Authors

A. Chinelli (1), D. Martinelli (2), G. Paparatto (1), L. Bonaldo (1), M. Di Nino (1), A. Musco (2), M. Ubbiali (3), M. Farinella (4), L. Mangieri (5), M. Rohani (6), I. Pennini (7), S. Bellini (8), R. Galipò (9), P. Meli (10), N. Catucci (11), M. Di Tullio (11), V. De Falco (12), P. Fallace (13), F. Rizzi (14), B. Suligoi (15), M.C. Salfa (15), P. Nardone (15), D. Pierannunzio (15), S. Donati (15), S. Ciardullo (15), L. Tavoschi (1)

Affiliation

(1) University of Pisa, Pisa, Italy, (2) University of Foggia, Foggia, Italy, (3) University of Verona, Verona, Italy, (4) Circolo di cultura omosessuale Mario Mieli, Roma, Italy, (5) Coordinamento Nazionale Comunità di Accoglienza (CNCA), Roma, Italy, (6) Arcigay, Bologna, Italy, (7) Arcigay, Padova, Italy, (8) Lega Italiana per la Lotta all’AIDS (LILA), Firenze, Italy, (9) Associazione Nazionale per la Lotta all’AIDS (ANLAIDS), Roma, Italy, (10) Coordinamento Italiano Case Alloggio HIV/AIDS (CICA), Bergamo, Italy, (11) Lega Italiana per la Lotta all’AIDS (CamaLILA), Bari, Italy, (12) Associazione Nazionale per la Lotta all’AIDS (ANLAIDS) Campania, Napoli, Italy, (13) ASL Napoli 2 Nord, Napoli, Italy, (14) Arcigay Friuli, Udine, Italy, (15) Istituto Superiore di Sanità, Roma, Italy

ABSTRACT

Background: Sexually transmitted infections (STIs) are on the rise all over Europe, including Italy, affecting especially young people. Among the different interventions promoting STIs knowledge and healthier behaviours, comprehensive sexuality education (CSE) represents the best approach. However, in Italy, CSE is not yet included in the curriculum of any grade of school. In this study, we present the preliminary results of a CSE pilot intervention in Italian secondary schools. This initiative was conducted as an objective of EduForIST national project, funded by the Ministry of Health, coordinated by the University of Pisa, in collaboration with the Italian National Institute of Health, Universities of Verona and Foggia, several civil society organisations (CSOs) and three local health departments. In particular, we described the results in the levels of knowledge and satisfaction of students participating in the intervention, from December 2023 to May 2024.

Material and Methods: The pilot intervention targets secondary schools' students and consists of a 10-hour intervention of 5 modules covering topics such as: changes in adolescence, relationships, consent, sexual identity, STIs, unwanted pregnancy prevention and sexual health services. The students’ evaluation consists in pre/post tests assessing knowledge and satisfaction that includes open-ended questions (e.g. sexuality definition; how to improve the intervention). A Solomon four-group design study was used to compare intervention and control classes. CSOs educators and local health unit personnel delivered the intervention in 26 secondary schools (13 lower) of 6 regions. A follow-up test will be conducted 4-6 months after the end of the activity.

Results: Between December 2023 and March 2024, a total of 789 students have completed the pre-tests, 596 the post-tests (including 383 from intervention group) and 351 the satisfaction questionnaires. Preliminary analysis on pre-post tests showed increase in correct answers among the intervention group. The activity was highly appreciated, especially the topics regarding changes in adolescence, emotions, relationships and methods to prevent STIs transmission. The vast majority of students (96% of upper secondary and 86% of lower secondary) considered schools to be the appropriate setting to receive comprehensive information on STIs prevention, preferably by external experts. Further analysis on qualitative and long-term results are ongoing and will aim to determine the impact of the intervention on students’ knowledge retention in short/medium term and satisfaction levels.

Conclusions: The results from this study will contribute to assess the impact of CSE initiatives on sexual health knowledge and attitudes among Italian secondary schools students, and on the efficacy of these programs in fostering healthier behaviours. The evidence generated will inform and support advocacy for the introduction of CSE within the Italian school curricula.

