Download NIHR HPRU for STIs and BBVs: Academy PhD project proposals

NIHR HPRU for STIs and BBVs: Academy PhD project proposals
1.
Supervisors
Dr Elaine Genders (Reader in
Criminology, UCL) and Dr Eamonn
O’Moore (Director Health & Justice,
PHE).
Research Proposal
A longitudinal qualitative study to explore
lived experiences of the Cascade of HIV
Care, within prison institutions and
between prison and community settings
Summary
Background: The Cascade of Care is a novel means of monitoring the HIV
epidemic, offering estimates of people living with HIV across the different phases of
care. Although the burden of blood-borne viruses (BBVs) in UK prisons is reportedly
high, HIV surveillance systems specific to prisons are undeveloped. The introduction
of opt-out BBVs testing in April 2014 is likely to have significant implications for
current understandings of HIV epidemiology in prisons, with similar interventions in
the US seeing a dramatic increase in case identification. There is little known about
the individual, social and systemic factors that shape experiences of HIV care in UK
prisons. Current HIV service deficiency compromises the health of prison populations
and heightens risk of further HIV transmission with prisoners living with HIV thought
to face considerable social and structural barriers to HIV treatment and care. Reentry into the community, and possible recidivism, are likely to pose additional
complications for continuity of care. There is a critical need for further evidence
relating to HIV treatment experiences in UK prison settings. How is HIV treatment
navigated in the context of the prison environment? How does the prison setting
shape treatment vulnerabilities and the capacity to engage in care? How are
meanings of HIV treatment and the care cascade shaped by the prison experience
and across ‘transitions’ between prison and community contexts?
Proposal: The proposed study will adopt a longitudinal qualitative approach, using
ethnographic methods and in-depth interviews, to explore prisoners’ lived
experiences of the Cascade of HIV Care. The study will also seek to examine how
treatment experiences and meanings are renegotiated across transitions
within/between institutions, following re-entry into the community and, where
relevant, re-entry into prison
Addressing the gap of undiagnosed HIV,
HBV, HCV using enhanced dried blood
spot/saliva sampling as a strategy to
impact on HIV, HBV, HCV Public Health
epidemiology in the UK
Background: Reducing the burden of undiagnosed BBVs is important in controlling
the public health impact on onward transmission and undetected disease
progression. Access to diagnosis and behavioural, attitudinal aspects of various
public health population groups are key determinants in formulating strategies to
address the gap in undiagnosed infections. The impact of this is more pronounced in
the hard to access population such as Black African/Black Caribbean, PWID and
those with higher rates of ongoing transmission such as MSM. Traditional diagnostic
and screening measures involving venous sampling has not resulted in an increase
in the proportion of diagnosed HIV and HCV. The aim of this proposal is to assess
non-traditional sampling (e.g. dried blood spot / saliva, home sampling) as effective
tools for screening and diagnosis to close the gap of undiagnosed BBVs whilst
providing real-time molecular epidemiology information on HIV and HCV,
commensurate with current diagnostic methods.
Proposal: This PhD proposal would involve sexual health providers covering
populations with higher ongoing transmissions for HIV, HCV (as mentioned above).
Health care seeking behaviours will be assessed by questionnaires and through
Professor Tim Rhodes
Head of SEHR and Professor of Public
Health Sociology
LSHTM
2.
Dr Greta Rait (UCL), Dr Tony
Nardone, Dr John Parry and Dr Noel
Gill, PHE Colindale (PHE)
Samuel Moses
(Virology)
Virus Reference Department
HIV/Viral STI, Antiviral Units
Public Health England Reference
Microbiology Services
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3.
Dr Cath Mercer (UCL), Dr Stephanie
Chisholm (PHE Colindale), Prof Nick
Thomson (The Wellcome Trust Sanger
Institute and LSHTM) and Dr Simon
Harris (The Wellcome Trust Sanger
Institute).
