Joint World STI & HIV & ASHM Congress

The World STI and HIV congress and Australasian HIV and AIDS conference are happening back to back this week. Delegates have come from all around the world to attend the event. Please read on for a summary of the first day’s events…

A small symposium on Innovations in program design for sexual and reproductive health was held before the official opening. Chaired by Sevgi Aral (@sevgiaral) and James Blanchard, the symposium was sponsored by the Australian Government Department of Health, Hologic, Roche, Cepheid, ViiV Healthcare, Abbott, bioCSL, the University of Manitoba, and HIV Foundation Queensland. The first Speaker was Susanne Awad (@awad_suzan) from Weill Cornell Medical College in Qatar who spoke about a novel modelling strategy and voluntary medical male circumcision (VMMC) among priority age groups in HIV prevention in Subsaharan Africa. In countries like Zambia they are aiming to circumcise 80% of males (aged 15-49) between 2010 and 2017. The total program cost will be $US 333 million and will avert over 300 thousand infections. However, with limited funds for these ambitious targets, such strategies need to start by targeting the most at-risk individuals. To her credit, Awad’s modelling took into account social and behavioural factors that would be impacted by reducing VMMC in certain subgroups and increasing VMMC in other subgroups. A multidisciplinary approach, as Awad made clear.

Susanne Awad’s talk was followed by Cliff Kerr talking about a program called Optima (developed by the Kirby Institute) as a first step to achieving maximal health impact with available resources. Jami Leichliter then took the podium to give a very convincing talk about the importance of policy development, assessment & evaluation in STD prevention & public health. She offered several examples where uptake of health interventions was improved through effective policies. Nana Clement was unfortunately not present to talk about her work in improving active participation of MSM and FSW in controlling HIV in Ghana. Babak Pourbohloul was also unfortunately unable to talk about integrated frameworks to optimize HIV management strategies.

After the break, Patricia Dittus spoke about providing eHealth resources to impecunious adolescents at-risk of STDs and HIV in LA. Patricia flagged the forthcoming STD Prevention Conference in Atlanta in September 2016. Moving to UK research, Sarah Woodhall (and Anne Johnson together with a whole host of collaborators and funding institutes) then spoke to delegates about the use of multiple non–experimental methods to assess a chlamydia screening programme in England. Sarah had some very sobering insights about the declining positivity rates found in laboratories being reflective of screening strategies as opposed to an absolute decline of disease transmission in human populations (but thankfully in the case of chlamydia she suspects there hasn’t been an increase). Of the 22 million people between 16 and 44 in Sarah and Anne’s study, 19 million were estimated to be at risk, 400 thousand were esimated to be infected, and less than 200 thousand were diagnosed, fewer were treated, and even fewer partners were diagnosed and treated (which of course led to cases of reinfection). Sarah described the situation as a leaky bucket. Following on closely from Sarah, John Saunders (@saunders_j) spoke about using a program science approach to improving quality and efficiency within the English National Chlamydia Screening Programme. Theory of Change and Programme Science were used to critically explore and codify approaches to screening programme evaluation and service delivery. Sexual health, reproductive health and HIV services in England are multiple and include local authorities (of which there are 152), NHS England, and clinical commissioning groups. Accessing care from multiple different places can be a significant challenge to some patients. With a light-hearted presentation style, John highlighted three important issues to address: (1) low coverage in high positivity population, (2) low coverage in high positivity testing venue types, and (3) low re-testing rates. A single model of screening delivery is unlikely to work in all settings so John advocated support for local authorities to identify the best service delivery methods for their populations. Improvements through his programme science approach are incremental and accrue through an iterative style of implementation, development and evaluation.

