bluuebunny/crossref_metadata_2025 huggingface dataset:
P117 Audit on uptake of HIV test in sexual health clinic, antenatal and TOP services in Dumfries between January and June 2011
Authors: Steshenko O
Published: May 2012

Background

BASHH introduced “UK National Guideline for HIV testing 2008” recommending universal HIV testing in GUM or sexual health clinics, antenatal and termination of pregnancy services. Early identification HIV positive persons help to reduce further transmission of HIV infection to others and allow referring them to appropriate services for further treatment.

Aims and Objectives

The audit was undertaken to identify compliance of local sexual health clinic, antenatal and TOP services with “UK National Guideline for HIV testing 2008”. To establish uptake of HIV test by patients accessing Sexual Health Clinic, Antenatal and TOP services in Dumfries between 1st January and 30th June 2011 and give recommendations according to findings.

Methods

Retrospective audit of electronic patients' records of all persons accessing the local sexual health clinic in relation to STI issues, pregnant women attending antenatal clinic, patients receiving TOP service care between 1st January and 30th June 2011.

Results

From 844 episodes of care in sexual health clinic, HIV test performed in 400 (47%) episodes. 511 women attended antenatal clinic and 507 (99.2%) of them had HIV test. From 42 patients having TOP, 6 (14.2%) women had HIV test.

Discussion

Not all patients might have been offered the HIV test in sexual health clinic. TOP service does not offer the HIV test routinely.

Recommendations

Sexual health clinic should offer HIV test to all patients accessing their service and document in patients' medical records that the HIV test was offered. When patients decline the HIV test, reasons for declining have to be documented. TOP service should update their local TOP guideline instructing their nurses, midwives and doctors to offer HIV test to all patients accessing their services. To present findings of the audit to medical staff at local, regional and national levels. To conduct re-audit in 3–6 months once changes have been implemented.
P12 HIV testing: are we doing enough? A staff awareness survey in East Midlands
Authors: Dhar J , Nyatsanza F
Published: May 2012

Background

The overall HIV prevalence in East Midland is low and since 2000 most of the new cases in our region continue to be diagnosed in the same three Primary Care Trusts, peaking in the 35–39-year-old adults in 2009/2010. HIV uptake rates vary from 69% to 80% and high coverage remains a possibility as demonstrated by 96% antenatal uptake rates.

Objective

To collect information from hospital and community based staff about HIV testing, to develop effective regional strategies.

Methods

A 10 min online Questionnaire was completed by staff members via Survey Monkey this included gender, age, time since qualification, experience of HIV test use, training issues etc.

Results

1067 responses have been analysed, >75% of respondents being female, representing a wide range of specialties including general practice. 21%, 28%, 28%, 22% are aged between 20–30 years, 30–40 years, 40–50 years and >50 years respectively. 25.5%, 21%, 25%, 29% of the respondents were qualified <5 years, 5–10 years, 10–20 years, more than 20 years respectively. 46.8% had no prior experience of offering an HIV test. 39.9% felt they had the necessary skills a similar proportion 39.5% felt they lacked them. 21.8% of the respondents would have concerns offering a test. While the majority 81.6% agreed with NICE guidance on expanded testing 57.7% would require further training, 50.2% saying they would be unable to answer patients questions on HIV testing. 85.1% agreed that HIV updates need to be incorporated in induction provided to health care professionals with 45.9% stating that current methods were not adequate.

Conclusions

The survey highlights that while health care professionals are aware of the need to have a HIV test nearly half of them have never offered one and a large proportion have identified anxieties around consultation. Inadequate training was cited as a major factor for not considering or offering a test.
P121 Do guidelines help promote sexual health screening (SHS) and detect sexually transmitted infections (STIs) in older adults with HIV?
Authors: Baugh A , Taylor R , Bellingham L , Ahmed I
Published: May 2012

Background

Adults over 50 with HIV comprise 20% of the national cohort. BASHH/BHIVA guidelines recommend all patients have a sexual health assessment documented at presentation and 6-monthly, with a full SHS offer annually and outcome documented.

Aims

We audited practice against these guidelines, to establish any difference in services offered to over-50s. We also examined rate of STI detection.

Methods

80 case notes were retrospectively audited–40 aged over 50 and 40 aged under 50.

Results

Abstract P121 Table 1 Shows the demographics of the groups. Only 75% of over-50s had sexual history documented at presentation compared to 86% of under-50s. 45% of >50s had SHS documented at presentation (Chlamydia, GC and Syphilis), with a further 15% having Syphilis test only. 77% of over-50s had full SHS at baseline. In 24 baseline SHS performed in the over-50s we found 8 STIs: 2 Syphilis, 1 HSV, 1 Hepatitis B, 1 Chlamydia and 3 Gonorrhoea. In the 34 SHS performed in under-50s we found 11 STIs: 1 HPV, 2 Syphilis, 2 HSV, 1 Hepatitis B, 3 Chlamydia and 2 GC. Sexual history documentation in 2010/11 was poor in both groups. In the >50s, only 28% had a documented sexual history. In the under-50s, 35% had documented sexual history. SHS in 2010/11 was offered to 20% of over-50s with 1 declining and in 35% of under-50s with 2 declining. Positivity was low; 1 case of Syphilis in each group.