Dr Gwenda Hughes
STI Section Head, PHE Colindale
Use of whole genomic sequencing to
understand the relationship between
sexual attitudes and behaviours on
spatial and phylogenetic clustering of
gonorrhoea in high-risk sexual networks
Respondent-Driven Sampling [RDS] where preference for DBS/saliva sample in
community/home sampling has been indicated, sampling for such will be undertaken
with a control arm randomisation for routine blood sampling. Where participants do
not state a preferred choice, consent would be obtained for both non-traditional and
venous sampling. Part of the PhD student’s time will be employed in refining the
serological and molecular tests for HIV, HBV, HCV in non-traditional samples at PHE
Colindale and working with laboratory and epidemiology colleagues to analyse the
prevalence estimates, molecular epidemiology and viral resistance/polymorphisms
using Sanger/Next Generation Sequencing comparing it to outputs from paired blood
samples where available within the study testing algorithm. Within the participant
care pathway, the testing algorithm will allow for subsequent blood sample access for
saliva samples alone as molecular yield for HIV, HCV is poor in saliva.
Background: The overarching aim of the 'Risk and risk reduction theme' of the
Health Protection Research Unit on STIs and BBVs is to improve understanding and
the knowledge-base of the behaviours, attitudes, and factors that influence the risk of
STI and BBV acquisition and transmission in key population groups, to inform and
support the targeting and delivery of interventions. In the short term the aim is to
develop a system for periodic, in-depth exploration and assessment of behaviours,
attitudes, decision-making, and factors related to STI and BBV risk in black
Caribbeans (BCs) and men who have sex with men (MSM) using qualitative and
quantitative methods. The aim is to implement a bio-behavioural rapid risk
assessment system (RRAS) in selected sexual health clinics and link this
behavioural data to socio-demographic and clinical data available in the genitourinary
medicine clinic activity dataset – GUMCAD.
Proposal: This mixed methods PhD proposal will seek to develop this work further
by investigating how whole genomic sequencing can be used to enhance
behavioural and other contextual risk information to determine sexual networks which
could be targeted by specific, tailored interventions. The study will investigate the
degree to which specific risk behaviour profiles are correlated with spatial clustering
and phylogenetic relatedness, and whether they are useful markers of high-risk
sexual networks. Using gonorrhoea as an example, the study will link the data
collected on BC and MSM populations diagnosed with gonorrhoea in the combined
RRASs/GUMCAD dataset, to data on sequence types from specimens collected
through the gonococcal resistance to antimicrobials surveillance programme
(GRASP). The relationship between risk behaviour and antimicrobial resistance
profiles will also be explored.
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4.
Dr Greta Rait (UCL), Katy Turner
(SCCM/CVS), Sarah Woodhall (PHE)
Development and evaluation of a
Chlamydia Control Cascade
Dr John Saunders
Clinical Champion
National Chlamydia Screening
Programme
Public Health England
5.
Dr Fiona Burns
Dept of Infection & Population Health,
UCL
Alison Rodger (UCL), Tony Nardone
(PHE), Chris Bonnell (UCL)
Meeting the HIV prevention needs for
those of black African ethnicity in London
Background: In England the National Chlamydia Screening Programme (NCSP)
recommends opportunistic testing of women and men aged <25 years annually or on
change of sexual partner. The aim is to identify and treat infected individuals and
their partners to prevent serious reproductive outcomes in women and to reduce the
burden of population disease by reducing transmission and incidence of infection.
