Research

Australian Needle and Syringe Program Survey (ANSPS)
The Australian Needle and Syringe Program Survey (ANSPS) forms the basis of Australia’s sentinel surveillance of HIV and hepatitis C virus (HCV) prevalence and behaviour indices of risk among people who inject drugs (PWID). Since 1995, all clients attending selected Needle and Syringe Program (NSP) sites during a specified one to two week period are asked to complete a brief self administered questionnaire and to provide a capillary blood sample for HIV and hepatitis C antibody testing. Demographic and behavioural data captured include injecting and sexual behaviour, blood borne virus testing, drug treatment and needle and syringe acquisition. A National Data Report, summarising National and State/Territory data is produced by NCHECR on an annual basis.

Culture and HIV Prevention in Cambodia
This study assesses two cultural measures particular to Asian cultures, ‘harmonious control’ and ‘fatalism’ and their association with HIV infection and related risk and preventive behaviour, including adherence to a preventive vaccine regimen, among young women working in the sex and entertainment industry in Phnom Penh, Cambodia. Phase 1 consists of a formative qualitative phase to assess the constructs of harmonious control and fatalism, risk behaviours, and attitudes toward biomedical prevention technologies. Phase 2 consists of a prospective observational study with clinical and serological assessments for HIV and other STIs, risk behaviours and measurement of adherence to a multidose preventive HPV vaccine series.

Economic, Social and Cross-cultural Issues in Non-pharmaceutical Protection of Front Line Responders to Pandemic Influenza and Emerging Infections
Non-pharmaceutical interventions such as face masks are one of the few widely available strategies that can be offered to front line responders (FLR) in outbreak situations and that can be guaranteed to be available regardless of the type of infection. This study aims to 1) determine knowledge, attitudes and practices of FLR related to infection control and barriers to adherence to mask use; 2) conduct the first international RCT of the protection afforded to FLR by face masks against influenza and other respiratory viruses; 3) compare knowledge, attitudes and practices of FLR in Australia and Vietnam, and identify both culturally specific and universal issues that may affect the behaviour of FLRs in an emergency; 4) model the cost-effectiveness of surgical and N95 face masks; and 6) inform disease control policy nationally and internationally on the use of face masks in control of pandemic influenza, emerging infections or a bioterrorist attack.

Examination of injecting Drug Use Life Course and Estimating Prevalence and Health Consequences of a Dynamic Population
This project examines longitudinal datasets of injecting drug users from the UK (e.g. Edinburgh Addiction Cohort Study) and Australia (e.g. Hepatitis Incidence and Transmission Study - community) taking into account periods of injecting and non-injecting. This will allow for more valid projections of injecting drug use health consequences and associated health impacts and costs of interventions.

Exploring the Natural History of Injection Drug Use
This study seeks to: (1) examine the influence of social and environmental factors on critical initiation and transitional events among street youth and adults who inject drugs, including transitions in drug use, initiation into drug scenes and sex work; (2) examine the influence of social
and physical context within ‘drug scenes’ on HIV risk behaviour; (3) refine and document an evolving
ethno-epidemiological approach to investigating the natural history of injection drug use. The study employs observational ethnographic activities, in-depth interviews, mapping techniques, photography, and epidemiological data. Observational activities will be conducted in settings where illicit drugs are consumed. Qualitative in-depth interviews will be conducted with participants in existing cohort studies, including the VIDUS cohort and will utilize a longitudinal perspective through annual follow-up of participants.

Hepatitis Acceptability and Vaccination Incentives Trial (HAVIT)
Injecting drug use is the leading exposure category for notifications of newly acquired hepatitis B virus (HBV) in Australia. Funded by the NHMRC, the Hepatitis Acceptability and Vaccination Incentives Trial (HAVIT) is a two-arm open-label randomized controlled trial designed to determine the efficacy of incentive payments to increase HBV vaccine completion in PWID. Secondary endpoints are to evaluate the cost effectiveness of standard care compared to incentive payments as a means of improving HBV vaccination series completion, identify the correlates of immunity and assess hepatitis B knowledge and barriers to immunisation uptake and completion. Using a 3-dose accelerated schedule (0, 7 and 21 days), the trial is being conducted at two inner-Sydney health services which target PWID. To date 401 PWID have been screened with 129 participants eligible and enrolled following baseline serology.

Hepatitis C Vaccine Preparedness Study
This program of work, funded by the NHMRC and commenced in 2010, continues and extends earlier work conducted under the UNSW HCV Vaccine Initiative. The project aims to establish the feasibility of conducting field trials of candidate HCV vaccines with PWID. Specific aims are to 1) determine HCV incidence and spontaneous clearance in a prospective cohort of uninfected PWID; 2) identify associated risk factors; 3) evaluate retention strategies and factors associated with adherence to the study protocol; and 4) investigate immunisation acceptability, clinical trial literacy and willingness to participate in future vaccine trials in this group. The project includes the Hepatitis C Incidence and Transmission Study – community (HITS-c), an ongoing prospective observational study HCV antibody negative PWID. By July 2011, more than 150 participants had been enrolled in the cohort and a total of 17 cases of incident hepatitis C infection had been observed (9.3 per 100 person years; 95% CI 5.8-14.9)..

