A Nardone

ICL, Londinium, England, United Kingdom

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Publications (98)673.34 Total impact

  • The Lancet 11/2015; 386:S73. DOI:10.1016/S0140-6736(15)00911-3 · 45.22 Impact Factor

  • The Lancet 11/2015; 386:S10. DOI:10.1016/S0140-6736(15)00848-X · 45.22 Impact Factor

  • The Lancet 11/2015; 386:S79. DOI:10.1016/S0140-6736(15)00917-4 · 45.22 Impact Factor

  • The Lancet 11/2015; 386:S16. DOI:10.1016/S0140-6736(15)00854-5 · 45.22 Impact Factor
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    ABSTRACT: Objectives: Following national guidelines to expand HIV testing in high-prevalence areas in England, a number of pilot studies were conducted in acute general medical admission units (ACUs) and general practices (GPs) to assess the feasibility and acceptability of testing in these settings. The aim of this study was to estimate the cost per HIV infection diagnosed through routine HIV testing in these settings. Methods: Resource use data from four 2009/2010 Department of Health pilot studies (two ACUs; two GPs) were analysed. Data from the pilots were validated and supplemented with information from other sources. We constructed possible scenarios to estimate the cost per test carried out through expanded HIV testing in ACUs and GPs, and the cost per diagnosis. Results: In the pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs, respectively. In scenario analyses we fixed offer time, diagnostic test cost and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40% for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000 tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed by either hospital consultants or GPs. Conclusions: Expanded HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of a shorter offer time, higher patient uptake, higher HIV positivity and lower diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV positivity, expanded HIV testing should be promoted in high HIV prevalence areas.
    HIV Medicine 09/2015; DOI:10.1111/hiv.12293 · 3.99 Impact Factor
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    ABSTRACT: Background: Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect. Methods: PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex with men who had had anal intercourse without a condom in the previous 90 days. Participants were randomly assigned (1:1) to receive daily combined tenofovir disoproxil fumarate (245 mg) and emtricitabine (200 mg) either immediately or after a deferral period of 1 year. Randomisation was done via web-based access to a central computer-generated list with variable block sizes (stratified by clinical site). Follow-up was quarterly. The primary outcomes for the pilot phase were time to accrue 500 participants and retention; secondary outcomes included incident HIV infection during the deferral period, safety, adherence, and risk compensation. The trial is registered with ISRCTN (number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986). Findings: We enrolled 544 participants (275 in the immediate group, 269 in the deferred group) between Nov 29, 2012, and April 30, 2014. Based on early evidence of effectiveness, the trial steering committee recommended on Oct 13, 2014, that all deferred participants be offered PrEP. Follow-up for HIV incidence was complete for 243 (94%) of 259 patient-years in the immediate group versus 222 (90%) of 245 patient-years in the deferred group. Three HIV infections occurred in the immediate group (1·2/100 person-years) versus 20 in the deferred group (9·0/100 person-years) despite 174 prescriptions of post-exposure prophylaxis in the deferred group (relative reduction 86%, 90% CI 64-96, p=0·0001; absolute difference 7·8/100 person-years, 90% CI 4·3-11·3). 13 men (90% CI 9-23) in a similar population would need access to 1 year of PrEP to avert one HIV infection. We recorded no serious adverse drug reactions; 28 adverse events, most commonly nausea, headache, and arthralgia, resulted in interruption of PrEp. We detected no difference in the occurrence of sexually transmitted infections, including rectal gonorrhoea and chlamydia, between groups, despite a suggestion of risk compensation among some PrEP recipients. Interpretation: In this high incidence population, daily tenofovir-emtricitabine conferred even higher protection against HIV than in placebo-controlled trials, refuting concerns that effectiveness would be less in a real-world setting. There was no evidence of an increase in other sexually transmitted infections. Our findings strongly support the addition of PrEP to the standard of prevention for men who have sex with men at risk of HIV infection. Funding: MRC Clinical Trials Unit at UCL, Public Health England, and Gilead Sciences.