There is still uncertainty about the effectiveness and cost-effectiveness of
programmes to control chlamydia transmission at a population level and to prevent
reproductive sequelae following a diagnosed and treated chlamydia infection. Part of
the reason for this uncertainty is the multiple elements to control activities which can
act synergistically or antagonistically and thus affect the apparent impact of the
programme. The notion of care cascade has been successfully used to prioritise
control activities for HIV and to locate areas for service improvement. A chlamydia
control cascade would encompass all elements of a chlamydia control programme
within a simple structure. The key elements of chlamydia control include effective
case management and prompt treatment, opportunistic screening and diagnosis,
effective partner notification and retesting of positives at three months
Proposal: We will develop and validate a chlamydia control cascade and apply the
tool to regional and national level data in the UK. We will use national data collected
by PHE to better estimate maximal and minimal rates of chlamydia testing and
diagnosis since the inception of the NCSP in 2003. We will also use data from the
NATSAL surveys (UK national surveys of sexual attitudes and lifestyles) to inform
sexual behaviour data and an individual cohort from regional and local settings to
inform testing behaviour in a UK setting. We will populate the model with data from
local areas to assess a fully integrated dataset of chlamydia control activity
regionally. We will explore differences observed and analyse which variables have
the greatest influence on reported positivity.
Background: In the UK, the HIV epidemic is largely concentrated in London with
nearly half (32,500) of the 77,600 people living with a diagnosed HIV infection living
in London and 42% (2,832) of the 6,360 new HIV diagnoses in 2012 made in London
clinics. The two communities who remain most at risk from HIV are men who have
sex with men (MSM) and Black African heterosexual men and women. The
prevalence of HIV in both communities is high (>5%). The London-wide HIV
Prevention Programme (LHPP) is an evidence based behavioural intervention (using
media, condom distribution, and outreach programmes) being established to
interface with and complement the biomedical (test and treat) services commissioned
by Local Authorities in clinics since 2013, to achieve a combination intervention
package across London focused on MSM and Black Africans. This PhD will focus on
assessing if current initiatives meet the HIV prevention needs of those of black
African ethnicity living in London and spans two HPRU theme areas, theme A
(understanding risk and risk reduction for STIs and BBVs) and theme B (Reducing
the burden of undiagnosed STIs and BBVs)
Proposal: To explore whether HIV prevention needs for black Africans in London are
currently being met. This will be a mixed methods programme of work involving (i)
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analysis of PHE databases (GUMCAD and HIV) to assess changes in GUM service
use, HIV testing patterns and late HIV presentation in those of black ethnicity, (ii) a
mapping exercise followed by the development and implementation of a large scale
cross-sectional survey of Black African communities in a variety of social and
community settings and (iii) qualitative work including focus group discussions and
semi-structured interviews to assess the reach and impact of the LHPP.
6.
Prof Andrew Philips
Dept of Infection & Population Health,
UCL
How frequently should individuals living
with HIV be seen for clinical care? What
is the most cost-effective approach to
monitor such patients?
Valentina Cambiano, Alec Miners
(LSHTM), PHE
7.
Prof Caroline Sabin
Dept of Infection & Population Health,
UCL
Fiona Burns (UCL), Jonathan Sterne
Are sub-optimal out-patient attendance
patterns ‘bad’ for HIV patients?
Background: The introduction of combination antiretroviral therapy (cART) has led
to a dramatic reduction in HIV-associated morbidity and mortality. The life
expectancy of those living with HIV has increased to the extent that it is now similar
to that of the general population. This has resulted in a burgeoning clinical population
of patients who are well on therapy, but are required to attend for care for follow-up
visits. As there have been no increases to the resources available to clinics, many
clinics have had to make changes to the way their HIV service. These changes have
commonly included less frequent scheduled visit dates, and a reduction in the
numbers of laboratory tests. These changes have generally been made based on
expert opinion rather than on evidence. It is generally felt that a policy of less
frequent patient visits is unlikely to introduce safety concerns for patients. It is
possible that the identification of virological failures on cART, should they occur, may
be delayed with less frequent patient monitoring, which may lead to an increase in
the development of drug resistance at the population level. Whilst this may have
only a limited effect on the outcomes of the person’s next cART regimen for most
people, there may be longer term implications for these people. Unfortunately,
assessment of the associations between the frequency of clinic visits and/or
laboratory monitoring and resistance development and clinical outcomes are fraught
with problems due to the presence of confounding and issues around missing and
incomplete data. Use of mathematical modelling may provide an alternative means to
address this issue. The HIV Synthesis model is an existing model for HIV disease
progression developed by Prof Phillips, which simulates the full course of an
individual’s HIV infection.
