(P375) Prevalence of, and factors associated with, HIV, syphilis, chlamydia and gonorrhoea in individuals tested in walk-in clinics in North-Rhine Westphalia, Germany, in 2021

Background: In North-Rhine Westphalia (NRW) state, local public health authorities provide free anonymous sexually transmitted infection (STI) counselling and testing for high-risk population groups who do not have access to health insurance. Only HIV and syphilis are notifiable, and testing data are not routinely collected or reported within the German public health system. We describe the prevalence of, and factors associated with, HIV, syphilis, chlamydia and gonorrhoea infections in individuals tested at walk-in clinics in NRW using publicly-funded tests.

Methods: We used logistic regression to analyse testing data from a sentinel surveillance network of 53 walk-in clinics in NRW, January-December 2021. This is the first year that individual-level data were available for all STIs and that testing for chlamydia and gonorrhoea was offered.

Results: Of 11,575 individuals tested, 9,736 and 8,042 were tested for HIV and syphilis, respectively, and 7,527 individuals were tested for both chlamydia and gonorrhoea (Table 1). Positivity (number of positive tests divided by number of tests performed) was 0.6%, 5.1%, 6.4% and 2.7% for HIV, syphilis, chlamydia and gonorrhoea, respectively.

In multivariable analysis, higher odds of HIV infection were associated with men-who-have-sex-with-men (MSM) (adjusted odds ratio=5.4; 95%CI=3.2-9.8), country of origin not being Germany (3.6; 2.1-6.2), and aged 45-64 years (4.4; 2.4-6.7.6). For syphilis, higher odds were associated with MSM (5.9; 4.4-8.2), sex work (4.6; 3.0-7.1), male gender (2.1; 1.4-3.3), pre-exposure prophylaxis use (2.4; 1.5-3.5), country of origin not being Germany (1.5; 1.1-1.8), and aged >34 years (2.4; 1.9-2.9). For chlamydia, higher odds were in MSM (1.7; 1.4-2.1), sex workers (2.0; 1.4-2.9), and those with a partner positive for an STI (1.8; 1.2-2.5). Gonorrhoea test positivity was associated with country of origin not being Germany (1.8; 1.3-2.6), MSM (7.2; 4.9-10.8) and sex workers (4.1; 2.3-7.1).

Conclusion: STI positivity is high in this population group, with MSM and sex workers at highest risk of a positive STI test. Walk-in clinics play an important role for STI testing and management in these under-served populations, and will be scaling-up activities to compensate for tests missed during the COVID-19 pandemic. Continued testing activity surveillance is important for prioritising resources and ensuring at-risk population groups are reached.