Background: HIV self-testing (HIVST) is a new approach to HIV testing that is aimed facilitate HIV screening particularly among vulnerable populations in contexts such as Sub-Saharan Africa. We conducted a nominal group technique (NGT) meeting with HIV experts and representatives of young people in Southern Ethiopia to examine potential strategies to provide efficient and targeted HIVST to young people.
Methods: The NGT was conducted with 18 experts to refine best strategies for HIVST promotion, service delivery and legislative considerations. Participants were presented with recommended strategies to improve HIVST service that were drawn from the literature and our qualitative study among urban young people in Southern Ethiopia. Mean scores and standard deviation respectively were used to examine the ranked scores given to the strategies and to determine consensus in the two rounds of meeting. Qualitative data collected during the NGT discussion was analysed with thematic content analysis.
Results: Out of nine strategies, the panellist rated community-based institutional delivery of HIVST (e.g. schools) as the top ranked strategy and with the highest degree of consensus in the second round of the NGT, while online marketing and delivery of HIVST kits was ranked as the last (9th) strategy in both rounds. The first and last strategies respectively showed a statistically significant increase and decrease in mean scores on Wilcoxson signed rank test. Feasibility was the major concern across all the strategies (except health facility-based delivery) though online distribution was emphasized as impractical in present urban Ethiopia.
Conclusions and recommendations: Experts believed strategies that involve young people’s usual places of gathering (community institutions and everyday places) were very important venues to scale up HIVST services. The NGT analysis would be a valuable input to policy makers, program planners and researchers for implementation or further examination on how best to promote HIVST among young people.

Aim: This systematic review aimed to estimate Hepatitis C virus (HCV) infection prevalence among migrants residing in high-income countries with low or intermediate HCV prevalence.
Methods: We searched Scopus, PubMed, PsycINFO, and Cochrane Library for peer-reviewed articles published in English between 2015 and 2024. Studies from European Economic Area (EEA) countries, Switzerland, the United Kingdom (UK), the United States of America (USA), Canada, New Zealand, and Australia were included. The studies’ quality was assessed using The Joanna Briggs Institute (JBI) Critical Appraisal Tools. A proportional meta-analysis was used to estimate HCV prevalence.
Results: A total of 1302 studies were screened. Thirty-six studies were included in this review. Most of the studies (n:14) were from Italy. Seventeen studies included both people <18 and ≥18 years old, 16 studies only included people ≥18 years old, and three studies included people aged 18 and younger. Thirty-five studies reported results of anti-HCV and 20 HCV-RNA tests. The pooled prevalence of HCV antibody (anti-HCV) and RNA (HCV-RNA) was 1.5% (95% CI, 1.1-2.0%) and 0.6% (95% CI, 0.4-0.9%), respectively. The prevalence of anti-HCV was higher among males (1.9%) than females (0.6%). Among those aged 18 and older, the prevalence of anti-HCV and HCV-RNA was 1.5% (95% CI: 0.9-2.4%) and 0.5% (95% CI: 0.2-0.8%), respectively. Among refugees and asylum seekers, the prevalence of anti-HCV and HCV-RNA was 1.4% and 0.7%, respectively.
Conclusion: The prevalence of HCV among migrants is comparable with that among the general population of the destination countries. Given the barriers migrants, especially refugees and asylum seekers, face in accessing health services, their access to HCV information, testing, and treatment should be facilitated.

Background: Eliminating hepatitis C virus (HCV) requires efficient testing and treatment strategies. We evaluated cost-effectiveness of alternative approaches to HCV diagnosis and treatment initiation for treatment-naive people who inject drugs attending Australian community settings.

Methods: We compared seven strategies differing by use of antibody screening, laboratory and/or point-of-care tests; and the stage at which treatment was commenced. Outcomes were treatment initiation and completion. We considered costs from a healthcare sector perspective at a one-year time horizon. We used decision analytical models parametrised with publicly available estimates, assuming equivalent probabilities of treatment completion given RNA confirmation across strategies.

Results: Standard of care laboratory antibody then RNA testing on separate samples (33% treatment uptake, 95%CI: 32-34%) was cheapest but least effective per person screened. Laboratory antibody then reflex RNA testing on one sample (47% uptake, 95%CI: 46-48%) provided higher effectiveness and was the only strategy to reduce average cost per completion. Combined point-of-care antibody and RNA testing (57% uptake, 95%CI: 46-66%), point-of-care RNA alone (61% uptake, 95%CI: 50-70%), and point-of-care antibody with immediate treatment initiation (90% uptake, 95%CI:80-95%) in turn provided incremental improvements in completion at higher average costs per completion. The lower cost per completion for reflex laboratory testing was insensitive to RNA prevalence; changes in treatment uptake of at least 16 percentage points were required to achieve equivalence with point-of-care strategies. Although treatment of non-viraemic individuals contributed substantially to the higher costs of point-of-care strategies at the base-case medication cost (63% discount to the Australian list price), reflex laboratory testing remained less costly per completion at generic medication prices.