    The Lancet 09/2015; DOI:10.1016/S0140-6736(15)00056-2 · 45.22 Impact Factor
  • Thomas Hartney · Paula Baraitser · Anthony Nardone ·
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    ABSTRACT: The National Chlamydia Screening Programme performs 1.7 million tests annually among young adults in England. The effect of chlamydia screening on subsequent behavior is unknown. This study examined the self-reported impact of testing on young adults' subsequent health care-seeking and sexual behavior. We conducted a cross-sectional Web-based anonymous survey using an online panel to recruit 1521 young adults aged 16 to 24 years and resident in England. Survey questions were developed using the theory of planned behavior. Multivariate log-binomial regression was used to identify the variables associated with an impact on subsequent behavior after testing. Most respondents reported that being tested for chlamydia had a positive effect on their subsequent sexual behavior (68.6%; 422/615) or health care-seeking behavior (80.0%; 492/615). In multivariate analysis, being female and having a high level of engagement at last test were both associated with positive impacts on sexual behavior (72.7% [adjusted prevalence ratio {aPR}, 1.19; 95% confidence interval {CI}, 1.07-1.33] and 82.7% [aPR, 1.55; 95% CI, 1.27-1.89], respectively), and health care-seeking behavior (84.4% [aPR, 1.13; 95% Cl, 1.04-1.24] and 86.3% [aPR, 1.23; 95% CI, 1.07-1.41], respectively). Among respondents with minimum level of engagement, 72.4% (76/105) reported an increase in subsequent health care-seeking behavior. Chlamydia testing had a positive impact on young adults' self-reported health care-seeking and sexual behavior. This suggests that chlamydia screening has a wider effect on young adults' sexual health beyond that of treatment alone.
    Sexually transmitted diseases 09/2015; 42(9):486-91. DOI:10.1097/OLQ.0000000000000323 · 2.84 Impact Factor
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    ABSTRACT: Sexually transmitted infections, HIV and unplanned pregnancies continue to be a major public health problem in England, especially in young adults. Strengthening the provision of free condoms, HIV testing, chlamydia screening and contraception within primary care will contribute to reducing poor sexual and reproductive health outcomes. Recent research demonstrated the benefit for general practices of educational support visits based on behaviour change theory. Public Health England (PHE) has piloted an educational training programme to improve the delivery of sexual health services and HIV testing within general practice. The 3Cs & HIV programme used practice based workshops to improve staffs' awareness and skills in order to increase opportunistic offers of chlamydia testing, provision of contraceptive service information and free condoms (the '3Cs') to 15-24 year olds and HIV testing according to national guidelines. The programme was based on the theory of planned behaviour and has been implemented using a stepped wedge design. Process evaluation, testing and diagnosis data, plus qualitative interviews were all used in the evaluation. The primary outcome measures were chlamydia testing and diagnosis rates. Secondary outcome measures were HIV testing and diagnoses rates within each practice and rates of consultations where long acting reversible contraceptives had been discussed. A key strength of the 3Cs & HIV programme has been the evidence base underpinning the development of the resources and the formal process evaluation of its implementation. The programme was designed to encourage sustainable relationships between general practice staff and local sexual health services as well as the knowledge, awareness and behaviours cultivated during the programme. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
    Public health 08/2015; 129(9). DOI:10.1016/j.puhe.2015.07.016 · 1.43 Impact Factor
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    ABSTRACT: Objectives: Including questions about sexual health in the annual Health Survey for England (HSE) provides opportunities for regular measurement of key public health indicators, augmenting Britain's decennial National Survey of Sexual Attitudes and Lifestyles (Natsal). However, contextual and methodological differences may limit comparability of the findings. We examine the extent of these differences between HSE 2010 and Natsal-3 and investigate their impact on parameter estimates. Methods: Complex survey analyses of data from men and women in the 2010 HSE (n = 2,782 men and 3,588 women) and Natsal-3 undertaken 2010-2012 (n = 4,882 men and 6,869 women) aged 16-69y and resident in England, both using probability sampling, compared their characteristics, the amount of non-response to, and estimates from, sexual health questions. Both surveys used self-completion for the sexual behaviour questions but this was via computer-assisted self-interview (CASI) in Natsal-3 and a pen-and-paper questionnaire in HSE 2010. Results: The surveys achieved similar response rates, both around 60%, and demographic profiles largely consistent with the census, although HSE participants tended to be less educated, and reported worse general health, than Natsal-3 participants. Item non-response to the sexual health questions was typically higher in HSE 2010 (range: 9-18%) relative to Natsal-3 (all <5%). Prevalence estimates for sexual risk behaviours and STI-related indicators were generally slightly lower in HSE 2010 than Natsal-3. Conclusions: While a relatively high response to sexual health questions in HSE 2010 demonstrates the feasibility of asking such questions in a general health survey, differences with Natsal-3 do exist. These are likely due to the HSE's context as a general health survey and methodological limitations such as its current use of pen-and-paper questionnaires. Methodological developments to the HSE should be considered so that its data can be interpreted in combination with those from dedicated sexual health surveys, thus improving our ability to monitor trends in sexual health.
