bluuebunny/crossref_metadata_2025 huggingface dataset:
Slave trades, kinship structures and women's political participation in Africa
Authors: Walters Leoné , Chisadza Carolyn , Clance Matthew
Published: May 2024

We study whether present‐day women's political participation in sub‐Saharan Africa is associated to the temporary gender ratio imbalances caused by the transatlantic and Indian Ocean slave trades, taking into account pre‐existing gender norms influenced by kinship structures. To study the interrelatedness between historical exposure to the slave trades, patrilineality and their association to contemporary women's political participation, we use individual‐level data for 35,595 women from 28 sub‐Saharan African countries from three rounds of Afrobarometer surveys, georeferenced to historical ethnic region kinship and slave trade data. Our findings suggest that a woman's ethnic region historical exposure to the transatlantic slave trade is associated with an increase in her likelihood to vote today, however, only in non‐patrilineal ethnic regions. This effect is mitigated in patrilineal ethnic regions, where women have less decision‐making power. This paper contributes to the literature on the contemporary sub‐national effects of the slave trades and the historical causes of gender gaps in political participation.
Non‐destructive quantitative analysis of melt inclusions in extraterrestrial samples: Case study of chassignite via nanoscale X‐ray computed tomography
Authors: Wu Peiyu , Dayton Kyle , Gazel Esteban , Porri Teresa
Published: May 2024

Estimation of the composition of planetary rocks and minerals is crucial for understanding their formation processes. In this study, we present the application of X‐ray nano‐computed tomography (nano‐XCT) for non‐destructive three‐dimensional (3‐D) phase analysis and estimation of phase abundances in rare Martian meteorite samples, specifically chassignite Northwest Africa (NWA) 2737. We determined the most suitable laser power for minimizing artifacts and maximizing phase contrast. By utilizing nano‐XCT, we successfully identified and segmented primary phases in the bulk meteorite sample. Additionally, we were able to locate and segment crystallized silicate melt inclusions within the meteorite. The phase abundances in bulk NWA 2737 and within melt inclusions calculated using nano‐XCT were in good agreement with previous studies that used thin section calculations, demonstrating the reliability of nano‐XCT as a non‐destructive alternative for estimating bulk phase abundances in rare samples. This study develops a benchmarking protocol and demonstrates the efficacy of nano‐XCT as a non‐destructive technique for generating an overview of phase distribution and assemblages of melt inclusions within rare samples. Future research can benefit from combining non‐destructive 3‐D phase assemblage estimations with non‐destructive 3‐D chemical analysis techniques to achieve a fully non‐destructive parental magma composition estimation of rare cumulate samples.
Vagus nerve stimulation in bursts can efficiently modulate gastric contractions and contraction frequency at varying gastric pressures
Authors: Tovbis D. , Yoo P. B.
Published: May 2024

Objective

There has been recent clinical interest in the use of vagus nerve stimulation (VNS) for treating gastrointestinal disorders as an alternative to drugs or gastric electrical stimulation. However, effectiveness of burst stimulation has not been demonstrated. We investigated the ability of bursting and continuous VNS to influence gastric and pyloric activity under a range of stimulation parameters and gastric pressures. The goals of this study were to determine which parameters could optimally excite or inhibit gastric activity.

Materials and Methods

Data were collected from 21 Sprague–Dawley rats. Under urethane anesthesia, a rubber balloon was implanted into the stomach, connected to a pressure transducer and a saline infusion pump. A pressure catheter was inserted at the pyloric sphincter and a bipolar nerve cuff was implanted onto the left cervical vagus nerve. The balloon was filled to 15 cmH2O. Stimulation trials were conducted in a consistent order; the protocol was then repeated at 25 and 35 cmH2O. The nerve was then transected and stimulation repeated to investigate directionality of effects.

Results

Bursting stimulation at the bradycardia threshold caused significant increases in gastric contraction amplitude with entrainment to the bursting frequency. Some continuous stimulation trials could also cause increased contractions but without frequency changes. Few significant changes were observed at the pylorus, except for frequency entrainment. These effects could not be uniquely attributed to afferent or efferent activity.

Significance

Our findings further elucidate the effects of different VNS parameters on the stomach and pylorus and provide a basis for future studies of bursting stimulation for gastric neuromodulation.
The stomatal response to vapor pressure deficit drives the apparent temperature response of photosynthesis in tropical forests
Authors: Slot Martijn , Rifai Sami W. , Eze Chinedu E. , Winter Klaus
Published: May 2024

As temperature rises, net carbon uptake in tropical forests decreases, but the underlying mechanisms are not well understood. High temperatures can limit photosynthesis directly, for example by reducing biochemical capacity, or indirectly through rising vapor pressure deficit (VPD) causing stomatal closure.

To explore the independent effects of temperature and VPD on photosynthesis we analyzed photosynthesis data from the upper canopies of two tropical forests in Panama with Generalized Additive Models.

Stomatal conductance and photosynthesis consistently decreased with increasing VPD, and statistically accounting for VPD increased the optimum temperature of photosynthesis (Topt) of trees from a VPD‐confounded apparent Topt of c. 30–31°C to a VPD‐independent Topt of c. 33–36°C, while for lianas no VPD‐independent Topt was reached within the measured temperature range. Trees and lianas exhibited similar temperature and VPD responses in both forests, despite 1500 mm difference in mean annual rainfall.