Allegato: Slide presentate alla conferenza

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Reserarch

Authors

A. Tavelli (1), A. Cingolani (2), L. Cosmaro (3), S. De Benedittis (1), N. Frattini (4), G.V. Calvino (5), F.M. Fusco (6), A. Costantini (7), A. Di Biagio (8), B.M. Celesia (9), M. Guastavigna (10), M. Cernuschi (11),(4), D. Calzavara (11), A. Antinori (12), F. Von Schloesser (13), A. d’Arminio Monforte (1), on behalf of Icona Foundation Study Group

Affiliation

(1) ICONA Foundation, Milan, Italy, (2) Clinic of Infectious Diseases, Catholic University, Rome, Italy, (3) LILA ONLUS, Milan, Italy, (4) A.S.A. ONLUS, Milan, Italy, (5) ANLAIDS ONLUS NAZIONALE, Rome, Italy, (6) P.O. ‘D. Cotugno’, Azienda Ospedaliera dei Colli, Naples, Italy, (7) Clinical Immunology Unit, Azienda Ospedaliero Universitaria delle Marche - Università Politecnica delle Marche, Ancona, Italy, (8) Infectious Disease Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy, (9) Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy, (10) S.C. Malattie Infettive e Tropicali I, ASL Città di Torino, Amedeo di Savoia Hospital, Turin, Italy, (11) Milano Checkpoint ETS, Milan, Italy, (12) Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy, (13) NADIR Onlus, Rome, Italy

ABSTRACT

Background: The "undetectable equals untransmittable” (U=U) message should contribute to reduce stigma affecting PWH, who can live without the fear of transmitting HIV once they have reached undetectable HIV-RNA. Nevertheless, still many PWH are unaware of this concept. To spread the U=U message in Italy, an awareness campaign designed by the community ‘U=U-Impossibile sbagliare’ was launched in Sept 2023. This study aims to verify its impact among PWH by measuring the awareness of U=U and its association with self-stigma.

Methods: A survey was disseminated within the PWH of the ICONA network before (Jul-Sept2023) and after the launch of the campaign (Sept2023-March2024). It was accessible via web or Icona mobile app and consisted of the validated HIV Stigma Scale (12-items) and 3 questions on U=U (Do you know U=U? Do you think it is reliable? Did it change your life?). The domains of the stigma scale were 4: personalized stigma, disclosure concerns, concerns with public attitude, negative self-image. Scores varied from 3 to 12, with higher scores indicating higher stigma. The survey was anonymous and not designed to compare pre-/post results of same subject. Data on knowledge of U=U pre-and post-campaign were compared by logistic regression; association between U=U knowledge and HIV stigma was analyzed by linear regression. A logistic regression analysis was conducted to identify factors associated with lack of knowledge of U=U.

Results: A total of 820 PWH responded to the survey: 362 (44.1%) pre- and 458 post- start of campaign (55.9%). 333 (40.6%) PWH responded “No” and 487 (59.4%) “Yes” to the question on knowledge of U=U with no differences according to the period: 226 (62.4%) pre- vs 168 (56.6%) post-campaign knew about U=U (p=0.13) (Table 1). After adjusting for age, gender at birth, MSM, center, education and nation of birth, the marginal predicted probability of knowing U=U pre-campaign was 61.3% (95%CI 56.4%-66.3%) and 57.7% (52.3%-63.0%) post-campaign (p=0.32).
The HIV stigma domain with the highest score was related to disclosure concerns. There was no evidence for an association between knowledge of U=U and the HIV-stigma scale scores; the “concerns with public attitudes” domain was even higher for those who knew U=U (Table 2). Independent factors associated to lack of U=U knowledge were age > 40, being non-MSM, education below university level and not-knowing last HIV-RNA (Table3).