    PLoS ONE 08/2015; 10(8):e0135203. DOI:10.1371/journal.pone.0135203 · 3.23 Impact Factor
  • M Desai · M Gafos · D Dolling · S McCormack · A Nardone ·
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    ABSTRACT: Pre-exposure prophylaxis (PrEP) has proven biological efficacy in reducing the risk of sexual acquisition of HIV. Healthcare providers' (HCPs) knowledge of and attitudes to PrEP will be key to successful implementation. In England, PrEP is only available to men who have sex with men (MSM) through the open-label randomized PROUD pilot study of immediate or deferred use. In September 2013, a cross-sectional survey of UK HCPs distributed through sexual health clinics (219) and professional societies' email lists (2599) and at a conference (80) asked about knowledge of, attitudes to and practice of PrEP. Overall, 328 of 2898 (11%) completed the survey, of whom 160 of 328 (49%) were doctors, 51 (16%) sexual health advisers (SHAs), 44 (14%) nurses and 73 (22%) unspecified. Over a quarter (83 of 311; 27%) were involved in PROUD. Most respondents (260 of 326; 80%) rated their knowledge of PrEP as medium or high. Over half of respondents (166 of 307; 54%) thought PrEP should be available outside of a clinical trial. The main barriers to supporting PrEP availability outside a clinical trial were concerns about current evidence (odds ratio [OR] 0.13), lack of UK-specific guidance (OR 0.35), concerns about adherence (OR 0.38) and risk of sexual or physical coercion for patients to have condomless or higher risk sex (OR 0.42 in multivariate regression). Just over half (147 of 277; 53%) had been asked about PrEP by patients in the past year, including almost half of those working in a clinic not involved in the PROUD study (86 of 202; 43%). There is support for PrEP availability outside a clinical trial, but HCPs have residual concerns about its effectiveness and negative consequences, and the absence of UK-specific implementation guidance. © 2015 British HIV Association.
    HIV Medicine 07/2015; DOI:10.1111/hiv.12285 · 3.99 Impact Factor
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    ABSTRACT: Background MSM continue to be disproportionately burdened by STIs and HIV, but sexual well-being is increasingly recognised as being broader than the absence of disease. Aim To compare the sociodemographic, behavioural, and health profiles of MSM (reporting > = 1 male partner(s), past 5 years) in Britain with men reporting sex exclusively with women (MSEW) during this time, and with MSM a decade earlier, to consider changes over time. Methods Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability survey, interviewed 15,162 people aged 16–74 years (6,293 men) during 2010–2012 using computer-assisted personal-interviewing with computer-assisted self-interviewing for the more sensitive questions. Natsal-2, completed a decade earlier used a similar methodology. Results Among all men in Natsal-3, 2.6% (n = 190) were MSM, of whom 52.5% identified as gay. Relative to MSEW, MSM were more likely to report recreational drug use (38.4% vs. 15.7%), treatment for depression (14.2% vs. 5.8%), health condition (s) they perceived affected their sexual activity/enjoyment (26.1% vs. 15.3%), dissatisfaction with their sex life (26.3% vs. 16.2%), and STI diagnosis/es (past 5 years; 16.0% vs. 3.7%). MSM reported larger numbers of partners than MSEW in all timeframes considered, differences that remained in multivariable analyses. No changes in MSM prevalence, profile, or behaviour were observed between Natsal-2 and Natsal-3. Conclusion Poor sexual and mental health is more common among MSM than MSEW. There is thus an urgent need for health promotion among MSM that includes, but goes beyond, focusing on STI/HIV risk reduction and which is appropriate regardless of sexual identity.