Over ecologically relevant temperature ranges, photosynthesis in tropical forests is largely limited by indirect effects of warming, through changes in VPD, not by direct warming effects of photosynthetic biochemistry. Failing to account for VPD when determining Topt misattributes the underlying causal mechanism and thereby hinders the advancement of mechanistic understanding of global warming effects on tropical forest carbon dynamics.
Stabilized oral lichen planus does not compromise dental implants survival: A systematic review and meta‐analysis
Authors: Li Jing Wen , Kot Wai Ying , McGrath Colman Patrick , Chan Bik Wan Amy , Zheng Li Wu
Published: May 2024

Background

This study aimed to evaluate the incidence of implant failure in patients with oral lichen planus (OLP) and investigate the potential association between OLP and peri‐implant diseases.

Materials and Methods

Embase, Web of Science, PubMed, and Scopus databases were searched for studies with no time restrictions. Meta‐analysis was performed calculating pooled proportion of peri‐implantitis (PI), peri‐implant mucositis (PIM), and bleeding on probing (BOP) prevalence using fixed‐effects model. Odds ratio and corresponding 95% CI were calculated to assess the potential risk of PI, PIM, and BOP in dental implant patients with OLP compared to healthy controls.

Results

Implant failure rate was 4.38% at the patient level and 4.37% at the implant level. Six patients (3.92%) from five studies were diagnosed with oral cancer after receiving implant. The prevalence of PI, PIM, and BOP at the implant level were 14.00%, 20.00%, and 40.00%, respectively. There was no significant difference in the occurrence of PI and PIM between OLP patients and healthy controls.

Conclusions

Stabilized OLP is not considered a significant risk factor for peri‐implant diseases. It is advised against placing implants or prostheses during the acute phase of the disease. Histopathological investigation to differentiate OLP from oral lichenoid dysplasia is crucial.
Bridge over troubled waters? Experimental evidence into the influence of leadership on employees' collaborative engagement
Authors: Grøn Anders Barslund
Published: May 2024

It is not easy to secure and sustain efficient interorganizational collaboration in hierarchically demarcated and functionally specialized public sectors. This article investigates whether and how public leaders can motivate and catalyze their own employees to engage in behaviors that foster and support collaboration across organizational jurisdictions. Using survey data from 555 occupational therapists in Danish municipalities, we employed an innovative scenario‐based research design including video vignettes and a centipede game to mimic real‐life collaboration. We show that clear and collaboration‐focused leadership has a positive and substantial effect on employees' engagement in an interorganizational collaboration with a regionally employed nurse. Further, the effects are stronger for respondents with higher public service motivation, higher collaborative self‐efficacy, more tenure, and at a younger age. The findings contribute to understanding public leadership and employee engagement in interorganizational collaboration and emphasize that leaders should carefully consider their context and communication when engaging their employees.
The Linder hypothesis for foreign direct investment revisited
Authors: Kim Dongin , Steinbach Sandro
Published: May 2024

This article investigates the Linder hypothesis for foreign direct investment (FDI) within the three‐way gravity framework, utilizing a newly compiled and extensive dataset encompassing greenfield and brownfield investment activities across diverse sectors from 2003 to 2018. The Linder hypothesis posits that multinational firms invest in countries with comparable income levels to their home country. Our primary findings affirm the relevance of the Linder hypothesis in the context of horizontal FDI. The influence of the Linder effect varies among sectors, with the service sector exhibiting the most pronounced effect, while no detectable effect is observable for the manufacturing sector. We also find that the Linder effect depends on the sector's position within the value chain and the degree of quality differentiation. Sectors closer to final consumer demand and those characterized by higher product differentiation exhibit greater exposure to the Linder effect. Additionally, our analysis reveals that the Linder effect is subject to variations based on the income levels of the host country and highlights the significance of consumer preferences in shaping FDI patterns. Our article underscores the pivotal role of industry dynamics, product quality considerations, and value chain positioning in influencing the Linder effect on FDI.
A Hybrid Continuation Framework for Analyzing Nonlinear Normal Modes of Systems With Contact Nonlinearity
Authors: Huang Shih-Chun , Tien Meng-Hsuan
Published: May 2024

The prediction of the modal properties of structural systems with contact clearances and prestress presents a computational challenge, as the nonlinearity induced by piecewise-linear stiffness eliminates the use of efficient linear modal analysis techniques. The most common approach to obtaining the nonlinear normal modes (NNMs) of these structural systems is a numerical framework that integrates numerical integration, the shooting method, and the pseudo-arc-length continuation scheme. This numerical continuation framework (NCF) computes NNMs through iterative numerical calculations; thus, the computational cost of the nonlinear modal analysis of complex nonlinear systems, particularly piecewise-linear systems, becomes prohibitively expensive as the model size increases. In this study, a hybrid continuation framework (HCF) combining analytic and numerical methods is proposed to enable efficient computations of NNMs for systems with contact boundaries. This new hybrid framework utilizes a semi-analytic method to conduct the iterative shooting procedure; thus, the computational burden of the numerical continuation can be significantly reduced. The proposed method is demonstrated on spring-mass oscillators with contact elements, and the NNMs obtained using the proposed method are validated by those computed using the traditional numerical continuation framework. The modal properties of the systems can be computed using the proposed framework with significant speed-up. Furthermore, the modal properties, including internal resonance and sharp turning in NNM curves, of the piecewise-linear systems are identified and discussed.
Smithmeyerella , a replacement name for Meyerella Amrine et al . (Acariformes, Eriophyidae), a preoccupied name