Conclusions: Still 40% of PWH do not know about U=U; it is essential that medical staff dedicate due time to inform their patients. The campaign did not result in an increased knowledge of U=U. Possible reasons relate to the lack of funds to promote the concept widely. In this setting, the spot intervention suggests the need for additional campaigns targeting people still unaware of this concept (those with lower educational level, older age and not MSM). Finally, HIV stigma is a multifactorial issue of which personal awareness of U=U is one -but not the only- driver.

Allegato: Slide presentate alla conferenza

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS end Antiviral Research

Authors

V. Casigliani (1), A. Santoro (2), A. Chinelli (1), A. Agostini (2), G. Giupponi (3), F. Zollo (2), L. Tavoschi (1)

Affiliation

(1) Department of Translational research and new technologies in Medicine and Surgery, University of Pisa, Pisa, Italy, (2) Ca' Foscari University of Venice, Venezia, Italy, (3) LILA Onlus - Italian League for the Fight against AIDS, Italy

ABSTRACT

Background: Despite a declining trend in new HIV diagnoses, late diagnosis remains prevalent, potentially due to reduced HIV risk visibility and stigma. Media play a pivotal role in disseminating accurate information, particularly regarding U=U (Undetectable = Untransmittable) and preventive measures like PrEP and PEP. However, media language often perpetuates stigma. This study analyses HIV media communication in Italy by examining the communication language of the main Italian news sources on Facebook and Instagram, with a focus on U=U evidence.

Methods: A mixed-method analysis examined Facebook and Instagram posts on HIV, along with linked articles. from Italian news sources from 01/2009 to 04/2023. News sources were categorised as “reliable” or “unreliable” using independent third-party classification. Topic analysis identified the main topics in the posts, while an inductive content analysis was conducted on linked articles regarding U=U. The language and the accuracy in explaining U=U were evaluated through a checklist.

Results: A total of 10,539 Facebook posts were analysed, with 716 (7%) from unreliable sources, and 749 Instagram posts, with 18 (2%) from unreliable sources. Reliable and unreliable content surged around World AIDS Day (WAD) on both social media platforms, while it did not happen during the European Testing Week. On Facebook, the frequency of unreliable content increased over time, whereas on Instagram it was rare and recent. On Facebook, topics varied between reliable and unreliable sources: the 3 most frequent topics from reliable sources were: WAD, voluntary HIV spread, and public figures with HIV; those from unreliable sources were: Death and Migrant People; Luc Montagnier and COVID-19 Conspiracies; Public Figures with HIV. The first 3 topics on Instagram were the Italian National Institute of Health and Prevention, WAD, and public figures with HIV. After filtering duplicates, 68 articles nominating U=U were analysed. The analysis revealed 4 main areas: U=U definition, Prevention, Impact on people living with HIV (PLWHIV), and Stigma. Sub-areas within the “U=U definition” included Scientific evidence, Revolution, and Dissemination of the evidence. “Prevention” sub-areas covered Treatment as prevention, Test and treat, PrEP/PEP, and Risk of other STIs. "Impact on PLWHIV" was subdivided into Relationships and sexuality, Parenting, Life expectancy and chronicity, and Quality of life. The accuracy in explaining U=U was generally low, with 6 articles (8.8%) providing only a definition.

Conclusions: The communication surrounding HIV in Italy is limited and primarily centred around WAD. Particularly on Facebook, biases persist, mainly from unreliable news sources, such as associating migration with HIV. The dissemination of the U=U evidence remains inadequate. Urgent action is needed to shift the narrative and emphasize this groundbreaking evidence, which significantly impacts HIV epidemiology and the lives of PLWHIV.

