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Phillip Keen: AFAO Syphilis Forum: Outcomes Overview


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Phillip Keen's overview of the aims and outcomes of AFAO's forum on syphilis in May 2009.

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Phillip Keen: AFAO Syphilis Forum: Outcomes Overview

  1. 1. AFAO Syphilis Forum Overview of Aims, Outcomes & Recommendations Phillip Keen
  2. 2. Aims  Link with BBVSS National Syphilis Action Plan process:  Brief AFAO/NAPWA membership on the National Action Plan  Provide an opportunity for AFAO/NAPWA membership and other HIV/STIs Partnership professionals to contribute to the development of the National Syphilis Action Plan
  3. 3. Aims  Update participants on  Current syphilis epidemiology  Syphilis 101 and manifestation in PLHIV  Mathematical modelling of outcomes from interventions  Behavioural research  Innovative interventions  Rapid syphilis testing (New Zealand)  Chemoprophylaxis  Encourage review of STI prevention program planning among AFAO/ NAPWA membership
  4. 4. Outcomes  Significant increase in understanding:  Syphilis epidemiology  Syphilis transmission (ease of transmission)  Manifestation (incl. neurosyphilis)  Effective, acceptable & feasible interventions  Considered input from the community based HIV/STIs sector to the National Action Plan
  5. 5. Outcomes/Recommendations  New and multi-faceted approaches needed, with action in:  Partner notification:  Support for development of procedures in clinical settings that utilise anonymous ICT solutions (eg. web to SMS)  Consider network notification strategies  Syphilis testing:  Increase reach by offering syphilis testing in new settings, including exploration of outreach and community settings; partnerships with health care workers & established clinics in establishment of these  New technologies (eg rapid testing) to increase acceptability and enable new settings  Increase frequency for HSA men (4/12), focus on untested (15% of HSA)  Attention to HIV positive men’s health monitoring & routine syphilis testing  Consider opt-out testing
  6. 6.  Sexually Adventurous Men (SAM):  Not a deficit model. Support for community development approaches. Don’t problematise, just proceed.  Agreement that asking sexually adventurous men (SAM) to reduce partner numbers is less likely to succeed than aligning testing frequency with partner numbers, and other strategies to reduce risks without reducing partner numbers.  Consider recommending re-introduction of condom use for HSA & SAM men (who don’t consistently use them) for a limited period of time.  Social marketing:  Focus on highly sexually active men (HSA) & SAM;  Differentiate syphilis from other STIs – impact  Highlight impact of serosorting in syphilis transmission  Highlight ease of treatment
  7. 7.  Research:  Build evidence base for interventions  Clarify research questions re: blood testing for syphilis  Surveillance:  Build enhanced and sentinel surveillance systems across all jurisdictions (leverage Chlamydia research infrastructure)  Ensure comparability of data & synchronised reporting cycles  Chemoprophylaxis trial:  Interest and likely broad support. Drug resistance unlikely. Inexpensive  Episodic use may suffice  Policy & Health Service Development:  Attention to consistency in testing guidelines  Suggestions for new models of health service delivery; separate testing & treatment.  Policy work in relation to testing costs, pathology payments; aim to reduce barriers to testing for individuals and remove impediments to different service models eg. Rapid testing
  8. 8. Next Steps  A second forum in late 2009 to review outcomes of the National Syphilis Action Plan:  Review market testing  Mathematical modelling  Consider implications for HIV/STIs Partnership responses