A matched comparison study of hepatitis C treatment outcomes in the prison and community setting, and an analysis of the impact of prison release or transfer during therapy.

Prisoners are a priority group for hepatitis C (HCV) treatment. Although treatment durations will become shorter using directly acting antivirals (DAAs), nearly half of prison sentences in Scotland are too short to allow completion of DAA therapy prior to release. The purpose of this study was to compare treatment outcomes between prison- and community-based patients and to examine the impact of prison release or transfer during therapy. A national database was used to compare treatment outcomes between prison treatment initiates and a matched community sample. Additional data were collected to investigate the impact of release or transfer on treatment outcomes. Treatment-naïve patients infected with genotype 1/2/3/4 and treated between 2009 and 2012 were eligible for inclusion. 291 prison initiates were matched with 1137 community initiates: SVRs were 61% (95% CI 55%-66%) and 63% (95% CI 60%-66%), respectively. Odds of achieving a SVR were not significantly associated with prisoner status (P=.33). SVRs were 74% (95% CI 65%-81%), 59% (95% CI 42%-75%) and 45% (95% CI 29%-62%) among those not released or transferred, transferred during treatment, or released during treatment, respectively. Odds of achieving a SVR were significantly associated with release (P<.01), but not transfer (P=.18). Prison-based HCV treatment achieves similar outcomes to community-based treatment, with those not released or transferred during treatment doing particularly well. Transfer or release during therapy should be avoided whenever possible, using anticipatory planning and medical holds where appropriate.

Does the Internet assist clients to carry out contact tracing? A randomized controlled trial using web-based information.

The primary outcome was to determine the acceptability of the Internet, specifically a website for use in standard partner notification. A secondary objective was to determine if a website would enhance the outcomes of currently used partner notification methods. In a randomized control trial, 105 participants diagnosed with chlamydia and non-gonoccocal urethritis (NGU) were randomized and 97 completed the study. About 30% of participants were provided a standard partner letter and 70% were provided the standard partner letter and website. All participants reported that their partners had no objections to the website (0%, 95% confidence interval [CI] 0-5%). There were no complaints received from any partner. The odds ratio for contacting partners was not significantly different between the two groups of participants. The results of this study indicate that providing a website with specific information about the infection to which a partner has been exposed is not harmful.

New technology and partner notification--why aren't we using them?

Partner notification is crucial to the effective control of sexually transmissible infections (STIs) and has not changed substantially over recent years. New technology for communication has been rapidly adopted in our communities but little work has been carried out about its role in contact tracing. Text messaging, emails and the Internet could be useful tools for both provider and patient referral but considerable ethical considerations are involved. Technology is available to help protect the basic tenets of confidentiality and privacy but more thorough exploration of these methods is required to establish efficacy and appropriateness in contact tracing. This research is important if we are to procure an evidence base for future contact tracing strategies rather than allowing these methods to become commonplace at the initiation of our clients.

HIV partner notification: a 2002 Victorian audit.

This audit was carried out in August 2003 and examined HIV notification data in Victoria. We aimed to determine the proportion of partners reported as being traced from newly diagnosed HIV individuals, the type of contact tracing used and identify the number of HIV cases newly diagnosed from contact tracing. We compared men who have sex with men (MSM) with all other newly diagnosed HIV individuals in Victoria (non-MSM). Of the 215 newly diagnosed HIV-positive individuals, 49% (n = 105) could potentially carry out contact tracing. There was a difference between MSM and non-MSM in the proportion of contactable partners (44% vs 63% respectively, P = 0.017). MSM less commonly used provider referral than non-MSM (12% vs 53% respectively, P < 0.001) but more commonly used patient referral (41% MSM vs 9% non-MSM, P = 0.001). Of the 13 individuals found to be HIV-positive through contact tracing, nine (69%) were non-MSM.

Partner notification: preferences of Melbourne clients and the estimated proportion of sexual partners they can contact.

This study was conducted to determine the estimated proportion of contactable sexual partners, the most common types of contact information available and the most acceptable contact tracing strategies for our clients. Five hundred 'walk in' clients completed a questionnaire about their total number of sexual partners, the proportion of contactable partners and available contact information. Women had the highest estimated number of contactable partners (89-94%), men who have sex with men had the lowest (51-73%). The preferred contact tracing strategy was to give partners a website address (76%) and the least preferred was provider referral (33%). There was a difference in the type of information available for contacting sexual partners (P <0.001); most commonly clients reported partners contactable by phone or face to face and least commonly through a third person. The currently used method (doctor's letter) is not the preferred choice of these clients and more innovative methods using recent technology may prove more effective.

Molecular analysis of human immunodeficiency virus strains associated with a case of criminal transmission of the virus.

An investigation was done of the evidence for transmission of human immunodeficiency virus (HIV) from an HIV-positive man to several male and female sex contacts. Phylogenetic analysis of sequences from the gag and env genes showed a close relationship between the predominant virus strains from the source and 2 contacts. However, the likelihood that a female contact was infected by the source could not be determined, despite contact tracing indicating that this may have occurred. One male, shown by contact tracing and molecular evidence to have been infected by the source, subsequently transmitted HIV to his female sex partner. HIV sequence from a plasma sample used as a control in the phylogenetic analysis contained env and gag sequences that were closely related to those from the source. An epidemiologic link between these 2 individuals was subsequently confirmed by contact tracing.