Authors: André Henri M. , Flechtmann Carlos H.w.
Published: May 2024

N/A
New records of water mites from Uttarkhand, India, with description of two new species (Acari: Hydrachnidia, Torrenticolidae)

Authors: Lodhi Lokesh , Zawal Andrzej , Kumar Neeraj , Pešić Vladimir
Published: May 2024

New material of water mites (Acari: Hydrachnidia) from the Uttarakhand State of India is reported. Ten species are identified, among which Sperchon (Hispidosperchon) rostratus Lundblad, 1969 is reported for the first time for India and two species, i.e. Monatractides smiti (Torrenticolidae) and Atractides uttarakhandensis (Hygrobatidae) are described as new to science. One sample collected in standing water in Uttar Pradesh State revealed the presence of three Arrenurus species, of which A. (Truncaturus) indicus Smit & Pešić, 2008 was reported for the first time after the original description.
What's special about human speech? A student exercise for comparing speech production between humans and chimpanzees
Authors: Shofner William P.
Published: May 2024

Modern humans and chimpanzees share a common ancestor on the phylogenetic tree, yet chimpanzees do not spontaneously produce speech or speech sounds. The lab exercise presented in this paper was developed for undergraduate students in a course entitled “What's Special About Human Speech?” The exercise is based on acoustic analyses of the words “cup” and “papa” as spoken by Viki, a home-raised, speech-trained chimpanzee, as well as the words spoken by a human. The analyses allow students to relate differences in articulation and vocal abilities between Viki and humans to the known anatomical differences in their vocal systems. Anatomical and articulation differences between humans and Viki include (1) potential tongue movements, (2) presence or absence of laryngeal air sacs, (3) presence or absence of vocal membranes, and (4) exhalation vs inhalation during production.
Restoring colistin sensitivity in colistin-resistant
Salmonella
and
Escherichia coli
: combinatorial use of berberine and EDTA with colistin
Authors: Cui Xiao-die , Liu Xiao-kang , Ma Xiao-yuan , Li Shuai-hua , Zhang Jun-kai , Han Rong-jia , Yi Kai-fang , Liu Jian-hua , Pan Yu-shan , He Dan-dan , Hu Gong-zheng , Zhai Ya-jun
Published: May 2024

The appearance and prevalence of multidrug-resistance (MDR) Gram-negative bacteria (GNB) have limited our antibiotic capacity to control bacterial infections. The clinical efficacy of colistin (COL), considered as the “last resort” for treating GNB infections, has been severely hindered by its increased use as well as the emergence and prevalence of mobile colistin resistance (MCR)-mediated acquired drug resistance. Identifying promising compounds to restore antibiotic activity is becoming an effective strategy to alleviate the crisis of increasing MDR. We first demonstrated that the combination of berberine (BBR) and EDTA substantially restored COL sensitivity against COL-resistant
Salmonella
and
Escherichia coli
. Molecular docking indicated that BBR can interact with MCR-1 and the efflux pump system AcrAB-TolC, and BBR combined with EDTA downregulated the expression level of
mcr-1
and
tolC
. Mechanically, BBR combined with EDTA could increase bacterial membrane damage, inhibit the function of multidrug efflux pump, and promote oxidative damage, thereby boosting the action of COL. In addition, transcriptome analysis found that the combination of BBR and EDTA can accelerate the tricarboxylic acid cycle, inhibit cationic antimicrobial peptide (CAMP) resistance, and attenuate
Salmonella
virulence. Notably, the combination of BBR and EDTA with COL significantly reduced the bacterial load in the liver and spleen of a mice model infected with
Salmonella
. Our findings revealed that BBR and EDTA can be used as adjuvants collectively with COL to synergistically reverse the COL resistance of bacteria.

IMPORTANCE

Colistin is last-resort antibiotic used to treat serious clinical infections caused by MDR bacterial pathogens. The recent emergence of transferable plasmid-mediated COL resistance gene
mcr-1
has raised the specter of a rapid worldwide spread of COL resistance. Coupled with the fact of barren antibiotic development pipeline nowadays, a critical approach is to revitalize existing antibiotics using antibiotic adjuvants. Our research showed that berberine combined with EDTA effectively reversed COL resistance both
in vivo
and
in vitro
through multiple modes of action. The discovery of berberine in combination with EDTA as a new and safe COL adjuvant provides a therapeutic regimen for combating Gram-negative bacteria infections. Our findings provide a potential therapeutic option using existing antibiotics in combination with antibiotic adjuvants and address the prevalent infections caused by MDR Gram-negative pathogens worldwide.
P059 “What’s the problem with condoms?” a thematic analysis of public responses to online news coverage of a mathematical modelling study of HIV Prevention through the use of pre-exposure prophylaxis by men who have sex with men in the UK
Authors: Knox Chloe
Published: May 2024

Introduction

Little is known about how the public perceive the use of pre-exposure prophylaxis (PrEP) among MSM in the UK. The objectives of this study were to trace the media coverage of a mathematical modelling study by Punyacharoensin, et al, which estimates the effect of potential prevention programmes on HIV incidence among MSM in the UK and to explore the public perceptions through analysis of their online comments.

Methods

Articles published prior to 7th March 2016 were included, and were identified using Altmetric software and through online searches. 16 news outlets were identified, with 19 published articles in total. Thematic analysis of the comments was conducted.