Conclusions: Reflex RNA testing was the most efficient strategy and could be implemented within the existing Australian laboratory framework. Point-of-care approaches may provide additional benefit at higher near-term costs. Studies accounting for transmission and disease sequelae are needed to understand cost-effectiveness in the longer term.

Background
Australia is committed to eliminating hepatitis C virus (HCV) as a public health threat by 2030. However, treatment uptake remains suboptimal, with declining treatment initiations by non-General Practitioner (GP) specialists not being offset by initiations by GPs and nurse practitioners. Little is known about clinical outcomes when GPs do not initiate treatment. The Coordinated Hepatitis response to Enhance the Cascade of Care (CHECCS) project, which aimed to improve follow-up of newly diagnosed HCV, identified 117 HCV RNA-positive cases notified to the Victorian Department of Health between September 2021 and March 2022, 50 of which were referred for non-general practice (GP) specialist care by their diagnosing doctor. However, CHECCS did not assess post-referral outcomes, and the care pathways and treatment outcomes of these cases was unknown. 

Methods
Between July and September 2024, we contacted the tertiary clinics where cases were referred to determine their appointment attendance, treatment initiation, sustained virological response (SVR) and cirrhosis investigations.  

Results  
Thirty-seven (74%) referrals to tertiary care resulted in scheduled appointments, 32 (86%) appointments were attended, and 28 (88%) started treatment. Treatment initiation was higher among older patients and those born overseas, but lower among those with a recent history of injecting drug use (IDU). Treatment uptake was 100% among those reporting no IDU history, 88% in those with IDU >2 years ago, and 20% in people with recent IDU (<2 years). Of treatment those who completed treatment, 92% achieved SVR. Among clinic attendees, 22 (69%) had cirrhosis investigations, with six positive results. 

Conclusion 
High treatment initiation and SVR rates were observed among referred cases. However, individuals with recent IDU history had lower treatment uptake. Greater awareness of non-tertiary care HCV referral pathways among diagnosing clinicians, including models of care integrated with primary care services specialising in care for people who use drugs, would support DAA uptake and HCV elimination strategies.

Background: Infant botulism accounts for 70% of all new botulism cases internationally per year. Infant botulism has been a notifiable disease in Australia since 1992, with approximately 1 new case per year from a birth cohort of 300 000 infants. Treatment is with human botulinum immune globulin (Baby BIG). Available internationally via the Californian Department of Health, administration early in clinical disease is associated with improved neurological outcomes. Over recent years, clinicians noted apparent regional clustering in Victorian infant botulism cases. This led to an investigation to determine if an outbreak, albeit a slow one, was occurring.


Methods: We undertook a retrospective, descriptive study of confirmed cases of infant botulism in Victoria presenting to hospitals in Victoria, Australia between 1978 and 2022. There was a focus on examining the geographical area where the infants resided or had visited prior to the clinical presentation.Moran’s I test for spatial autocorrelation was used to determine if spatiotemporal clustering was present.

Results: Twelve cases of infant botulism presenting to health services in Victoria between 1978 and 2022 were identified. All infants required tertiary hospital paediatric admissions for supportive management due to their clinical presentation, and the duration of admission ranged widely from 11-238 days. Eight of the twelve cases resided in regions in the north-west of Victoria or south-west of New South Wales. Case clustering was demonstrated in the north-west of Victoria (p<0.01).

Conclusion: Based on the available epidemiology, there appears to be a case clustering around the Victorian North-West. A causal hypothesis was not apparent, and a OneHealth approach is warranted to explore the complexity of Botulism transmission dynamics. Awareness and education for regional hospital staff and primary care providers around the spectrum of clinical presentations may provide a pathway for timely diagnosis, clinical care and treatment.