Allegato: Slide presentate alla conferenza

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research

Authors

B. Mocci, A. Pontis, A. Loddo, S. Campus

Affiliation

LILA Cagliari, Cagliari, Italy

ABSTRACT

Background: In 2023, LILA Cagliari ODV (voluntary association member of LILA Italian League for the fight against AIDS) run a campaign which consisted in an interactive map of some public places and hospitals in the city, equipped with QR code which enabled to find information and prophylactic materials, as well as medical centres for HIV, STIs and PrEP in Cagliari. Thanks to an agreement with local bars and nightclubs happy to disseminate our materials, we launched the campaign at the beginning of the summer, thinking of the many tourists on holiday in Cagliari who are not familiar with the city. We took the opportunity to provide specific training to staff who work in these public spaces and a training session was held with them so that they could provide correct information on the hospitals to turn to for PEP, PrEP, or how to take the test in our LILA Cagliari office. LILA Cagliari had a positive response in particular from foreigners on holiday who could not find correct references locally.

Material and methods: To convey the message, a graphic was chosen which resembled a subway network with stops for each of the public places involved in the campaign (Figure 1). To each stop corresponded a public place with its own specific QR code that linked up to the web and social page, likewise for the STIs and HIV centres in the city.
As part of the campaign, large 6x3 meters posters were displayed in the streets of Cagliari and on the seafront, alongside advertisements Online, in local newspapers, local tv and web tv. In addition to this, a strong social context allowed the campaign to amplify its communicative power and to bring users to interact and share the message even further.
A video version was also created and transmitted on monitors across the urban transport network for public information and a printed version with color posters of 15x20 cm format hanging on the buses. These posters literally sold out amongst collectors

Results: The campaign was a great success and LILA Cagliari received praise from tourists who contacted our office. It was picked up by all local media and the main Sardinian newspaper.
It was released in digital format on all social networks and on several online newspapers.
We believe we achieved the goals we set ourselves by bringing focus on sex, STIs and risks especially on holiday, and providing clear information on HIV, STIs and Prep centers in particular to travellers who are not familiar with our city.

Conclusions: The power of the claim created an effective communication campaign with a concrete message available to those who needed info and/or prevention and prophylaxis tools.
For future reference, the involvement of testimonials in places of fun and sexual encounters has been the key to provide correct answers and info.

Allegato: Poster presentato alla conferenza

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research

Authors

D. Martinelli (1), G. Paparatto (2),(3), B. Suligoi (4), M. Salfa (4), P. Nardone (5), S. Donati (5), D. Pierannunzio (5), S. Ciardullo (5), C. Silvestri (6), M. Di Tullio (7), A. Camposeragna (8), P. Meli (9), C. Celata (10), L. Bonaldo (2), M. di Nino (2), M. Ubbiali (11), A. Chinelli (2), L. Tavoschi (2)

Affiliation

(1) Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy, (2) Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy, (3) Health Science Interdisciplinary Research Centre, Sant’Anna School of Advanced Studies, Pisa, Italy, (4) Department of Infectious Diseases, National Institute of Health, Rome, Italy, (5) National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy, 6Healthcare Regional Agency (ARS), Epidemiological Observatory, Tuscany, Italy, (7) Italian League for The Fight Against AIDS (Cama-LILA), Bari, Italy, (8) CNCA – Italian Coordination of Care Communities, Italy, (9) Italian Coordination of Residential Homes For People With HIV/AIDS (CICA), Bergamo, Italy, (10) UO Prevenzione DG Welfare Regione Lombardia - UO a valenza regionale “Promozione della Salute, ATS Città Metropolitana di Milano, Milano, Italy, (11) Department of Human Sciences, University of Verona, Verona, Italy

ABSTRACT

Background: Comprehensive sexuality education (CSE) is widely recognised worldwide as the best approach to promoting sexual health and preventing STIs. In Italy, CSE is not routinely included in the school curriculum: several initiatives have been piloted, although not always adequately evaluated. The EduForIST project, funded by the Ministry of Health, first proposed a unique model for CSE interventions and tested it in a group of secondary schools in 6 Italian regions. As one of the main objectives, the EduForIST project aimed to develop an evaluation model for CSE interventions to assess their real-world effectiveness if the CSE approach were to be introduced into Italian school curricula nationwide.