Results

119 comments left in response to 3 online articles were analysed. 19% of comments (n=23) were “positive” towards the use of PrEP, 52% (n=62) were “negative” and 29% (n=34) were “neutral” or included both “positive” and “negative” themes. The content of the online public discourse can be summarised into four main themes: “costs of PrEP,” “othering,” “framing of condom non-use” and “encouragement of risky behaviours.”

Discussion

This study is the first of its kind to investigate public reactions to use of PrEP use by MSM in the UK through online platforms and social media. Results allow the exploration of common views and misconceptions among the public. This has implications for the development of social norms and helps to guide the approach required in policy and practice in order promote a more receptive public atmosphere towards PrEP use among MSM in the UK.
P060 Drug resistance among women attending antenatal clinics in ghana
Authors: Enyan Philip
Published: May 2024

Introduction

Initial evidence from resource-limited countries using the WHO HIV drug resistance (HIVDR) threshold survey suggests that transmission of drug-resistance strains is likely to be limited. However, as access to ART is expanded, increased emergence of HIVDR is feared as a potential consequence. We have performed a surveillance survey of transmitted HIVDR among recently infected persons in the geographic setting of Accra, Ghana.

Methods

As part of a cross-sectional survey, 2 large voluntary counselling and testing centres in Accra enrolled 50 newly HIV-diagnosed, antiretroviral drug-naïve adults aged 18 to 25 years. Virus from plasma samples with >1,000 HIV RNA copies/mL (Roche Amplicor v1.5) were sequenced in thepolgene. Transmitted drug resistance-associated mutations (TDRM) were identified according to the WHO 2009 Surveillance DRM list, using Stanford CPR tool (v 5.0 beta). Phylogenetic relationships of the newly characterised viruses were estimated by comparison with HIV-1 reference sequences from the Los Alamos database, by using the ClustalW alignment program implemented.

Results

Subtypes were predominantly D (39/70, 55.7%), A (29/70, 41.4%), and C (2/70; 2, 9%). Seven nucleotide sequences harboured a major TDRM (3 NNRTI, 3 NRTI, and 1 PI- associated mutation); HIVDR point prevalence was 10.0% (95%CI 4.1% to 19.5%). The identified TDRM were D67G (1.3%), L210W (2.6%); G190A (1.3%); G190S (1.3%); K101E (1.3%), and N88D (1.3%) for PI.

Discussion

In Accra the capital city of Ghana, we found a rate of transmitted HIVDR, which, according to the WHO threshold survey method, falls into the moderate (5 to 15%) category. This is a considerable increase compared with the rate of <5% estimated in the 2006–7 survey among women attending an antenatal clinic in mamobi. As ART programs expand throughout Africa, incident infections should be monitored for the presence of transmitted drug resistance in order to guide ART regimen policies.
P063 Pepse from the emergency department: reducing missed opportunities for patient follow up
Authors: Megarity Stephen , Rafferty Paul , Quah Say
Published: May 2024

Introduction

PEPSE is one method of reducing HIV transmission in higher risk groups. It is commonplace for PEPSE to be delivered from the Emergency Department (ED) out-of-hours. PEPSE delivered outside of GUM can be met with challenges in regard to follow up; resulting in missed opportunities for health promotion, education and STI testing.

Methods

Retrospective case-note review of ED episodes from 1/4/2015–31/3/2016. Demographic information and data collected compared with audible outcomes (BASHH 2015 PEP guidelines).

Results

37 patient episodes identified; 97% male with a mean age 28.2 years. 86% of these episodes occurred out-of-hours with 84% receiving PEPSE within recommended indications (standard 90%). 81% of patients prescribed PEPSE had an HIV test within 72hours (standard 100%). In regard to follow up, 59% of all patients attended for STI testing (standard 90%). There was a 9% rate of STIs reported in those attending for follow up. 51% of all patients had an 8–12 week HIV test (standard 75%). There was 1 new HIV diagnosis reported. Introduction of an ED staff education programme and e-referral pathway has resulted in a 24% increase in patients attending for STI testing. In addition, 100% of patients using pathway had an HIV test within 72 hours and 100% of PEPSE prescriptions were within recommended indications.

Discussion

Targeted quality improvement strategies can have a significant impact on PEPSE outcomes for higher risk groups. Improved follow up within GUM after PEPSE prescription in ED has increased opportunities for diagnosis and treatment of STIs, vaccine provision and patient education.
P065 The gmi community coaching model – coaching HIV self-testing and self-sampling within high risk MSM
Authors: Dunkley Yasmin , Wang Dee , Worrall Steve , Skipper Karen , Evans Andrew
Published: May 2024

Introduction

In light of moves towards online provision of HIV services, e.g. self-testing, or online self-sampling, the GMI Partnership wanted to understand whether there was a way in which community based organisations could support and incorporate trends towards online provision of services, as well as understand the knowledge of at risk communities in light of changes, through the provision of community coaching on self-testing and self-sampling. The GMI Partnership provides sexual health promotion and HIV prevention services to 76,000 high risk MSM across London each year, as well as in-depth interviews with at least 4,000 MSM each year.

Methods

2888 online surveys identified existing literacy re- HIV self-testing and self-sampling in MSM (targeted via dating apps.) Recognising that literacy was limited, GMI provided community coaching on self-testing with MSM in high risk venues, to identify whether the intervention was more likely to engender comfort with new technologies (200 quantitative interviews).

