Research Focus
Gonorrhoea Resistance Assessment by Nucleic Acid Detection: A Program Evaluation (GRAND II Study)
In Australia, gonorrhoea infection disproportionately affects bisexual men living in urban areas and young Aboriginal and Torres Strait Islander people living in regional and remote areas. Antibiotic resistance in the bacterium causing gonorrhoea is increasing. Local strains of this bacterium may soon become resistant to our current first-line therapy with ceftriaxone, which is given by injection.
It is important to preserve the most effective antibiotics to treat gonorrhoea by using them only when the infection is known to be resistant to other therapies.
Western Sydney Sexual Health Centre recently completed a trial of a new diagnostic assay for gonorrhoea, which both detects the infection as well as indicates if an alternative older oral antibiotic (ciprofloxacin) can be given instead of the injectable ceftriaxone. This is called resistance-guided antimicrobial therapy.
Some of our patients were offered oral ciprofloxacin instead of the usual injectable ceftriaxone when this test indicated it is possible to do so. Established patient follow up procedures at clinical services assessed if treatment has been successful.
SpeeDx ResistancePlus GC assay
Ongoing Research Projects
GOGOVAX:
A multi-centre randomised controlled trial evaluating the efficacy of the four-component meningococcal B vaccine, 4CMenB (Bexsero®), in the prevention of Neisseria gonorrhoeae infection in gay and bisexual men
Gonorrhoea poses a serious global public health threat, with increasing prevalence and drug resistance. Without a vaccine, it disproportionately affects high-risk groups, such as gay and bisexual men (GBM) and transgender individuals, increasing HIV transmission risk and potentially causing infertility. Recent studies suggest a potential link between receiving the meningococcal B vaccine and reduced risk of gonorrhoea.
The Western Sydney Sexual Health Centre is involved in a trial to test the effectiveness of the meningococcal B vaccine (4CMenB,Bexsero®) in preventing gonorrhoea infection among high-risk populations. Sponsored by UNSW Sydney and managed by The Kirby Institute, the trial enrolled over 630 participants from six sexual health clinics in Australia.
The trial targets GBM+ individuals, including those who are HIV-negative on PrEP, on PEP with planned PrEP initiation, or those living with HIV who have an undetectable viral load, who have had recent diagnoses of gonorrhoea or infectious syphilis in the last 18 months. This group has the highest known gonorrhoea incidence and is recommended for regular comprehensive sexual health screening.
Participants received either the vaccine or placebo (an injection which looks like the vaccine but does not contain any active ingredients of the vaccine) in two doses over three months to assess if the vaccine reduces new gonorrhoea infections compared to placebo. Recruitment began in late 2021, with routine follow-ups every 3 months over 2 years and data collection involving laboratory tests and research specimens.
Cohort of AustraLIan wOman with HIV (CLIO)
Despite advancements in HIV treatment making it manageable, disparities persist, particularly for women living with HIV. Research predominantly focuses on men, leaving significant knowledge gaps about women's experiences.
Additionally, late diagnosis and undiagnosed HIV remain issues among marginalized populations, including women in Australia. To ensure equitable progress, we must understand and address the unique challenges faced by women living with HIV.
Western Sydney Sexual Health Centre is involved in a CLIO study which is conducted across multiple clinical sites throughout NSW, Victoria, Queensland and Western Australia. The CLIO study aims to address gender-specific issues among women living with HIV (WLHIV) to enhance prevention, education, and health outcomes. The study is aimed at describing the demographic and clinical characteristics of WLHIV in Australia and the care that women are receiving, identify barriers to care, and explore their experiences with HIV healthcare, stigma, and discrimination.
The study aims to enrol at least 250 cisgender or transgender women aged 18 or above living with HIV across various clinical sites in Australia over two years. Participants complete a baseline survey covering various aspects of their health and experiences and have the option for a follow-up study. This study seeks to understand the willingness and barriers to research participation among women living with HIV to enhance their representation in HIV research in Australia.
Currently, 158 women are enrolled, with 30 at Parramatta Clinic. New enrollments are encouraged. Women living with HIV who visit our clinic are invited to participate. Consult your doctor during your next appointment to join. Participants will receive a $20 voucher as a gesture of gratitude.
The Australian HIV Observational Database (AHOD) Sub study
The Australian HIV Observational Database (AHOD) tracks over 4,600 HIV-positive patients across Australia and New Zealand since 1999, providing crucial data for HIV care planning. AHOD collects demographic and clinical data, including HIV markers, treatment use, and coinfections. Participation involves routine data collection by physicians, with optional additional surveys. Data is kept anonymous and confidential, monitored by UNSW Sydney's Ethics Committee.