Material and Methods: A group of experts (GoE) belonging to the EduForIST partnership (Universities of Pisa, Foggia and Verona; Italian National Institute of Health; Regional Departments of Prevention of Tuscany and Campania; Civil Society Organisations) developed a framework for the short-, medium- and long-term monitoring and evaluation of clinical and behavioural outcome indicators and process indicators to assess interventions implementation. To this end, the GoE met repeatedly, using monthly focus group discussions from April 2023 to February 2024, to reach agreement on the proposed set of indicators. The GoE defined the calculation methods for the proposed indicators, identified available data sources, and assessed the feasibility of the calculations and likelihood bias.

Results: A total of 35 indicators were developed: 17 clinical and 8 behavioural indicators for medium and long-term outcome evaluation, 1 for short-term behavioural outcome evaluation and 9 process indicators. Clinical and behavioural indicators can be computed using administrative data sources from the Ministry of Health and the Regional Health Authorities. The National Institute of Health provides data from the AIDS Operations Centre and the national Health Behaviour in School-aged Children surveillance (HBSC). Most process indicators require ad hoc data collection and calculations. Although their computation appears feasible, challenges of under-reporting and underestimation persist for several clinical and behavioural indicators, particularly in regions where CSE interventions have not been widely implemented.

Conclusions: Developing an effective system for monitoring the outcomes and processes of CSE interventions requires the integration of a variety of data sources, including health and administrative information, and behavioural and learning assessments, collected over time. While the effectiveness of the proposed model will be fully realized after the widespread implementation of CSE interventions in Italian secondary schools, the selected indicators are proposed as an example for assessing their real-world effectiveness. This assessment involves comparing the baseline (pre-intervention) status with the post intervention impact of the CSE programmes implemented in secondary schools.

Allegato: Poster presentato alla conferenza

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research

Authors

G. Dessì, G. Giupponi, L. Supino

Affiliation

LILA Nazionale, Como, Italy

ABSTRACT

Background: In 2022 and 2023 LILA (Italian League Fighting AIDS) developed a training course for journalists. The activities were carried out within the project “Comunicare correttamente l’HIV per raggiungere gli obiettivi ONU 2030” (Correctly communicate HIV to achieve the UN 2030 goals), granted by ViiV Healthcare. The project led to the creation of a training module for journalists - implemented in three Italian regions - and the publication of a guide for information operators.

Material and methods: At the beginning of the project, two professional journalists supported the working group in research on Italian journalistic deontology and investigating the archives of national and local newspapers.
Based on these activities, a training module was developed which included: scientific and historical information on HIV/AIDS, a review of the most common communication errors in the Italian media and an introduction to working tools and useful resources for journalists. The training program was illustrated with a set of slides and a guide for information workers. LILA identified three Italian regions without local affiliated offices and organized the courses with the regional orders of journalists of Campania, Lazio and Veneto. Each meeting took place with LILA operators and the support of doctors. The participating journalists were awarded with credits for professional training.

Results: Over one hundred journalists attended the courses held in: Rome (December 2022), Dolo-Venice (May 2023) and Naples (September 2023). Furthermore, a 21-page guide for information workers has been created with essential information on HIV/AIDS from a health and social point of view and with suggestions on correct and non-discriminatory communication towards PWH.

Conclusions: Correct and accurate information can be decisive in winning the fight against HIV, a goal that the UN considers possible by 2030 (SDGs), if the appropriate social and health policies are implemented. The media can be fundamental in this challenge, supporting the scientific community and the communities with the dissemination of reliable, easily understandable and without prejudice news.

Allegato: Poster presentato alla conferenza

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research

Authors

G. Dessì (1), S.M. Pani (2), A. Mereu (2), C. Sardu (2), P. Contu (2)

Affiliation

(1) LILA Cagliari OdV, Cagliari, Italy, (2) Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

ABSTRACT

LILA (Italian League Fighting AIDS) Cagliari has been working on HIV prevention in Sardinia since 1993. From 2013 to 2022, the EducAids project involved 9551 high school students in 69 days of activities, distributed 2062 condoms, and 5444 information leaflets. The project involved about 9 schools and seven volunteers per year. This work presents the results of the project's initial questionnaires collected between 2017 and 2022 in 36 Sardinian schools.