Proposal: This project will involve the modification of the existing model structure for
HIV Synthesis to introduce different patterns of monitoring and attendance, and to
assess the impact of these on virological failure, resistance development, CD4 count
responses to therapy and subsequent clinical progression. The student will apply
utility scores and NHS costs to clearly defined health states within the model to allow
the student to model disease progression, quality-adjusted life years and NHS costs,
at different levels of engagement. The final model will then be broadened to consider
other models of care that may be used within the HIV setting.
Background: Combination antiretroviral therapy (cART) has revolutionised the care
of people living with HIV (PLWH). In addition, cART has been recognised as an
effective means of reducing HIV transmission. Yet these individual and public health
benefits can only be achieved if PLWH are aware of their infection and have
sustained engagement with HIV care. Good engagement with health care is
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(Bristol), Valerie Delpech (PHE)
associated with improved adherence, virological and immunological outcomes on
cART and survival. Poor retention in care represents one of the major challenges of
optimising patient outcomes. Traditionally, retention in care has been defined in
terms of attendance data over an arbitrarily defined time period. However, this simple
approach may hide many different patterns of attendance, some of which may be
associated with poorer outcomes than others. The REACH study (Exploring patterns
of Reach and Engagement Across specialised Care services of HIV positive patients
in the UK) aims to explore, describe, and understand HIV out-patient attendance in
people living with HIV, in order to develop cost effective interventions to optimise
their engagement in care. To date, study researchers have described typical
attendance patterns using data from the UK Collaborative HIV Cohort (CHIC) study,
a large observational study of individuals attending for HIV care at some of the
largest HIV clinics in the UK. Researchers have demonstrated that patients may
exhibit several different patterns of attendance, and that the pattern of attendance
may change over time within an individual. The challenge now is to correlate these
patterns with clinical outcomes. However, assessment of the impact of attendance
patterns on clinical outcomes is difficult due to problems of reverse causality
(whereby patients who are sicker tend to attend more frequently than those who are
well). Furthermore, statistical methodology for assessing the association between
changing patterns of attendance and outcomes is restricted.
Proposal: The focus of this PhD project is in the development and application of
novel statistical methodology to describe associations between patterns of outpatient attendance and long-term outcomes. This would be a joint PhD with the
HPRU in Evaluation of Interventions at the University of Bristol. Estimates from this
work would be directly used to inform models to be used to assess cost effectiveness
of different models of HIV care.
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Prof Caroline Sabin
Dept of Infection & Population Health,
UCL
Valerie Delpech (PHE) Fiona Burns
(UCL)
Assessment of HIV patient complexity
using routinely collected linked data from
several source
Background: There is considerable interest in an evidence-based method to
describe HIV patients under care as either ‘complex’ or ‘stable’. From a
commissioning perspective, the ability to robustly stratify patients into one of these
groups would allow funding to be distributed appropriately, to centres with the
greatest burden of care. From a patient and provider-perspective, accurate
categorization of patients would allow frequency of monitoring to be optimized.
Whilst many clinics already have their own definitions of ‘stability’, these are varied
and criteria may differ from clinic to clinic. The UK Department of Health National
Payment by Results (PBR) working group has proposed a means to classify patients
as ‘complex’ – however, the criteria selected largely reflect a compromise between
widely differing opinions, and several of the proposed criteria require clinical
information that may not always be captured in clinical databases, limiting the use of
this definition for research purposes.
