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BackgroundHepatitis C virus (HCV) testing and counselling have the potential to impact individual behaviour and transmission dynamics at the population level. Evidence of the impact of an HCV-positive status notification on injection risk reduction is limited. The objective of our study was to (1) assess drug and alcohol use and injection risk behaviours following notification; (2) to compare behaviour change in people who inject drugs (PWID) who received a positive test result and those who remained negative; and (3) to assess the effect of age on risk behaviour.MethodsData from the International Collaboration of Incident HIV and HCV Infection in Injecting Cohorts (InC3 Study) were analysed. Participants who were initially HCV seronegative were followed prospectively with periodic HCV blood testing and post-test disclosure and interview-administered questionnaires assessing drug use and injection behaviours. Multivariable generalised estimating equations were used to assess behavioural changes over time.ResultsNotification of an HCV-positive test was independently associated with a small increase in alcohol use relative to notification of a negative test. No significant differences in postnotification injection drug use, receptive sharing of ancillary injecting equipment and syringe borrowing postnotification were observed between diagnosis groups. Younger PWID receiving a positive HCV test notification demonstrated a significant increase in subsequent alcohol use compared with younger HCV negative.ConclusionsThe proportion of PWID reporting alcohol use increased among those receiving an HCV-positive notification, increased the frequency of alcohol use postnotification, while no reduction in injection drug use behaviours was observed between notification groups. These findings underscore the need to develop novel communication strategies during post-test notification to improve their impact on subsequent alcohol use and risk behaviours.

There is increasing emphasis on involving the private sector in public health to harness the considerable resources and skills of the business world to address significant health issues. While such collaboration should be encouraged, the involvement of business in public health campaigns can raise unexpected challenges when the approaches and priorities of the public and private sectors clash. We report our experience in developing a public-private partnership to deliver a health promotion intervention using mobile phone text messages in Victoria, Australia. Although the partnership enabled the delivery of text messages on a far wider scale than previously possible, difficulties were experienced during implementation which are likely to have negatively impacted on project outcomes. Our experience has implications for any public health practitioner considering involving a private sector partner in program delivery.

Mobile phone text messages (SMS) are a promising method of health promotion, but a simple and low cost way to obtain phone numbers is required to reach a wide population. We conducted a randomised controlled trial with simultaneous brief interventions to (i) evaluate effectiveness of messages related to safer sex and sun safety and (ii) pilot the use of mobile advertising for health promotion. Mobile advertising subscribers aged 16-29 years residing in Victoria, Australia (n = 7606) were randomised to the "sex" or "sun" group and received eight messages during the 2008-2009 summer period. Changes in sex- and sun-related knowledge and behaviour were measured by questionnaires completed on mobile phones. At follow-up, the sex group had significantly higher sexual health knowledge and fewer sexual partners than the sun group. The sun group had no change in hat-wearing frequency compared with a significant decline in hat-wearing frequency in the sex group. This is the first study of mobile advertising for health promotion, which can successfully reach most young people. Challenges experienced with project implementation and evaluation should be considered as new technological approaches to health promotion continue to be expanded.

Background: Multiple PrEP studies suggest incidence of bacteria STIs among gay and bisexual men (GBM) increases following PrEP initiation, possibly due to changes in behaviour, sexual networks or testing. Regular, asymptomatic STI testing of PrEP users (Australian guidelines recommend three-monthly) may also help suppress incidence longer-term. Using national sentinel surveillance data, we report trends in STI incidence among GBM PrEP-users. Methods: Retrospective patient data were extracted from 35 clinics, with individuals' records linked between clinics. HIV-negative GBM with evidence of TDF/FTC prescription (excluding PEP) contributed person-time from their first subsequent STI test and were censored at their last test or six months after their last PrEP script. Censored participants could re-enter at PrEP re-initiation. Infection date was imputed as a random date between diagnosis and previous negative test. Using Poisson regression, we estimated half-yearly incidence and assessed trends (July 2016-December 2019) for syphilis, chlamydia and gonorrhoea, overall and stratified by anatomical site and age (35 years). To account for selection bias associated with differences in characteristics of GBM initiating PrEP over time, a closed-cohort analysis was conducted among GBM continuously using PrEP across the study period. Results: Among 17,250 PrEP-users contributing 24,823 person-years (median time between tests = 84 days) chlamydia (51.3/100 py to 39.1/100 py; p < 0.001) and gonorrhoea (43.1/100 py to 32.8/100 py; p < 0.001) incidence declined, whereas syphilis incidence increased (6.4/100 py to 9.9/100 py; p > 0.001). Among 3498 continuous-PrEP-users (10,538 person-years), declines were observed for overall chlamydia (54.0/100 py to 42.3/100 py; p < 0.001) and gonorrhoea (43.8/100 py to 34.9/100 py; p < 0.001) incidence; pharyngea chlamydia (p = 0.116) and urogenital gonorrhoea (p = 0.973) were stable, and syphilis incidence increased (6.8/100 py to 11.8/100 py; p < 0.001). For both cohorts, gonorrhoea and chlamydia incidence were greater among GBM < 35 years, with declines most prominent among those [greater than or equal to] 35 years. Syphilis rates and trends did not differ by age. Conclusions: Representing the largest cohort analysis of STI incidence among PrEP-users reported internationally, these data suggest that initial increases in incidence of some STIs following PrEP initiation may be attenuated over time. Frequent testing or changes in the risk profile of PrEP initiates over time may explain some reductions. Risk-mitigation strategies may be needed for younger GBM and to curtail syphilis incidence., OA16.01 M. Traeger (1); J. Asselin (1); C. El-Hayek (1); J. Dittmer (1); E.Wright (2); A. Carter (3); T. Vickers (3); P. Patel (3); C. Fairley (4); B. Donovan (3); [...]