The anonymous questionnaires were administered in BYOD (bring-your-own-device) and compiled in class with an operator from the association. Questionnaire sections: 1) age, gender, orientation, sexual debut; 2) prophylactic use, other contraceptives, alcohol and drug use during sexual encounters; 3) students' attitude on HIV (approach, stigma towards people with HIV/considered at risk of HIV, points of view on sexuality) (Tab.1), opinions on the organization of emotional and sexual education activities, availability of condoms during LILA intervention, and condoms sale in vending machines at school; 4) self-assessment of knowledge about statements about HIV; 5) feedback on difficulties and embarrassment about covered topics.

4194 questionnaires were analyzed (age 13-20, mean 17 years; gender: 2378 women; 1804 men; 12 non-binary; orientation: 85.1% heterosexual; relationship status: 70.3% single)(Tab.2). 38% of participants already had sexual intercourse (57% before the age of 16)(Tab.1). 37.3% always used condoms in penetrative intercourse, 46.3% sporadically, 16.5% never. Reasons for the assiduous use of condoms were pregnancy prevention and STIs, greater safety, and agreement between partners. Among sporadic users, 37.2% didn't always have condoms, 26.5% found condoms uncomfortable, and 17.4% felt less satisfied. Among those who don't use condoms, 19.2% feel uncomfortable, 14.1% report decreased sexual pleasure, and 8.6% were exclusive.

The knowledge reported on general statements on HIV was mostly higher than 60% (Tab. 3). On statements about HIV testing and PrEP, the level of knowledge was lower (e.g., "If someone becomes infected with HIV it may take several weeks before it can be detected in a test" (30.3% correct answers)) (Tab.4). 100% of the students were in favour of the proposed interventions, and the majority were not embarrassed nor experienced difficulties dealing with the topics.

Our results highlighted the need for more adequate education on HIV. The inadequate formation proposed by the Italian school system on emotional and sexual education was highlighted by the majority of participants that were in favour of structured and high-quality interventions. Furthermore, the scientific community, civil society, and international organizations recommend comprehensive sex education. Therefore, projects like EducAids by LILA Cagliari are essential to inform the students and amplify their voices about the need for the institutional actors to implement the international recommendations.

Allegato: Poster presentato alla conferenza 

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research

Authors

S. Penon (1), L. Cosmaro (1), F. Falzetta (1), M. Oldrini (1), D. Savarino (1), A.R. Raccagni (2), C. Candela (2), S. Nozza (2),(3)

Affiliation

(1) Fondazione LILA Milano ETS, Milan, Italy, (2) Vita-Salute San Raffaele University, Milan, Italy, (3) Infectious Diseases Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy

ABSTRACT

Background: PrEP effectiveness in preventing HIV infections calls for the expansion of dedicated services. In Italy access to PrEP is still insufficient, especially in the South and places far from infectious disease clinics and checkpoints. A team of community health workers (CHWs) and infectious disease specialists was constituted to offer online PrEP services (TelePrEP). When the pilot program started in Feb 2023, PrEP was not yet reimbursable and access to dedicated sites was delayed by long waiting times. Main objectives were to allow access to PrEP for those unable to access existing services, minimize use of informal PrEP by promoting safe uptake and adherence through adequate follow-ups and verify the actual feasibility of such approach.

Methods: TelePrEP offers access to an online service managed by CHWs and infectious disease doctors. File exchange (test and PrEP prescriptions, test results) and consultations are carried out by means of an ePlatform, so that clients can be effectively monitored for psychological and medical aspects. A dedicated database allows for collection of clients’ demographic and behavioral data, for M&E of TelePrEP activities and reminders for follow-up visits. Interested people residing near existing PrEP programs are referred to such services to benefit of drug refundability.