Proposal: The objectives of this project are to: perform an assessment of the various
criteria for ‘complexity’ (or ‘stability’) to determine the likely value of each set of
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criteria for research purposes; conduct studies to determine clinical perceptions
about ‘complexity’ and to see whether these perceptions are affected by the
demographics of either the clinician or the patient; use routine clinical data to
compare the various different criteria in current use, and their associations with
longer-term clinical outcomes and make recommendations for the most appropriate
criteria to use in any given setting. Data for the project will come from the UK
Collaborative HIV Cohort (CHIC) Study, a large multi-centre study of >45,000
patients with HIV seen for care at one of 15 clinical sites from 1996 onwards, with
linkage to HIV surveillance datasets collected by Public Health England (PHE).
9.
Prof Caroline Sabin
Dept of Infection & Population Health,
UCL
Use of linked clinical and genotypic
databases to understand the genetic
contributions to clinical outcomes in
individuals with HIV
Tamyo Mbisa (PHE), Samuel Moses
(PHE)
Background: A number of genome-wide association studies have addressed
genetic correlates with HIV disease progression. The main driver for such studies
has been to identify correlates of natural attenuation of infection, to inform vaccine
development. However, little work has been undertaken in the context of
combination antiretroviral treatment (cART) or related to specific risks for
complications of HIV infection. There is evidence to suggest that suppression of viral
replication by cART is insufficient to prevent premature acquisition of cardiovascular
events, or hepato-renal pathology and the risk of non-AIDS cancers also appears to
be raised. Further, there remains heterogeneity in the immunological response to
cART.
Proposal: The UK Collaborative HIV Cohort (UK CHIC Study) is a longitudinal study
of >45,000 HIV-positive individuals seen for care at many of the largest HIV clinics in
the UK. Recently, we have received funding for host genome sequencing of 10,000
participants in this study through the UK BioResource, as well as capture of
information on several non-AIDS clinical conditions. Using the information generated
through linkage of the genotypic data that will be obtained, with extensive phenotype
data from UK CHIC (including longitudinal data on responses and outcomes of
cART), this project will investigate the genetic contributions to several outcomes,
including (but not limited to): discordant virological and immunological responses to
cART; immune reconstitution syndrome; switches in antiretroviral therapy for toxicity
reasons; renal disease progression and cART-associated nephrotoxicity; central
nervous system diseases; cART-associated hepatotoxicity and long-term virological
control in the absence of cART.
10.
Prof Caroline Sabin
Dept of Infection & Population Health,
UCL
Richard Gilson (UCL), William
Rosenberg (UCL), Sam Lattimore
(PHE)
Ongoing assessment of uptake and
outcomes of drugs active against
hepatitis B and hepatitis C virus in
individuals co-infected with HIV
Background: Despite the lack of information on drug-drug interactions and
resistance development to the new directly acting antivirals (DAAs) in those coinfected with HIV and HCV, it is likely that use of these drugs will become
widespread rapidly. Over the past two years, we have undertaken a detailed review
of data for all patients who are co-infected with HCV (n=3299) attending 11 of the
participating UK CHIC clinics. As a result, our database now contains detailed
information on ultrasound, biopsy and fibroscan results, prothrombin time, INR,
alpha-feto protein, HCV treatment, HCV genotype, clinical events and transplants
performed. Data collection will continue on this subset (as well as newly identified
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co-infected individuals) on a two-yearly basis. This dataset will provide a
tremendous resource to answer new questions relating to co-infection in the UK.
Proposal: The proposed study will examine the following: How frequently are the
new DAAs used in this cohort and are there any differences in the characteristics of
those who have access to these drugs and those that do not?; What are the
virological and clinical outcomes of the new DAAs?; What impact do these drugs
have, if any, on response to cART? Is there still a detrimental effect of HCV coinfection on immunological responses to cART; What are the patterns of resistance
among individuals with treatment failure on the new DAAs?; How frequent is reinfection with HCV in this population (particularly in MSM and IDU) and does the
success of treatment decline with subsequent courses of therapy?; How do the
virological and clinical outcomes in those co-infected with HIV compare to those seen
in individuals infected with HCV or HBV alone?; Are there any other genetic
determinants of clearance/reinfection with HCV other than IL28b?