    Sexually Transmitted Infections 05/2015; 91(Suppl 1):A3-A3. DOI:10.1136/sextrans-2015-052126.8 · 3.40 Impact Factor
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    ABSTRACT: Background/introduction Control of STIs is challenged by inadequate access to prompt diagnosis and treatment for patients and partners. Novel point-of-care diagnostics have real potential to address some of these challenges but their robust evaluation, and hence utility, is hampered by the ethics and regulatory landscape that confronts industry and academia.
    Sexually Transmitted Infections 05/2015; 91(Suppl 1):A82-A83. DOI:10.1136/sextrans-2015-052126.244 · 3.40 Impact Factor
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    ABSTRACT: Introduction HIV incidence among men who have sex with men (MSM) has remained unchanged over the last decade despite increases in HIV testing and antiretroviral (ARV) coverage, suggesting sexual risk behaviours have increased.
    Sexually Transmitted Infections 05/2015; 91(Suppl 1):A2-A2. DOI:10.1136/sextrans-2015-052126.5 · 3.40 Impact Factor
  • T. Hartney · P. Baraitser · K. A. Folkard · K. Dunbar · A. Nardone ·
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    ABSTRACT: Background/introduction Individuals who test positive for chlamydia are at increased risk of subsequently testing positive. NCSP standards recommend offering re-testing three months after treatment completion. Concerns have been raised that re-testing could undermine prevention messages.
    Sexually Transmitted Infections 05/2015; 91(Suppl 1):A69-A69. DOI:10.1136/sextrans-2015-052126.206 · 3.40 Impact Factor
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    ABSTRACT: Background/introduction Post-exposure prophylaxis following sexual exposure (PEPSE) is a potential method of preventing HIV infection in certain circumstances. Initiation of PEPSE is recommended following receptive anal intercourse with a partner of known positive or unknown HIV status from a high risk group. Aim(s)/objectives To investigate the characteristics and risk profile of patients receiving PEPSE to determine whether this could inform development of pre-exposure prophylaxis (PrEP) policy for men who have sex with men (MSM). Methods Data from the Genitourinary Medicine Clinic Activity Dataset (GUMCADv2) were used to investigate the characteristics of patients receiving PEPSE. Associations with PEPSE use were assessed using multivariate logistic regression. Results Between 2011 and 2013, 14,118 patients received PEPSE, of which 63% (8,896) were MSM. Among MSM receiving PEPSE, 14% (1,213) received more than one course (maximum 13 courses), 45% (3,990) were aged 25–34 years and 75% (6,702) were of white ethnicity. 2.0% were diagnosed with HIV between 4 and 16 months after receiving their last course of PEPSE. Compared to MSM controls not receiving PEPSE, MSM receiving PEPSE were significantly more likely to be of non-white ethnicity (adjusted OR = 1.28, 95% CI 1.21–1.36), and to be diagnosed with HIV following a subsequent exposure (adjusted OR = 1.21, 95% CI 1.03–1.41). Discussion/conclusion MSM prescribed PEPSE are at high risk of acquiring HIV infection following a subsequent exposure and may require intensive interventions to ensure course completion and reduce HIV risk behaviour. PrEP may be beneficial for high-risk MSM receiving PEPSE and also avoid the need for repeat PEPSE prescriptions.