Results

HIV literate MSM do not understand the difference between self-testing and self-sampling.

The community coaching model ensures high levels of confidence and acceptability in self-testing technologies.

Discussion

Community testing models can complement self-testing and self-sampling.

There will always be clients for whom online provision of new technologies will not work.

Scalability of the model within African groups (community based intervention).
P066 Risk reduction’ referrals to a specialist london HIV and sexual health psychology service
Authors: Coffey Caroline , Jovanovic Mirjana , Forjaz Vera
Published: May 2024

Introduction

Considering the low number of referrals of ‘risk reduction’ patients to the HIV and Sexual Health Psychology service in comparison to number of patients presenting with sexual risk taking at referring sexual health clinics, we implemented a ‘sexual wellbeing’ service development initiative in 2016.

We aimed to compare all the ‘risk reduction’ referrals in 2014 to 2016 in order to reflect on the impact of the service developments implemented in 2016.

Methods

A retrospective case note review was conducted to identify referral rates to psychology over a 1-year period in 2014 and 2016. Age at referral, referral outcome and number of sessions were included.

Results

The number of referral increased fivefold from 2014–2016. In 2014, 23 patients were referred. The mean age at referral was 32. 16 patients opted in to the service, 13 engaged in assessment/therapy. The mean number of sessions attended was 5. In 2016, 115 patients were referred. The mean age at referral was 36. 72 patients opted in and 48 patients engaged in assessment/therapy. The mean number of sessions was 3.

40 patients are still engaged with the service and will complete an intervention.

Discussion

The service development initiative has resulted in a significant increase in the number of referrals to psychology. Further service initiatives are ongoing to address the continuing low number of patients opting in and engaging with psychological interventions.
P068 Prep for ireland? an ngo policy paper to inform discussion on legalising the availability of prep in ireland
Authors: Nolan Ann , Mulligan Niall
Published: May 2024

Introduction

PrEP is illegal in Ireland and the issue of the introduction of PrEP has not been adequately researched within an Irish context. This paper, due for completion in April 2017, examines the question, ‘Should PrEP be introduced to Ireland?’

Methods

A comprehensive literature review on PrEP has been completed, to be followed by key informant interviews with national and international stakeholders to ensure coherence with national policy, to capture multiple perspectives and priorities, highlight implementation and operational difficulties, and off-set unintended consequences.

Results

The results of this paper will focus on PrEP within five key areas – Public Health Effectiveness, Adherence, Feasibility/Knowledge/Willingness to take PrEP, Risk/Risk Compensation, and Cost/Cost Effectiveness. The findings will contextualise PrEP within key populations of MSM, PWID, as well as Sex Workers and will inform Irish policy makers’ decision making by providing input to debates on the pros and cons of introducing PrEP to Ireland.

Discussion

It is argued that PrEP adds to the package of proven HIV prevention options already available and is recommended by UNAIDS for use in conjunction with other prevention methods. However PrEP is frequently not seen in value-neutral public health terms and is a contested intervention along economic, ethical, and rights-based axes. This paper examines PrEP in detail in order to inform discussion on its potential introduction within Ireland.
P070 A retrospective audit of the provision of pepse in a community sexual health clinic
Authors: Draeger Elenor , Vonau Barbara , Clark Sarah
Published: May 2024

Introduction

When setting up a specialist GUM clinic within a community sexual and reproductive health service we started offering Post Exposure Prophylaxis (PEPSE) to eligible patients. The patient pathway was to start PEPSE in our service, then attend the HIV clinic in the hospital for all related follow-up appointments.

Aims

To audit our practice against the 2011 BHIVA guidelines for the use of PEPSE.

Methods

Our electronic record was interrogated for consultations coded as PEPSE between January 2013 and July 2015. 78 records were found, of whom 5 did not receive PEPSE. Thus 72 records were audited.

Results

Abstract P070 Table 1

PEPSE Audit

Number (%)Audit StandardSettingHIV test within 72 hours72 (100)100%CommunityPrescription fits indication72 (100)90%CommunityPEPSE within 72 hours72 (100)90%CommunityCompleting 4 weeks PEPSE21 (29.2)75%HospitalFull STI screen58 (80.6)90%HospitalHIV test 12-weeks post PEPSE18 (25%)60%Hospital

The BHIVA standards were met in all categories that were implemented in the community GUM clinic, but were not met in any of the categories that were implemented in the hospital setting.

Discussion

While it is encouraging that PEPSE was initiated successfully in our clinic setting, the follow-up data was disappointing. Following the results of this audit all patients who start on PEPSE in our community clinic are now followed up in the community.
P074 Significant efficacy and long term safety difference with taf-based str in naïve adults
Authors: Arribas Jose , Thompson Melanie , Sax Paul , DeJesus Edwin , Clark Amanda , Das Moupali , McCallister Scott
Published: May 2024

Introduction

At Week(W) 48, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) was statistically noninferior to E/C/F/tenofovir disoproxil fumarate(TDF) for the proportion of subjects with HIV-1 RNA <50 copies (c)/mL and had significant improvements in renal and bone safety endpoints. We report W144 data.

Methods

ARV-naïve participants randomised 1:1 to receive E/C/F/TAF or E/C/F/TDF. W144 viral suppression (HIV-1-RNA <50 and <20 c/mL) by FDA snapshot analysis, pre-defined bone and renal safety, and tolerability endpoints are reported.