11.
Dr Nigel Field (UCL), Dr Pete
Weatherburn (LSHTM) and Professor
Nick Thomson (The Wellcome Trust
Sanger Institute and LSHTM).
Dr Gwenda Hughes
STI Section Head, PHE Colindale,
Prevalence, risk markers and
phylogenetic clustering of Shigella spp.
infection among men who have sex with
men attending genitourinary medicine
clinics: Use of a bio-behavioural rapid risk
assessment system to identify
opportunities for infection control
Background: In 2010, an outbreak of non-travel related Shigella flexneri (a
gastrointestinal [GI] infection transmitted through the faecal-oral route which can
cause severe dysentery) among adult males in England was associated with sexual
transmission among men who have sex with men (MSM). Since then, diagnoses
have continued to rise and Shigella flexneri is now considered endemic in this
population. In-depth qualitative interviews of a small sample of the infected men have
suggested specific sexual activities and drug-use behaviours among HIV-positive
MSM played a role in the outbreak. Many questions remain unanswered. It has not
been possible to determine the specific risk practices and contextual factors
associated with infection, and whether transmission occurs in the same sexual
networks as for ‘classical’ sexually transmitted infections (STIs). There is also a lack
of understanding of MSM’s attitudes and awareness of the risk of faecal-oral
transmission and of the acceptability of proposed interventions. Further, as there is
evidence to suggest that some GI infections may be carried asymptomatically, and
as such infections will not be routinely tested for in genitourinary medicine (GUM)
clinics, the background prevalence of Shigella spp infection and the risk of onward
transmission among sexually active MSM is unknown.
Proposal: The overall aim of this PhD proposal is to determine the prevalence and
associated risk factors of Shigella spp. infection in sexually active MSM attending
GUM clinics to improve the evidence base for better infection control. The research
will investigate the clinical outcomes, risk practices and risk contexts associated with
Shigella spp. infection and how these are influenced by attitudes and awareness. As
part of the 'Risk and risk reduction theme' of the HPRU on STIs and BBVs, the study
will develop a bio-behavioural rapid risk assessment system (RRAS) on Shigella spp.
infections for completion by MSM attending selected sexual health clinics. Those
agreeing to participate will also be asked to provide a faecal sample or swab to test
for Shigella. Data from the RRAS and Shigella testing will be linked to socio-
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demographic and further clinical data on STI and HIV co-infection available in the
GUM clinic activity dataset (GUMCAD). Whole genome sequencing (WGS) will be
used to analyses a sub-set of Shigella samples to identify molecular markers of
phylogenetic relatedness and explore whether strain types vary across population
groups, and thereby determine which clinical, behavioural and contextual factors
characterise distinct sexual networks and might be targeted for interventions.
12.
Dr Ali Judd
Inst of Clinical Trials &Methodology
(UCL)
Prof David Dunn (UCL), Valerie
Delpech (PHE)
13.
Dr Cath Mercer (UCL), Dr Gwenda
Hughes STI Section Head, PHE
Colindale,
Dr. Martine Collumbien (LSHTM)
Young people with life-long HIV
transitioning to adult care: keeping track
of engagement in care and long-term
well-being and life expectancy. Type of
PhD: Applied statistics or infectious
disease epidemiology
Background: For young people who acquired HIV perinatally or in early life (PHIV),
the process of transition from paediatric to adult care is key to shaping HIV care
engagement as well as health outcomes. Evidence suggests considerable morbidity
and mortality in PHIV transferring to adult care, in excess of that seen in paediatrics
and in horizontally HIV-infected adults. This study will utilise existing cohort studies
and datasets within the HPRU to identify who are the most vulnerable PHIV in terms
of care disengagement and mortality, in order to help inform future NHS service
delivery.