    Sexually Transmitted Infections 05/2015; 91(Suppl 1):A1-A1. DOI:10.1136/sextrans-2015-052126.2 · 3.40 Impact Factor
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    ABSTRACT: Background/introduction There is a lack of data on the sexual behaviour of patients between being tested for chlamydia, receiving the test result, and being treated. This time-period may be important in the transmission of chlamydia, as infection could continue to be spread to sexual partners whilst awaiting the test result and treatment. Aim(s)/objectives To investigate the sexual behaviours of patients between the time of being tested for chlamydia and receiving test result and treatment in order to investigate the benefits that a point-of-care test (POCT) might bring to clinical practice. Methods We conducted a cross-sectional clinical audit of GUM clinic attendees. Clinic staff conducted a notes review of patients returning for chlamydia treatment following a positive chlamydia test result, and of age- and sex-matched chlamydia negatives. The data also served as an audit for the GUM clinics, following BASHH guidelines. Results Five of nine GUM clinics approached participated, in July–December 2014. Data from 775 patients were included in analyses, 365 of whom were chlamydia-positive. Males with 2–4 partners, and those who reported never using a condom, were more likely to be chlamydia positive. For 21/143 (14.7%) positive patients who provided data, last new sexual contact was in the period between test and treatment. Data were missing on condom use (22%) and recent new partners (81%). Discussion/conclusion Patients continue to form new sexual partnerships whilst awaiting chlamydia test results, allowing for the possibility of infecting new sexual partners. POCTs which remove the test to treatment delay could prevent this onward transmission.
    Sexually Transmitted Infections 05/2015; 91(Suppl 1):A37-A37. DOI:10.1136/sextrans-2015-052126.108 · 3.40 Impact Factor
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    ABSTRACT: Background Pre-exposure prophylaxis (PrEP) is highly protective against sexual acquisition of HIV among men having sex with men (MSM). The cost-effectiveness of PrEP will play a major role in deciding whether the NHS should introduce PrEP.
    Sexually Transmitted Infections 05/2015; 91(Suppl 1):A1-A1. DOI:10.1136/sextrans-2015-052126.1 · 3.40 Impact Factor
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    ABSTRACT: Background/introduction General practice (GP) offers a wide range of sexual health services, although provision varies across England. Educational support visits to GPs are effective in improving sexual health services. 3Cs and HIV is a national pilot that provided GP training for opportunistic offers of chlamydia testing, free condoms and information about contraceptive services to 15–24 year olds (i.e. 3Cs), plus HIV testing according to national guidelines. Aim(s)/objectives To describe local authority (LA) and GP engagement with the 3Cs and HIV pilot using process evaluation measures. Methods The training programme comprises two practice educational support visits, the first on 3Cs and the second on HIV testing. Data on LA and GP recruitment, retention and implementation of the training was collected throughout the programme. Results In total, 56 LAs invited 2,532 practices to the programme, 461 agreed to participate. Data was returned by 46 LAs accounting for 405 practices (88%). Half of participating practices received at least one visit (255/461, 55%). Nearly a third of practices received only the 3Cs visit (143/461, 31%) and 24% (111/461) received both the 3Cs and HIV visits. More general practitioners than nurses attended the training (826 vs. 752), especially for the HIV sessions (263 vs. 211). Discussion/conclusion Many practices reported an interest in receiving sexual health educational support visits, however a large proportion did not start or complete the full programme. This highlights the difficulties sustaining GP engagement over time, which may be due to competing priorities for protected learning time. Future programmes may need to be shorter.