Results: In the 1st 13 months of activity (Feb’23-Feb’24), 200 people contacted TelePrEP for initial information; 108 were enrolled: 107 cis men and 1 cis woman. Data on age, education, professional condition, region of residency, sexual orientation, risk factors, reasons for accessing PrEP and contacting TelePrEP are detailed in Figures 1-9, respectively. Fifty-nine people were referred to existing PrEP services close to their residence that they had not heard about; 33 people after the 1st consultation decided not to proceed.
Thirty-five clients already attended follow-up visits (foreseen after 3, 6, 9 months); no one decided to quit PrEP. Overall, 66% of clients firstly opted for on-demand PrEP and 34% for daily PrEP; 9% referred to have switched from one to the other mostly due to specific occasions (vacation, Pride events…). Some transient side effects (nausea, chills, gastrointestinal problems) were reported in 34.8% cases. Concomitant use of chemsex, either “rarely” or “sometimes”, occurred in 8.6%, similarly to what reported during 1st consultations (8.3%). Condom use decreased if compared to what initially referred (Figure 10). Number of partners was reported as increased by 42.8% of clients, while it remained stable for the others (57.2%). No HIV infections occurred; 3 cases of gonorrhea and 1 of acute HCV infection were identified.

Conclusions: TelePrEP has proven to be an essential service due to persisting barriers in accessing PrEP services, even after drug refundability was approved; the program will continue at least till end 2024. Management of remote follow-up data is complex; improvements are being introduced to optimize it.

Allegati:

• Poster presentato alla conferenza 
• Commento audio di Sabrina Penon (LILA Milano)

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research

Authors

L. Cosmaro (1), S. Curridori (1), S. Penon (1), M. Cernuschi (2), D. Calzavara (3), P. Russo (3), M. Prandelli (3), P. Meli (4), I. Mercurio (4)

Affiliation

(1) Fondazione LILA, Milano, Milan, Italy, (2) ASA Milano, Milan, Italy, (3) Milano Checkpoint, Milan, Italy, (4) Bergamo Fast-track City, Bergamo, Italy

ABSTRACT

Background: The three pillars for achieving the 95-95-95 UNAIDS targets are early ARV treatment for all, preventive measures such as PrEP and increased HIV testing to detect undiagnosed ongoing infections. The latter pillar is difficult to achieve, as vulnerable groups unaware of their HIV status may encounter difficulties in taking the first step towards testing at healthcare services. Community-Based Voluntary Counseling and Testing (CBVCT) centers are an alternative option that can intercept clients unwilling to seek testing elsewhere. This retrospective study focuses on testing data collected by Italian CBVCT services that joined the COBATEST network in the period 2020-2023.

Material and methods: To measure CBVCT activity in Italy, data provided by the COBATEST database were analyzed. COBATEST links organizations across Europe and Central Asia that offer CBVCT services for HIV and STIs, and promotes testing, early diagnosis and linkage to care in at-risk populations. COBATEST offers a common instrument to gather information on clients and a comprehensive database from which the data for this study were extracted, to highlight the increase in participation of Italian CBVCTs and give a descriptive analysis of data collected on HIV tests performed.

Results: From 2020 to 2023, the Italian CBVCT centers joining the COBATEST network increased from 2 to 25, covering different Italian regions and determining a consequent rise in number of tests performed. In 2020, 1135 people who had never tested before were tested for HIV; this number raised to 7411 in 2023 (figure 1). Reactive tests detected raised from 6 in 2020 to 35 in 2023; the proportion of reactive HIV tests remained stable ranging from 0.4 to 0.5 percent (figure1). The number of tests increased not only due to the increase in Italian organizations joining the COBATEST network, but also because these services incremented, year by year, their testing offer (figure 2).

Conclusions: HIV testing at CBVCT services adhering to COBATEST has increased over the years of the study period. This highlights increased awareness of alternative ways for HIV testing and counseling services; furthermore, it underscores the importance of having a variety of community testing centers that succeed in reaching vulnerable populations. Between 2020-2023, 82 new HIV diagnoses were made thanks to the CBVCT centers included in this study, confirming that community-based activities can significantly contribute to the 95-95-95 goal. Being part of an international network offers the opportunity to collect standardized data that reflect the national situation and to plan more effective actions. The contribution of CBVCT centers and their social relevance should be acknowledged by policy makers and their work should be adequately supported economically. In conclusion, our analysis highlights the relevance of CBVCT services in actively contributing to HIV testing and prevention strategies.