Proposal: This PhD project will form part of a wider NIHR-funded mixed methods
study evaluating how the health of PHIV changes during and after the process of
transition to adult care. The proposed study will include: conducting a literature
review describing health outcomes of PHIV following transition to adult care;
exploring methods to use routine outpatient attendance data to estimate care
disengagement; initiating and validating data linkage of CHIPS/ CHIPS+ to UK CHIC,
PHE HARS and mortality data to minimise loss-to-follow-up and maximise the validity
of mortality and progression to AIDS estimates; exploring methods to deal with
missing data; estimating rates of care disengagement and mortality in PHIV and
exploring predictive factors for these outcomes; comparing rates of outcomes in
PHIV to those with horizontal infection
Identifying social and contextual factors
mediating Black Caribbean & Black Other
populations’ vulnerability to poorer sexual
health outcomes: participatory qualitative
research to explore risk and risk reduction
capacity.
Background: Black Caribbean/Black Other populations in Britain have poorer sexual
health outcomes than other ethnic minority groups, including the majority white
population. The Black Caribbean (BC) population in particular has a higher
prevalence of bacterial STIs. The second British National Survey of Sexual Attitudes
and Lifestyles (Natsal-2) completed in 2001 found significant association between
the number of reported STIs and ethnic origin with BC most at risk. Evidence from
Natsal-2 of specific risk practices showed higher reported numbers of sexual
partnerships by BCs in lifetime than other ethnic groups, as well as higher reported
concurrency for BC men than white men. Questions remain about the contextual
vulnerabilities and behaviours which lead to negative sexual health outcomes among
these two populations. Individual-level behaviours need to be examined; this includes
attitudes to and consistency of condom use, age at first sex, drug and alcohol use.
Deeper understanding of group-level risk associated with poorer outcomes is
essential; topics for exploration would include cultural norms, discrimination, and age
mixing. Identification of the most salient social and contextual factors is critical to the
improvement of cultural competency in clinics and target interventions.
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Proposal: The overall aim of this PhD proposal is to identify social and contextual
factors which affect the sexual health of two ethnic minority populations: Black
Caribbean people and those identifying as Black Other. This work would inform
social interventions across the life course and improve the evidence base for tailored
sexual health promotion. It would also seek to describe ways to inform improved
cultural competence of healthcare workers and best practices in service delivery.
The research will describe the sexual networks of these populations, and ascertain
their attitudes towards STIs/BBVs risk and use of any risk reduction practices. This
will aid understanding of factors mediating risk and risk reduction capacity.
The study will consider specific vulnerabilities and routes to risk reduction of subpopulations within these ethnic groups, including women, young people, faith groups,
gender and sexual minorities. It will examine other risks associated with poorer
sexual health outcomes, such as non-volitional sex and alcohol or drug use.
Under the HPRU theme 'Understanding risk and risk reduction' related to STIs and
BBVs, the study will investigate how attitudes, behaviours and contextual factors
affect sexual health outcomes for two population groups. Research participants will
be engaged with using a variety of qualitative methods and participatory approaches.
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Dr Greta Rait Dept of Primary Care
and Population Health, UCL
Prof Jackie Cassell (PHE)
HIV diagnosis and management in
primary care
Background: HIV testing in primary care is advocated by NICE in high prevalence
areas and in people presenting with clinical indicator conditions or at risk of HIV.
Around 50% of people with HIV present late. This is associated with increased
morbidity, and contributes to a high proportion of HIV related deaths. There majority
of new HIV diagnoses had attended primary and secondary care previously, with
missed opportunities for earlier diagnosis. While testing at registration with a GP has
been piloted and trialled, many undiagnosed individuals will be registered with the
same GP long term. Clinical indicator diseases (CIDs) provide a robust opportunity to
offer an HIV test with a higher chance of a positive result, without stigmatising people
since this would be a universal offer based on their clinical condition. Increasingly
people with HIV are known to their general practice and with increasing life
expectancy are presenting in primary care with other long term conditions.