Background: The Vanuatu Ministry of Health, supported by the Pacific Integrated Neglected Tropical Diseases Elimination (PINE) project, aimed to deliver two rounds of mass drug administration (MDA) to accelerate the control and elimination of scabies, yaws and soil-transmitted helminths (STHs) in Tafea, Sanma and Shefa provinces. Prevalence surveys were integrated with MDA activities to assess the prevalence of scabies and STHs, as well as evaluate self-reported yaws.
Methods: Cluster prevalence surveys in a random selection of villages were integrated with the first round of MDA in Tafea (November 2021), Sanma (August 2022) and Shefa (April 2023) (pre-MDA surveys); and with the second round of MDA in Tafea (December 2023) and Shefa (May 2024) (post-MDA surveys). Cluster adjusted prevalence estimates for scabies and STH species were calculated for each area council and province for the pre- and post-MDA surveys.
Results: Scabies was most prevalent in Tafea with a prevalence of 14.1% (area council range 0.4, 28.1) and 11.9% (range 0, 20.0) at pre- and post-MDA surveys, respectively. At follow-up there were 4 area councils with a scabies prevalence >10%. In Sanma, the pre-MDA scabies prevalence was 2.6% (range 0, 7.8), and in Shefa the pre- and post-MDA prevalence was 3.9% (range 0, 13.7) and 4.4% (range 0, 6.8), respectively. Soil-transmitted helminths were most prevalent in Tafea with a prevalence of 67.3% (range 0, 79.2) and 43.9% (range 8.9, 100) at pre- and post-MDA surveys respectively. At follow-up there were 5 area councils with a STH prevalence >50%. In Sanma, the pre-MDA STH prevalence was 22.5% (range 3.1, 44.8), and in Shefa the pre- and post-MDA prevalence was 40.9% (range 16.7, 73.3) and 21.7% (range 0, 31.1), respectively.
Conclusion: There remain several area councils in Tafea with scabies prevalence above the World Health Organization (WHO) MDA threshold of 10% and at high risk for STHs (prevalence >50%). Monitoring and evaluation should continue with ongoing MDA programs to inform targeted interventions and track progress toward control and elimination targets.

Oral antivirals have been available in Australia since 2022 to treat people with COVID-19 at risk of severe disease. Early clinical trials demonstrated that they were effective in unvaccinated people if taken early. However, subsequent trials and observational studies had mixed results. Evaluating evidence since the emergence of the Omicron variant among vaccinated populations is needed.

We conducted a systematic review and meta-analysis of studies of the effectiveness of 1) nirmatrelvir-ritonavir compared with no treatment, 2) molnupiravir compared with no treatment and, 3) nirmatrelvir-ritonavir compared with molnupiravir in adults. Our primary outcomes of interest were hospitalisation and death. We included RCTs from 2020 onwards, and observational studies conducted since January 2022 among populations where vaccination coverage was >70%.

We identified 49 studies (8 RCT, 41 observational) that presented 64 comparisons of 3,336,305 participants who had 6709 hospitalisations and 1660 deaths. Most studies (n=46) included high risk participants only. Compared to no treatment, nirmatrelvir-ritonavir was associated with reduced hospitalisations (13/16 comparisons; 81%), mortality (10/17; 59%), and hospitalisation or death (11/13; 85%), and molnupiravir was associated with reduced hospitalisations (3/4; 75%), mortality (7/11; 64%), and hospitalisation or death (2/6; 33%). Compared to molnupiravir, nirmatrelvir-ritonavir was associated with a lower risk of hospitalisation in 2/5 (40%) comparisons, mortality in 4/4, and hospitalisation or death in 0/4. Of the three RCTs that included vaccinated participants, none reported significant effects of antivirals on reducing hospitalisations or mortality.

Most observational studies suggest that antivirals are effective in reducing hospitalisation and mortality in high-risk groups, but these are subject to higher risk of bias. Further analysis to evaluate the utilisation and cost effectiveness of oral antivirals in Australia, and to confirm the age groups and risk factors most likely to benefit will determine whether the current eligibility criteria are appropriate.

The numerous and ever evolving prevalence of SARS-CoV-2 variants post-pandemic stresses the importance of vaccination strategies to consider the breadth and longevity of the protection conferred. Despite the significance of central memory T-cells in vaccine conferred immunity, the leading functional assay, the cultured ELISpot, has varied protocols between laboratories with no systematic investigation for its implementation in analysing SARS-CoV-2 immune responses. Our study presents an optimised cultured ELISpot protocol for detecting central memory T-cell interferon gamma (IFNγ) responses against SARS-CoV-2 peptides following an initial priming with either peptides, or whole spike protein. Key variations optimised include the culture length, timing of exogenous survival signals (IL-2), endpoint analysis modality (chromogenic vs fluorescent) and cell density to enhance assay sensitivity without compromising specificity for central memory T-cell IFNγ recall responses to cognate antigen.



With regards to lower-frequency T-cell interactions, as observed with our donor SARS-CoV-2 epitope responses, we describe Fluorospot (Fluorescent ELISpot) to be preferable to the chromogenic ELISpot modality, enhancing assay sensitivity and specificity for cognate antigen recall responses while minimising the generation of visual artefacts. In-line with current papers within the literature, we utilised CCR7+ depleted PBMC fractions to validate our assay to selectively detect central memory T-cell driven responses.