Results

1,733 HIV-infected adults were randomised and treated: 15% women, 43% non-white, 23% viral load (VL) >100,000 c/mL. Median baseline characteristics: age 34 years, CD4 count 405 cells/µL, and VL 4.58 log10c/mL. At W144, E/C/F/TAF met pre-specified criteria for both non-inferiority and superiority to E/C/F/TDF by FDA snapshot algorithm (HIV-1-RNA <50 and <20 c/mL) (Table 1). Mean decrease in BMD was significantly less in the E/C/F/group for lumbar spine and hip (Table1). Multiple measures of renal safety were significantly better for participants on E/C/F/TAF (Table). No cases of renal tubulopathy in the E/C/F/TAF group vs 2 on E/C/F/TDF. No participants on E/C/F/TAF had renal-related discontinuations vs 12 on E/C/F/TDF (p<0.001). Participants on E/C/F/TAF had greater increases in lipids.

Discussion

E/C/F/TAF was significantly superior than E/C/F/TDF, driven by fewer participants on E/C/F/TAF with no W144 data. E/C/F/TAF continued to have a statistically superior bone and renal safety profile compared with E/C/F/TDF, demonstrating significant safety advantages over E/C/F/TDF through 3 years of treatment. Individuals on E/C/F/TAF had greater plasma lipid changes, but proportions starting lipid-lowering therapy were comparable.
P078 User participation in the development of HIV self-testing services: results of co-design workshops
Authors: Pilarski Nicole , Peralta Carlos , Rodriguez Liliana , Dean Gillian , Soni Suneeta , Llewellyn Carrie , Vera Jaime
Published: May 2024

Introduction

Novel ways to encourage HIV testing are urgently needed. In Brighton, the use of a digital vending machine to distribute free self-test kits to men who have sex with men (MSM) using saunas is being piloted along with a campaign to increase awareness of self-testing.

Methods

Volunteers attended design workshops and designers attended an LGBT community meeting. Participants completed a questionnaire and discussed visual concepts for the campaign. Workshops utilised tools such as personas (creating ‘characters’ to explore theoretical individuals’ thoughts and behaviours), construction of user journeys, and mock-ups of vending machine design and interaction.

Results

There were 11 respondents; 8 aged <25, two 25–34 and one 45–64 years. Eight had previously tested for HIV. Two had self-tested. Themes relating to concerns with self-testing were: perceived reliability or ‘faith in the results’; tests being ‘done properly’; familiarity with self-testing; fear of needles or blood; STI screening; support if test positive. Factors encouraging HIV self-testing were: awareness; accessibility; confidence in ease of use. Key themes relating to visual campaign options were: sense of community and support; clinical versus community settings; giving clear information. Participant discussions using personas included targeting appropriate populations for self-testing and framing the campaign within the ‘gay scene’.

Discussion

Few participants had previously self-testedKnowledge and generating a ‘sense of a testing community’ were the most important factors for promoting self-testing. Collaboration with designers and communities ensures a user-centred approach to HIV self-testing.
P079 Are patients with unexplained blood dyscrasias being tested for hiv?
Authors: Biddle Kathryn , Evans-Jones John
Published: May 2024

Introduction

The purpose of our audit was to determine whether our hospital is following the BHIVA National Guidelines (2008) and testing for HIV in patients presenting with unexplained blood dyscrasias.

Methods

Our initial sample consisted of all inpatients coded as having lymphopenia, thrombocytopenia or neutropenia between 1/1/16 and 1/11/16. We excluded patients with a known cause of cytopenia and those with mild cytopenias (platelets >80, neutrophils >1, lymphocytes>1). In our final sample of 82 patients, we used the electronic ordering system to collect patient and admission information and to determine whether a HIV test was ordered.

Results

37% of patients with unexplained blood dyscrasias were tested for HIV. 60% of patients with neutropenia were tested compared with 42% with thrombocytopenia, 25% with lymphopenia and 20% with mixed cytopenias. Patients with lower blood counts were more likely to be tested for HIV. Patients were more likely to be tested for HIV if they were admitted under the haematology team (55%) compared with those admitted under general medical (31%) or surgical teams (27%). HIV testing declined with increasing age of patients with 67% of those aged under 30 being tested compared with 60%, 56%, 22% and 0% of patients between 31–50, 51–70, 71–90 and over 90 respectively.

Discussion

We found that the majority of patients with unexplained blood dyscrasias were not tested for HIV. Our study highlighted several factors that influence whether testing is performed. These include the nature and severity of cytopenia, patient age and the admitting medical team.
P084 Are we considering HIV enough? an audit investigating routine use of HIV screening for patients aged 18–50 presenting with community acquired pneumonia to a provincial hospital
Authors: Rees Joanna
Published: May 2024

Introduction

It is known that a significant proportion of people within the United Kingdom are unaware of their HIV infection and late diagnosis is associated with HIV related Morbidity and Mortality. The British HIV Association recommend routine HIV screening for patients with an HIV indicator illness. This includes Bacterial Pneumonia, a condition commonly encountered in hospital departments throughout the United Kingdom.