Proposal: There is potential to use electronic health records to such as the THIN
(The Health Improvement Network) primary care database linked with Hospital
Episode Statistics to examine HIV testing and management in primary care. The
THIN database derives data from routine clinical practice in the UK and contains the
records of nearly 12 million patients. The proposed study will examine the delivery of
HIV testing to people with CID in general practice; examine HIV testing patterns and
also investigate how patients with HIV known to their general practice are managed,
particularly regarding other long-term conditions.
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Dr Greta Rait (UCL) Dept of Primary
Care and Population Health, UCL
Exploring the sexual health needs of
young bisexual, gay and other men who
Background: Gay, bisexual and other men who have sex with men (MSM) are
disproportionately affected by infection with HIV and other sexually transmissible
infections (STIs). For this reason many sexual health prevention strategies target this
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have sex with men
Dr John Saunders
National Chlamydia Screening
Programme (PHE)
Prof Jackie Cassell (PHE)
risk group. Ensuring that these men understand how to protect themselves from
infection is an important part of helping to reduce incident infection and diagnose
new infections. Providing this information before initiation of same sex activity may
be particularly important. However, the development of sexual identity and the debut
of same-sex sexual activity may mean that young men with sexual attraction to other
men do not yet identify as gay or bisexual, and indeed may never do so. This may
limit their access to relevant sexual health information or services available to them.
Proposal: This PhD would use a mixed method approach to better understand how
young men with sexual attraction to other men navigate the available information on
sexual health. It would also explore the knowledge, attitudes and behaviours of
young men with sexual attraction to other men to better understand how to produce
relevant and appropriate sexual health messages for this group.
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Dr Greta Rait (UCL) Dept of Primary
Care and Population Health, UCL
Prof Jackie Cassell (PHE), Dr Julia
Bailey (UCL)
Dr John Saunders
National Chlamydia Screening
Programme (PHE), Dr Lorraine
McDonagh (UCL)
Development of a theory-based and
evidence-based digital intervention to
increase screening for sexually
transmitted infections and blood borne
viruses among young men who have sex
with men.
Background: The impact STIs and BBVs is greatest among young people (aged 1524 years) and men who have sex with men (MSM) where the highest prevalence
rates are found. Younger MSM (YMSM) have been identified as a particularly
vulnerable subgroup with even higher rates of STIs. To detect and reduce the
transmission of STIs/BBVs, annual or more frequent screening for YMSM is
recommended in several countries; however, many of those at risk do not receive
screening. Innovative approaches to reach YMSM and increase screening among
this population are needed. The use of new digital technology (e.g., the Internet, text
messaging, applications) may be particularly beneficial in this regard as it holds
special appeal for sexual minority youths. For example, due to its anonymity and
perceived sense of safety against the stigma that surrounds same-sex activity, the
Internet is increasingly being used by YMSM to seek out romantic or sexual partners.
Thus far, however, the use digitally-based interventions to increase STI/BBV
screening remains unexplored among YMSM.
Proposal: The overall aim of this PhD proposal is to develop an intervention(s)
which will enable effective, efficient, and early diagnosis of STIs/BBVs for YMSM.
The first phase of the research will involve a systematic synthesis of evidence
relating to STI/BBV screening in YMSM. Information will be gathered relating to
current provision of screening services for YMSM, barriers and facilitators to
screening, and the effectiveness of interventions to increase screening. In the
second phase of research, a multifaceted qualitative approach using within-method
triangulation will be employed. Specifically, semi-structured individual interviews and
focus groups will be conducted. The qualitative component will focus on expanding
upon any gaps identified throughout the evidence synthesis. Furthermore, screening
location preferences and the acceptability of the use of new technologies to increase
screening will be explored.
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