    Sexually Transmitted Infections 05/2015; 91(Suppl 1):A66-A66. DOI:10.1136/sextrans-2015-052126.197 · 3.40 Impact Factor
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    R Malek · H Mitchell · M Furegato · Ian Simms · H Mohammed · A Nardone · G Hughes ·
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    ABSTRACT: HIV seroadaptive behaviours may have contributed to greater sexually transmitted infection (STI) transmission in HIV-positive men who have sex with men (MSM) and to the global increase in STIs. Using multiple national surveillance data sources and population survey data, we estimated the risk of STIs in HIV-positive MSM and assessed whether transmission in HIV-positive MSM has contributed to recent STI epidemics in England. Since 2009, an increasing proportion of STIs has been diagnosed in HIV-positive MSM, and currently, the population rate of acute bacterial STIs is up to four times that of HIV-negative or undiagnosed MSM. Almost one in five of all diagnosed HIV-positive MSM in England had an acute STI diagnosed in 2013. From 2009 to 2013, the odds of being diagnosed with syphilis increased from 2.71 (95% confidence interval (CI) 2.41–3.05, p<0.001) to 4.05 (95% CI 3.70-4.45, p<0.001) in HIV-positive relative to HIV-negative/undiagnosed MSM. Similar trends were seen for gonorrhoea and chlamydia. Bacterial STI re-infection rates were considerably higher in HIV-positive MSM over a five-year follow-up period, indicative of rapid transmission in more dense sexual networks. These findings strongly suggest that the sexual health of HIV-positive MSM in England is worsening, which merits augmented public health interventions and continued monitoring.
    Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 04/2015; 20(15). DOI:10.2807/1560-7917.ES2015.20.15.21093 · 5.72 Impact Factor
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    ABSTRACT: Active recall can improve reattendance rates and could increase retesting rates and detection of HIV and sexually transmitted infections (STIs), but the best strategy remains uncertain. We conducted a systematic review and meta-analysis of active recall for HIV and/or STI testing. We searched six electronic databases using terms for HIV, STIs, tests and active recall (defined as a reminder to retest for HIV/STIs) for randomised, non-randomised and observational English-language studies published between 1983 and 2013. Outcomes included reattendance/retesting rate and STI diagnosis at follow-up. Of 5634 papers identified, 17 met the inclusion criteria. Of the 14 comparative studies, all but one demonstrated higher reattendance/retesting rates in the intervention group, but the range was wide (17.5-89%). Meta-analysis of nine RCTs found reattendance/retesting rates were significantly higher in the intervention versus control groups (pooled OR 2.42 (95% CI 1.84 to 3.19)). In a subgroup analysis, home sampling increased retesting compared with clinic testing (pooled OR 2.20 (95% CI 1.65 to 2.94)). In observational studies SMS reminders increased retesting compared with standard clinic care (pooled OR 2.19 (95% CI 1.46 to 3.29)), but study estimates were highly heterogeneous (I(2)=94%, p<0.001). Active recall interventions are associated with higher reattendance/retesting rates for HIV/STI. Although home sampling and SMS reminders were associated with higher reattendance/retesting rates in most studies, evidence is limited by the heterogeneity of interventions and control groups and the quality of studies. Further work is needed to explore which active recall modality is clinically cost-effective and acceptable for HIV/STI screening. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Sexually Transmitted Infections 03/2015; 91(5). DOI:10.1136/sextrans-2014-051930 · 3.40 Impact Factor

Publication Stats

1k Citations
673.34 Total Impact Points


  • 2015
    • ICL
      Londinium, England, United Kingdom
  • 2013-2015
    • Public Health England
      • Virus Reference Department (VRD)
      Londinium, England, United Kingdom
  • 2012
    • UK Department of Health
      Londinium, England, United Kingdom
  • 2010-2012
    • Environment Agency UK
      Rotherdam, England, United Kingdom
  • 2008
    • European Union
      Bruxelles, Brussels Capital Region, Belgium
  • 2001-2008
    • Institut de veille sanitaire
      • Department of Infectious Diseases
      Charenton-Saint-Maurice, Île-de-France, France
  • 2006-2007
    • European Centre for Disease Prevention and Control
      Solna, Stockholm, Sweden
    • European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
      Lisboa, Lisbon, Portugal
  • 2004-2005
    • International Society for Disease Surveillance
      Brighton, England, United Kingdom