Methods

We designed an audit to evaluate the use of routine HIV screening for patients aged 18-50 presenting to the Royal Devon and Exeter Hospital with Community Acquired Pneumonia. Using a coding search of all discharges between May 2015 and September 2015, 38 patients were identified. Inclusion criteria required each patient to have either a positive microbiological sample or consolidation present on a chest radiograph. Of the 38 patients identified, 7 were excluded who did not satisfy the minimum inclusion criteria.

Results

Of the patients audited, 21 patients (67.7%) did not receive routine screening during their inpatient stay. One patient who was not tested had received testing immediately prior to their acute presentation. Two patients who were not tested had a significant history of intravenous drug use, an independent indicator for routine HIV screening. Of the 10 patients (32.3%) that were successfully screened for HIV, no samples tested positive.

Discussion

Routine screening for HIV in all patients with bacterial pneumonia could aid early identification of HIV infection, reducing overall morbidity and mortality. This audit highlights the continuing need for raised awareness of routine HIV screening for patients with HIV indicator conditions, particularly, in areas of low prevalence of HIV infection.
P095 Late diagnosis of HIV in northern ireland
Authors: Todd Suzanne , Walker Eoin , Hunter Michael , Donnelly Claire , Dinsmore Wallace , Emerson Carol , Quah Say , McCarty Emma
Published: May 2024

Introduction

Late HIV diagnoses (CD4 count <350 cells/mm3at diagnosis) across UK declined from 57% (2004) to 39% (2015) however a review within our region in 2013–14 revealed much higher proportion of late diagnoses than UK average, with multiple missed opportunities for testing in majority cases. Data was presented at educational meetings and feedback given to clinicians when delay in diagnosis occurred. We sought to assess impact on late diagnoses and mortality within our population.

Methods

Retrospective chart analysis of new diagnoses from March 2015–February 2016 (Period 2) to determine proportion of late diagnosis, missed opportunities for testing and mortality. Comparison made with results of previous review during July 2013–June 2014 (Period 1).

Results

76 new diagnoses during period 1; 71 in period 2. Late diagnosis decreased from 59% (45/76) to 49% (35/71). Proportion diagnosed through GUM increased from 20% to 34%. Remainder diagnosed in other specialities, most commonly general medicine. Mode of transmission in period 1 and 2 respectively; MSM 49% vs71%, heterosexual 47% vs 23%, IVDU 7% vs 11%. Prior to diagnosis, number patients presenting to other settings with clinical indicator diseases significantly decreased from 84% (38/45) in period 1 to 49% (17/35) period 2. Mortality more than halved from 7% (4/45) in period 1 to 3% (1/35) period 2.

Discussion

While there has been a decrease in number of late diagnoses and mortality rate, the proportion being diagnosed late remains higher than other UK regions. Opportunities for early testing are still being missed and ongoing education required.
P100 Prime: a web-based HIV risk reduction package for high-risk MSM
Authors: Taghinejadi Neda , Lau Rebecca , Amrapala Apichaya , McOwan Alan , Whitlock Gary
Published: May 2024

Introduction

Previous work has shown that HIV-negative MSM with the following characteristics attending our service have approximately a 10% chance of acquiring HIV in the following 12 months: rectal bacterial STI, early syphilis infection, previous PEP use. In May 2016, we introduced a web-based support package, PRIME, targeting such high-risk MSM to reduce their HIV risk and encourage more frequent STI testing with the aim of reducing their risk of HIV acquisition to below 5% per year.

Methods

Notes review of the first 50 MSM recruited to PRIME between 19thMay 2016 and 7thJune 2016.

Results

By the end of 2016, 1531 eligible MSM had joined PRIME. No one had left the service. Of the first 50 PRIME recruits, median age was 32 years. Median number of partners in the preceding 3 months was 5. Indication for joining PRIME was documented in 45 (39 PEP, syphilis 2, bacterial rectal STI 1, 2+ indications, 3). In the preceding 12 months 15 had been diagnosed with chlamydia and 10 with gonorrhoea. To 31stJanuary 2017, there is 18.8 person-year follow up for these individuals. The average frequency of STI screens per recruit increased from 2.7 to 7.1 per person-year follow-up. During follow-up the number of infections was: 7 chlamydia, 4 gonorrhoea. One individual tested positive for new HIV infection, 10 weeks after joining PRIME.

Discussion

The results show it is feasible to engage significant numbers of high risk MSM clinic attendees using online interventions such as PRIME. Early data suggests that the intervention has successfully increased STI screening in this group. Further follow up is required to see if the initiative has achieved its aim of reducing HIV seroconversion to below 5% per year.
P102 Integration of clinic services with online sexually transmitted infection (STI) testing (sh:24) in camberwell, se london: impact of active referral of asymptomatic testing online in 2016
Authors: Turner Katy ME , Zienkiewicz Adam , Looker Katharine , Barnard Sharmani , Brady Michael , Sa Joia da , Holdsworth Gillian , Syred Jonathan , Baraitser Paula
Published: May 2024

Introduction

An online service was implemented in an area with high burden of sexually transmitted infections and poor sexual health outcomes. The aim was to improve access and availability of sexual health, fully integrated within NHS services. This study looks at the impact of a change in management, whereby asymptomatic patients seeking STI testing in the GUM clinic were directed to the online service.

Methods

We compared clinic attendance in 2016 before (quarter 2, Q2) and after (quarter 3, Q3) the change in clinical practice. Individual level clinic attendance data were collated and summarised as simple STI test performed (chlamydia, gonorrhoea, HIV, syphilis) or complex service required. We also compared service use by age, ethnicity and sexual orientation. Changes in pattern of clinic attendance between the quarters were analysed using a Chi2test.