Allegato: Poster presentato alla conferenza

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research

Authors

P. Vinti (1), E. Caruso (1), V. Calvino (2), L. Cosmaro (3), M. Farinella (4), N. Frattini (5), G. Giupponi (6), F. Leserri (7), S. Mattioli (8), P. Meli (9), A. Moznich (10), S. Patrucco (11), I. Pennini (12), F. Schlösser (13), M. Stizioli (14), D. Calzavara (1)

Affiliation

(1) Milano Check Point ETS, Milano, Italy, (2) ANLAIDS Nazionale ETS, Roma, Italy, (3) Fondazione LILA Milano ETS, Milano, Italy, (4) CCO Mario Mieli APS, Roma, Italy, (5) ASA ODV, Milano, Italy, (6) LILA Nazionale ONLUS, Como, Italy, (7) Plus Roma APS, Roma, Italy, (8) Plus APS, Bologna, Italy, (9) CICA ETS, Milano, Italy, (10) NPS Italia APS, Milano, Italy, (11) Arcobaleno AIDS ODV, Torino, Italy, (12) Arcigay APS, Bologna, Italy, (13) Nadir ETS, Roma, Italy, (14) PrEP in Italia, Brescia, Italy

ABSTRACT

Background: High PrEP coverage among people at substantial risk for HIV is essential to end AIDS as a public health threat by 2030. WHO encourages countries to simplify and demedicalise PrEP initiations, and to implement differentiated service delivery approaches. WHO has been updating its guidance on PrEP based on emerging implementation evidence, which may result in gaps in national guidelines incorporating those updates. In Italy, PrEP reimbursement within the national health system was approved in 2023, together with guidance for its delivery. Both the national PrEP guidelines and the AIDS strategic plan were last updated in 2017.

Methods: A policy analysis was conducted to assess inclusion of the WHO recommendations on PrEP adopted since 2017 into the current Italian national PrEP guidance. A list of recommended practices was extracted from the latest WHO PrEP guidance and their inclusion into the Italian guidance was checked.

Results: 24 practices recommended by WHO since 2017 were identified and grouped into three thematic areas. The policy analysis showed that only 9 of the 24 WHO-recommended practices are included in the Italian guidance (Table 1). Contrary to WHO recommendations, disclosure of personal details on sexual behaviour or drug use is required to access PrEP and only men who have sex with men are eligible for event-driven PrEP. PrEP is reimbursed within the national health system only when distributed at HIV clinics and can only be prescribed by HIV specialists. Community-based delivery is not linked nor integrated with the national health system. For those not eligible for event-driven PrEP, the Italian PrEP guidance recommends stopping PrEP 4 weeks after the last possible exposure, instead of 7 days as recommended by WHO.

Conclusions: The findings highlight a number of barriers to PrEP access in Italy. PrEP delivery is still highly medicalised and centralised in HIV clinics, making it undesirable for some members of key populations, and inaccessible to members of marginalised and underserved groups already facing barriers with the national health system. It is concerning that a number of evidence-based recommendations that do not entail additional costs and increase the acceptability of PrEP, especially for cisgender women and transgender people, were not considered. An evidence-based simplification of prescription requirements and clinical monitoring would allow same-day PrEP prescription and increase cost-effectiveness. The integration of community-based delivery and task-sharing with peer navigators and community health workers would increase PrEP accessibility, acceptability and cost-effectiveness. Not distributing PrEP outside of HIV clinics makes community-based PrEP services less convenient and less desirable. The current delivery model has to be reformed following WHO guidance, to make PrEP accessible to all those who can benefit from it and to increase coverage to a level that will make it effective population-wide.

Allegato: Poster presentato alla Conferenza

Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research