International Collaboration of Incident HIV and HCV in Injecting Cohorts (InC3)
Funded by NIH and led by Professor Kimberly Page from UCSF, the International Collaboration of Incident HIV and HCV in Injecting Cohorts (InC3) is the first global collaboration of prospective studies of HIV and HCV in people who inject drugs (PWID). InC3 will merge biological and behavioral data from nine prospective cohorts, allowing us to study 4,091 PWID who have been followed for a collective 9,016 person-years of observation, 859 incident HCV infections with longitudinal follow up, and 575 HIV infections in order to: 1) Assess temporal trends in HIV and HCV incidence; 2) Examine HCV incidence by HIV status and sexual behavior; 3) Estimate rates and determinants of HCV viral clearance and re-infection; 4) Identify the effects of HCV infection disclosure are on risk behaviours and ; 5) Evaluate outcomes related to clinical treatment of acute HCV in PWID.

Liver Spots: A Study of Hepatitis B Knowledge, Treatment and Health Care among Indigenous Australians
Funded through a NHMRC postdoctoral fellowship, this project aims to engage Indigenous individuals, families and communities affected by hepatitis B, as well as health care providers and policy makers in addressing the social and treatment needs of Aboriginal and Torres Strait Islander people living with chronic hepatitis B. Working with both urban and rural/remote communities, the study will investigate facilitators and barriers to biomedical knowledge, cultural healthcare needs, traditional health beliefs and facilitators and barriers of treatment uptake. Information generated from in-depth interviews and survey data will contribute to meeting the chronic health management and treatment needs of participating individuals and communities as well as providing data to inform the development of culturally appropriate resources and services for Indigenous Australians.

Preventing Sexually Transmitted Infections in Same-sex Attracted Young Women: An Examination of Perceived Vulnerability and Safer Sex Negotiation
This study, funded by a UNSW Faculty of Medicine post-doctoral research grant, aims to examine how social factors shape lesbian, bisexual and other same-sex attracted young women’s sexual behaviour and sexual health practices. This qualitative study will identify practical opportunities for intervention and education that can enhance young women’s capacity to negotiate safe sexual relationships.

Staying Safe: A Sociology of How Injecting Drug Users Avoid Viral Infection in the Long-term
Funded by the Economic and Social Research Council (ESRC), this study aims to reconstruct the life trajectories of injecting drug users to identify social practices and conditions linked to long term avoidance of hepatitis C virus infection. Using qualitative life history studies from long-term PWID who have not been exposed to hepatitis C alongside those who have been exposed; this is the first research in the UK on long-term avoidance of viral infections associated with injecting drug use. To date a total of 13 in-depth qualitative interviews have been conducted.

Staying Safe: How do Long-term Injecting Drug Users Avoid Hepatitis C Infection?
Using an established longitudinal cohort of PWID this project is looking to develop a new generation of hepatitis C virus prevention programs to assist both new and experienced PWID to develop and implement strategies to remain uninfected with HCV over the long term and to assist those who are infected but who clear the virus and continue to inject to avoid re-infection. Comparisons of PWID who have acquired HCV and those who have not over the long term (i.e. those who have “stayed safe”) will generate hypotheses about prevention to be explored in future research.

The Role of Resiliency in Responding to Blood-borne Viral and Sexually Transmitted Infections in Indigenous Communities
Funded by the International Collaborative Indigenous Health Research Partnership (ICIHRP), this project represents a collaboration between Australia, Canada and New Zealand to examine resilience to blood-borne viruses (BBVs) and sexually transmissible infections (STIs) in Indigenous communities. With a focus on adolescents and young adults in urban settings, the Australian component of the study, funded by NHMRC, seeks to identify factors that protect against acquisition of BBV/STI, promote access to prevention and treatment and provide capacity building opportunities for Indigenous researchers and Aboriginal Community Controlled Health Service (ACCHS) partner organisations. In 2010 the third and final component of the Australian-arm was completed, involving more than 300 interviews with young Aboriginal and Torres Strait Islander people in Townsville and Perth.

Viral Hepatitis Surveillance
The Viral Hepatitis Epidemiology and Prevention program (VHEPP) is responsible for monitoring patterns of transmission of incident viral hepatitis infections in Australia, with a particular focus on risk behaviour and blood-borne virus transmission among people who inject drugs. These surveillance activities are conducted in collaboration with the Commonwealth Government’s Department of Health and Ageing, State and Territory health authorities, other public health professionals and affected communities. Analyses and interpretation of trends in new diagnoses of viral hepatitis infections and estimates of prevalence and incidence among various groups of people who inject drugs are published in the NCHECR Annual Surveillance Report. Together with collaborating networks, including the National Notifiable Diseases Surveillance System (NNDSS) and in conjunction with the Surveillance and Evaluation Program for Public Health (SEPPH), VHEPP is working to facilitate the establishment of nationally consistent enhanced surveillance activities for newly acquired hepatitis B and C.

Sydney Women and Sexual Health (SWASH)
This community-based bi-annual survey of the health of lesbian, bisexual and queer women in Sydney is conducted in collaboration with ACON. For the first time in 2010 the survey was also conducted in Perth, in collaboration with the Western Australian Centre for Health Promotion Research, Curtain University.