Results

Abstract P102 Table 1

Changing pattern of GUM clinic use.

Q2 (Before)Q3 (After)Total visits (valid code)6,9495,397Simple STI test4,044 (58%)2,823 (52%)Complex service4,785 (69%)4,083 (76%)Complex service & simple STI test2,8452,170

There were significantly fewer simple STI tests (Chi-squared, p<0.001) and more visits requiring complex services (p<0.001) in Q3 versus Q2.

Discussion

Following establishment of efficient online STI testing, the clinic changed its triage practice: asymptomatic patients seeking STI testing were directed to use the online service. The change appears to facilitate a higher proportion of more complex visits although the absolute number of visits has decreased.
P105 Characteristics of frequent attenders at a central london sexual health service
Authors: Farhat-Dominguez Sara , Stegmann Katrina , McOwan Alan , Nwokolo Nneka , Suchak Tara , Whitlock Gary
Published: May 2024

Introduction

BASHH guidance recommends screening for STIs up to every 3 months for individuals at risk of HIV. Conversely, commissioning pressures aim to reduce inappropriate attendances. We describe below the characteristics and outcomes of frequent attenders at our service.

Methods

Notes review of individuals with 4 or more new or re-book attendance episodes at a central London sexual health service between 1stApril 2015 and 31stMarch 2016.

Results

170 individuals received more than 4 new episodes of clinical care in a year; 145(85%) were male, 136 MSM. 21(12%) were female, 4(2.4%) transgender. 23(14%) of the patients were HIV positive, all MSM. Median age was 31 years. Median number of sexual partners in preceding 3 months was 6. 75(44%) disclosed chemsex activity in the preceding month.

In the 12 months from April 2015, there were 442 new STIs in this population, an average of 2.6 per patient: 346 STI diagnoses were in the 147 HIV-negative individuals and 96 in the 23 HIV-positive individuals. In HIV-negatives, the diagnosis was a rectal bacterial STI in 36% and syphilis in 7%. 206 courses of PEP were prescribed; 25 individuals received 4 or more PEP courses. There were 5 new diagnoses of blood borne virus infections; 2 hepatitis C, both in HIV positive MSM, and 3 HIV.

Discussion

The majority of frequent attenders at our clinic had indicators of high risk sexual behaviour. The high number of STIs and PEP prescriptions implies that the frequent attendances are appropriate in this patient population.
P109 Routine hepatitis C antibody testing in MSM – are we overtesting?
Authors: Robinson Michael , Jeffery Katie , Edwards Anne
Published: May 2024

Introduction

The hepatitis C virus (HCV) is rarely transmitted sexually. MSM with HIV are at increased transmission risk. Debate exists regarding sexual transmissibility of HCV in those without HIV or additional risk factors beyond receptive anal intercourse. Following outbreaks of HCV in Europe and London in MSM, Oxfordshire Sexual Health Services introduced annual unselected HCV antibody testing as a screening minimum for all MSM. Evidence now suggests this may not be necessary. We set out to audit our HCV testing to assess this and identify potential policy modification.

Methods

We reviewed all HCV antibody tests undertaken in a 12 month period. We identified all HCV positive patients to determine risk factors for infection in order to establish whether these patients were identified through annual screening or would have been identified using a selective basic risk analysis.

Results

We found 13 positive results out of 1351 tests. 6 had previously known HCV, 4 were co-infected with HIV. 2 were heterosexual men with additional risk factors, one was an MSM with additional risk factors. No HIV negative MSM with HCV infection were identified through annual screening alone. Approximately 3.5% of tests undertaken were based on recognised risk factors for HCV, 96.5% were undertaken as part of annual screening. This equated to £1486 per new diagnosis, excluding service costs.

Discussion

Routine annual screening of HIV negative MSM in this study did not pick up any new HCV diagnoses. Cost per diagnosis may be reduced with targeted testing. The annual screening policy needs modification.
P110 Working smarter by incorporating online testing: maximising self-management or opening an additional channel? a twelve month review
Authors: Spelman Kez , Hughs Taylor
Published: May 2024

Introduction

We reviewed how the introduction of online access to sexually transmitted infection (STI) testing for a county wide sexual health service has affected face to face (F2F) attendances, and overall attendance numbers.

Methods

As part of managing a large county wide integrated-sexual health service we have based our planned attendance numbers on actual activity data from previous years to forecast service activity. In April 2016 we introduced the option of online STI access alongside a complementing triage system. Using electronic record and online access data we compared actual to projected activity, and established the effect of the online service in terms of overall activity for 2016/17.

Results

The introduction of an online channel together with a reviewed triage system appears to have directly reduced F2F attendances. The overall activity level including both F2F and online for the service did rise, but based on the cost of F2F attendance compared with theaverage cost of online tests, there are still estimated savings of over £500,000 and predicted reduction of around 10,000 F2F attendances.

Abstract P110 Table 1

F2F and Online testing

ServiceActivity plan 2016–17Activity actual 2016–17 (based on quarters 2 and 3 extrapolated)F2F5941049398Online access465417118Total6406466516

Discussion

People have been satisfied with the online service and it appears to be an acceptable and popular alternative and not and addition to F2F. The reduction in F2F attendances (10,000) frees up clinical time enabling improved and increased resource for complex care and staff and service development.