With three parallel sessions, it was hard to choose which talks to attend in the afternoon. The symposium on innovations in program design for sexual and reproductive health continued with presentations from Diego Cuadros, Ghina Mumtaz, and Jacky Jennings. Two other sessions were run alongside. Researchers funded by the Bill and Melinda Gates Foundation ran a session on strategies for HIV/STI prevention in low and middle income countries. Presenters included James Hargreaves (@HargreavesJR), Shari Krishnaratne (@SKrishnaratne), Geoff Garnett (@GatesFoundation), and Tim Hallett. Researchers from ASHA ran a session on “Education about Sex and Relationships: New directions in school and beyond”. Presenters included Peter Aggleton (@CSRH_UNSW), Mary Lou Rasmussen (@mlrasmus), Kerry Robinson, Bonney Corbin (@bonneycorbin), and Louisa Allen.

Eve Cheuk, Kyle Berstein and Sevgi Aral were on the program for the afternoon session on Program Science. Sami Gottlieb, Katherine Turner, Nick Kassebaum, and Teodora Wi were on the schedule to talk in the session on new global and regional estimates of prevalent and incident STI chaired by Nicola Low from the Universität Bern and Nathalie Broutet from the WHO. Chilling statistics (based on 2005-2012 data) about the incidence of 4 curable STIs–Chlamydyia (approx. 131 million cases), Gonorrhoea (approx. 78 million), Trichomoniasis (approx. 142 millon), Syphilis (approx. 6 million)–strengthened the resolve of delegates that they were working in an area of great need. Disparities in the available studies on male and female health were evident. Prevalence data in adults indicated that women had a much longer duration of infection. Sami Gottlieb (interviewed on ABC24) shared a word of caution about comparing previous estimates of incident cases pointing out that different methods were used to gather and analyse the data in previous years. STIs remain a global problem with an estimated 1 million new cases each day (circa. 357 million new cases per year). The lack of robust data was particularly concerning.

Data on worldwide Herpes Simplex Virus type 2 (genital herpes) infection indicated that there were an estimated 417 million individuals (aged 15-49)infected. The highest number of infections were in Africa, with the Americas and South Asia shoulder to shoulder at second. Women exhibited a higher prevalence in all settings around the world. People exhibiting symptoms at any one time were a small proportion of those infected.

HSV-1 infections worldwide in 2012 numbered 3.7 billion (in those aged 0 to 49) with the highest number in the Western Pacific region followed closely by Southeast Asia. Global prevalence was 67% (highest in Africa followed by Western Pacific) with men and women largely on par. The amount of genital HSV-1 was much lower.

In conclusion, STIs are among the most common acute conditions in the world and are more common in females and vary widely by geography. Of course this data required a lot of technical details beyond those presented in this blog. At the time of presentation, this data was under peer review to be published in academic journals. Readers are strongly encouraged to search and read the data when it becomes available in peer reviewed journals.

The first day closed with a keynote lecture on Vaccines against STIs delivered by Professor Ian Frazer, CEO and Research Director, Translational Research Institute, QLD, Australia. His most notable early achievement was the development of the Human Papilloma Virus vaccine with Jian Zhou. Reminding the audience that vaccines are the single best public health measure humans have developed, Frazer gave an overview of where we have got to in recent STI vaccine research developments. He surveyed some of the broad scientific and social challenges in developing vaccines with a sensible eye towards how supply and demand is altered by infection rates, mortality and cultural factors. Developing vaccines takes time and each disease, whether it is a virus or a bacteria, presents its own challenges. Interestingly, Frazer spoke about how his work on autoimmune disease fundamentally shaped his understanding of immunology and vaccinology. The seemingly random combination of genetic, environmental and stochastic events involved in autoimmune disease were crucial early lessons. Frazer’s soft voice and friendly accent warmed his audience as he shared data about topics that some may deem “not quite dinner conversation” (as Frazer’s wife reportedly suggests). His keynote was a great way to finish a day jam-packed with the latest data about STI and HIV research.

A major sponsor of the event is the International Union Against Sexually Transmitted Infections. Please visit their website if you are interested in becoming a member.