In 2023, Western Sydney Sexual Health Centre collaborated on an AHOD sub-study focusing on the quality of life (QoL) and social determinants of health among people with HIV. The study involves an online survey completed by the patient about their health and quality of life and linking patient responses to the main AHOD data. The study aims to understand how factors such as treatment, viral load, comorbidities, health behaviors, stigma, social factors and demographics may impact overall well-being and quality of life.
By linking to AHOD clinical data, the study seeks to understand the quality of life of individuals on antiretroviral treatment, informing strategies to improve their well-being and promote healthy aging. Recruitment of this sub-study is open to the existing AHOD main study participants till end of 2024. https://www.kirby.unsw.edu.au/research/projects/ahod
POZQOL
Valuing quality of life among people with HIV
Quality of life is important to all of us but can mean different things to different people. People living with HIV can face extra challenges to good quality of a life as a result of living with a virus that still is associated with stigma and discrimination as well as impacts to health and the need to adhere to daily medication. PozQol is a short questionnaire that was developed in Australia by HIV researchers, community organisations and people living with HIV to specifically measure quality of life in this population. Its use can help clinician to understand what factors are affecting our patient’s quality of life and encourages discussion around these topics.
Brown, G., Mikołajczak, G., Lyons, A. et al. Development and validation of PozQoL: a scale to assess quality of life of PLHIV. BMC Public Health 18, 527 (2018). https://doi.org/10.1186/s12889-018-5433-6
WSSHC incorporated PozQol into routine HIV care in September 2020. PozQol evaluates four quality of life domains: physical health, psychological health, social, and functional health. To enhance understanding of quality-of-life factors among HIV patients, data from all completed PozQol assessments between September 2020 and March 2022 were analyzed. 58% of individuals using the PozQoL tool reported high or very high quality of life, consistent with similar studies in Australia and New Zealand. Various factors, including physical/mental health, employment, Medicare access, and HIV-related concerns, were found to influence quality of life. Understanding these factors helps care teams provide tailored support and referrals to community resources.
For more information, visit https://www.pozqol.org/ or consult healthcare providers.
The SOS2 Study: Treponemal shedding, load, viability, and time to clearance in secondary syphilis: implications for transmission
Syphilis transmission remains a global concern. The transmission of syphilis between sexual partners, and the duration of infectiousness after treatment, remains unclear. The detection of DNA from the bacterium causing syphilis in the mouth and anus of asymptomatic men who have sex with men (MSM) with syphilis suggests possible asymptomatic transmission, especially during secondary syphilis. However, no studies have confirmed whether this detected DNA is from infectious live bacteria, leaving doubts about transmission from these sites. Existing studies primarily focus on asymptomatic MSM, with limited understanding of transmission among heterosexual individuals. Additionally, there's a lack of data on vaginal shedding in women.
Western Sydney Sexual Health Centre is part of a Melbourne Sexual Health Centre-led multicentre SOS2 research initiative which aims to investigate the presence and viability of the syphilis-causing bacterium in various bodily sites during early infection. The study aims to recruit 150 to 250 participants from sexual health centres across NSW and other states. Eligible participants, regardless of gender, will undergo routine physical examination and blood tests upon syphilis diagnosis. They will also provide additional saliva, oral, anal, and vaginal swabs for research purposes. Participation is voluntary, and routine care will be provided concurrently. Consented participants are asked to attend 4 follow-up visits over the course of a month to provide additional samples.
ADAPTPrEP Project
In Australia, GPs have been prescribing PrEP for years. However, some PrEP users are hesitant to see GPs for follow-up care. Utilising GPs for PrEP follow-up could offer added convenience and acceptability.
Western Sydney Sexual Health Centre has initiated an innovative ADAPTPrEP research project which aims to understand patients' needs for PrEP follow-up in general practice and assess their satisfaction with GP-provided care. It will determine if participants continue PrEP usage and adhere to recommended follow-up while seeing a GP. The study may inform the development of more convenient PrEP access options and identify areas requiring additional support and education for both patients and prescribing GPs.
PrEP users can join by completing an anonymous survey and opting into ongoing research. Step 2 involves linking survey responses to medical records for insight into PrEP care needs. Step 3 offers participation in a follow-up cohort with periodic surveys over 2 years. Interested participants must meet specific criteria (be 18 or older, already on PrEP, have no PrEP-related health issues, not in other WSSHC studies requiring clinic visits, have a Medicare card, complete surveys in English for 2 years, and not leave NSW for 12+ months) to participate in the study. Participants can always return to WSSHC for care, if needed. ADAPTPrEP uses a new data collection approach. It is fully automated by the REDCap platform throughout all study follow-up, ensuring privacy and confidentiality.
Interested in knowing about or participating in a WSSHC research study or clinical trial?
If you would like to be part of any of our current research projects, clinical trials or would like more information or want to give feedback, you can discuss the study with your clinician at your next visit
or email WSLHD-WSSHC@health.nsw.gov.au
Visit our website at wsshc.au or scan the QR code below.