Lastly, we provide preliminary evidence for the capacity of our assay to delineate individual responding peptides following peptide pool priming, and to explore cross-reactivity between viral variant peptides (Wuhan vs XBB.1.5) at an individualised donor level. This study advances the methodology for investigating central memory T-cell immunity, particularly in the context of SARS-CoV-2, and emphasises the balance between enhancing specific cognate central memory responses while limiting non-specific activation. Further implementation of our methodology within the literature may serve to enhance our understanding of central memory responses to specific peptide antigens, and further explore vaccine induced cross-reactivity to viral variants.

Background
Since late December 2024, an unseasonal increase in influenza notifications in WA has been observed, coinciding with a severe 2024/2025 influenza season in the Northern Hemisphere. This study aimed to determine whether increased influenza notifications in WA is driven by international travel to countries in the Northern Hemisphere and to assess household and close-contact transmission among non-travellers.

Methods
Data from laboratory-confirmed influenza cases were extracted from the WA Notifiable Infectious Diseases Database (WANIDD) from 23/12/2024 to 04/02/2025. A mobile survey was distributed via Essendex to influenza cases and data were analysed using Microsoft Excel.

Results
The survey was successfully sent to 1,030 individuals with a response rate of 65% (n=668). Among respondents, (n=346, 52%) reported recent travel, with most (n=306, 88%) having travelled internationally. Nearly all (n=294, 96%) visited countries in the Northern Hemisphere, primarily in Asia (n=183, 59%) and Europe (n=77, 25%). One-third (n=105, 34%) of international travellers also reported having close contacts with influenza-like illness, with most having travelled to the same country as survey respondents.
Among non-travellers (n=320, 48%), 26% (n=83) reported close contacts with influenza- like illness. Most of these contacts either remained in WA or travelled interstate (n=43, 52%), while (n=29, 35%) had contacts who travelled to the Northern Hemisphere. Influenza A predominated in both groups.

Discussion and Conclusions
International travel, particularly to the Northern Hemisphere, was a major driver of influenza transmission in WA. Household and close-contact transmission also played a role, albeit survey limitations underestimating the true impact. Pre-travel vaccination and targeted public health interventions to Northern Hemisphere travellers could mitigate travel-related influenza transmission and associated influenza risks.

Introduction: Staphylococcus aureus bloodstream infection (SABSI) is a significant public health concern due to its incidence, high morbidity and 30-day mortality rate of 15-30%. SABSI can be acquired in both the community and healthcare settings, however interventions have focused on prevention in healthcare facilities which have been regarded as the predominant setting for SABSI infections. SABSI has been notifiable under the Public Health Act 1997 in Tasmania since 2010. This study aims to describe notified cases of SABSI in Tasmania from 2010 to 2024.
Method: This descriptive study analyses SABSI notifications in Tasmania from 1 January 2010 to 31 December 2024 and describes the differences between healthcare-associated and community-associated SABSI in terms of age, sex and resistance to methicillin over time.
Results: From 2010 to 2024, there were 2320 notifications of SABSI, with 1566 (68%) classified as community-associated and 751 (32%) as hospital-associated. The number of notified cases has steadily increased since 2010, peaking in 2023 with 229 cases. Males accounted for 65% of notifications, and the number of notifications increased with age in both sexes. The proportion of Staphylococcus aureus resistant to methicillin was 7.6% overall.
Discussion: The increasing trend in SABSI cases suggests a persistent public health challenge. The high proportion of community-associated cases indicates that interventions should extend beyond healthcare settings to address risk factors in the broader population. Future research should explore the reasons behind the higher notifications of SABSI in males and could consider factors such as biological susceptibility, healthcare access, and environmental exposure. Future research should focus on identifying risk factors associated with community-associated SABSI to support evidence-based public health interventions aimed at reducing SABSI.

Amoebiasis is an important parasitic cause of morbidity and mortality worldwide and is known to be endemic in Northern Australia. The Northern Territory (NT) is the only jurisdiction in Australia where amoebiasis is notifiable. The epidemiology of amoebiasis across Australia is not well described. We undertook this retrospective study to describe the epidemiology of amoebiasis in the NT from January 2005 to June 2024. Data were obtained from the Northern Territory Notifiable Disease System (NTNDS). Of the 26 cases identified, most were men (21/26, 81%), non-Indigenous Australians (23/26, 89%) and overseas acquired (18/26, 69%). A majority had extra intestinal manifestations (17/26, 65%), required hospitalisation (14/26, 54%) and made a full recovery (25/26, 96%). Of the 6 locally acquired cases, 4 were from the Top End region. The highest annual incidence (5) was in 2024, all of whom were returned travellers from the Asia-Pacific region. This study highlights that amoebiasis in the NT is both endemic and overseas acquired, and that clinicians should consider this differential diagnosis in anyone presenting with abdominal pain, fever and/or diarrhoea and initiate timely testing and appropriate treatment. The true incidence of disease across Australia could be estimated if a national surveillance system were in place for amoebiasis, while encouraging clinicians to maintain a high index of suspicion for this condition.