American Sexually Transmitted Diseases Association. All rights reserved.


Wand H.,National Center in Epidemiology and Clinical Research | Guy R.,National Center in Epidemiology and Clinical Research | Donovan B.,National Center in Epidemiology and Clinical Research | McNulty A.,Sydney Sexual Health Center | McNulty A.,University of New South Wales
BMJ Open | Year: 2011

Objective: To develop and validate a risk scoring tool to identify those who are at increased risk of chlamydia infection. Methods: We used demographic data, sexual behaviour information and chlamydia positivity results from more than 45 000 individuals who attended Sydney Sexual Health Centre between 1998 and 2009. Participants were randomly allocated to either the development or internal validation data set. Using logistic regression, we created a prediction model and weighted scoring system using the development data set and calculated the odds ratio of chlamydia positivity for participants in successively higher quintiles of score. The internal validation data set was used to evaluate the performance characteristics of the model for five quintiles of risk scores including population attributable risk, sensitivity and specificity. Results: In the prediction model, inconsistent condom use, increased number of sexual partners in last 3 months, genital or anal symptoms and presenting to the clinic for sexually transmitted infections screening or being a contact of a sexually transmitted infection case were consistently associated with increased risk of chlamydia positivity in all groups. High scores (upper quintiles) were significantly associated with increased risk of chlamydia infection. A cut-point score of 20 or higher distinguished a increased risk group with a sensitivity of 95%, 67% and 79% among heterosexual men, women and men who have sex with men (MSM), respectively. Conclusion: The scoring tool may be included as part of a health promotion and/or clinic website to prompt those who are at increased risk of chlamydia infection, which may potentially lead to increased uptake and frequency of testing.


Martin L.,Sydney Sexual Health Center | Knight V.,Sydney Sexual Health Center | Ryder N.,Sexual Health and Blood Borne Virus Unit | Lu H.,Sydney Sexual Health Center | And 4 more authors.
Sexually Transmitted Diseases | Year: 2013

BACKGROUND: Sydney Sexual Health Centre (SSHC) commenced a fast-track sexually transmissible infection clinic, the Xpress Clinic (Xpress) pilot for asymptomatic clients in March 2010, using a computer-assisted self-interview and self-collected samples. This study examines client satisfaction and changes in intended screening frequency among clients of Xpress. METHODS: This was a cross-sectional study of all clients attending Xpress clinics during the initial 6 months. All clients were requested to complete a survey based on a previously validated questionnaire. Results were stratified by sex, sex of sexual partners, age, and sex work status. RESULTS: Of the 243 clients who attended Xpress, 145 (60%) returned questionnaires. The 2 most common reasons for choosing Xpress clinic were reduced waiting time (n = 42/138 [30%]; 95% confidence interval [CI], 23%-38%) and reduced length of consultation (n = 16/138 [12%]; 95% CI, 7%-17%).When asked if they would have come to SSHC anyway if Xpress was not an option, men who have sex with men (MSM) were more likely than non-MSM to say that they would come for screening anyway (77% MSM vs. 59% non-MSM, P = 0.034). Youth younger than 25 were less likely than those 25 years and older to have come for screening anyway (53% vs. 79%, P = 0.012).Most (n = 101/138 [73%]; 95% CI, 65%-80%) considered that they would test for sexually transmissible infections more frequently in the future using the Xpress model. Client satisfaction levels were high, with most respondents reporting that they would return to Xpress (n = 119/142 [83%]; 95% CI, 77%-89%) and would recommend it to friends (n = 122/142 [86%]; 95% CI, 79%-90%). CONCLUSIONS: Most clients were highly satisfied with all aspects of Xpress and reported intentions to retest using this model of care. Copyright © 2012 American Sexually Transmitted Diseases Association.

Loading Sydney Sexual Health Center collaborators
Loading Sydney Sexual Health Center collaborators