Abstract P121 Table 1

Demographics of HIV cohort

<50 years>50 yearsMean age82%62%Male gender6936MSM40%35%White ethnicity55%68%

Conclusion

In our sample, fewer over-50s had a sexual history and SHS offer documented at presentation. Screening at presentation identified STIs in both groups. Few patients declined SHS, suggesting patients find it acceptable. There were more STIs in the under-50s group at presentation, correlating to national trends. However, we tested more young patients, possibly explaining this difference. STI rate in 2010/11 was low but didn't differ with age—it is important to perform a sexual history in all patients and offer SHS, so we are developing a proforma to prompt clinicians.
P122 Management of sexual assault in the East Kent community
Authors: Abubakar M , Shakya A , Forey K
Published: May 2012

Background

Kent community health NHS Trust provides sexual health services (SHS) in East Kent serving an approximate population of 750 000 based in eight clinical sites. SHS see a significant number of sexual assault (SA) case referrals in this region as there is no designated Sexual Assault Referral Centre.

Aim

This audit was conducted to determine if the management of SA cases in the services is in accordance to the standards outlined by British Sexual Health and HIV(BASHH) SA auditable outcome measures.

Method

Case notes coded as SA based on a local code audited from the period of October 2010 to October 2011. Data were collected from the local SA proforma and case note documentation which identified information regarding victim's and assailant's profile and documentation of essential historical elements of SA. Other auditable outcomes measured included injury documentation, HIV risk assessment and post exposure prophylaxis (PEP) offer, police referral for crime and forensic examination (FME), self harm and child protection assessment. Data regarding emergency contraception, prophylactic antibiotics and hepatitis vaccination offered, testing for STIs and referral to EKRL were also collected.

Results

Total no SA codes92:7 notes missing: total 85 casesSource of referralsSelf: 59 (69.4%) Other: 26 (30.6%)Time since SA54 (63.5%) seen within 6 weeksAssailant detailsKnown: 51 (60.0%) Unknown: 34 (40.0%)HIV risk assessment: 100%Vaginal: 68 (81.9%) N=83Oral: 11 (12.9%) N=85Anal: 13 (15.3%) N=85High risk: 13—2 eligible for PEP. Offered but declinedReferral for FMEYes 19 (22.3%) No 66 (77.7%) 10 (11.7%) had FME prior attendanceReferral to A and ENoneEmergency contraceptionYes 6 (7.0%) No 79 (93.0%)Prophylaxis antibiotics for STDsYes 6 (7.0%) No 79 (93.0%)Hepatitis B vaccination59 (69.4%) indicated 43 (72.9%) vaccinatedFirst visit testYes 64 (75.3%) No 21 (24.7%)Repeat testYes 33 (38.8%) No 52 (61.2%)Child protection assessment under 1618 (94.7%) N=19Referral to police55 (64.7%) offered 5 (0.09%) declinedReferral to EKR lineYes 48 (56.4%) No 37 (43.6%)Follow-ups offered59 (69.4%)Total follow-ups seen40 (47.0%)

Conclusions

This audit highlighted the importance of clear documentation of treatment and care offered and provided to victims of SA. Poor documentation of management is likely to underestimate the overall outcome of care offered, but when a treatment is indicated and initiated there is a good clear documentation. The local SA proforma is concise and user friendly for any trained and qualified healthcare individuals and covers all aspects of care as recommended by BASHH except for the self harm assessment which will be included upon revision. A close working partnership with local police, SHS and EKRL is essential to ensure the management of SA within the community is in accordance with national standards.
P124 A motivational interviewing (MI) intervention aimed at reducing sexual risk taking in men who have sex with men (MSM): the launch of a pilot service
Authors: Yap S Y , Traynor D
Published: May 2012

Background

HIV is one of the fastest growing serious health conditions in the UK. HIV+ MSM have an increased burden of sexually transmitted infections (STIs). Effective interventions are needed to reduce the risk to MSM's health. MI is an evidence based goal-directed approach to behaviour change. There is some evidence for its use in risk reduction in sexual health. A clinic was set up to deliver an MI based intervention to MSM who engage in “high risk” sexual activity. The aim is to reduce the frequency of patients' unprotected sex, thereby reducing risk of transmission/acquisition of STIs.

Aims

The aim of this paper is to review the level of need for a MI based risk reduction clinic. An audit of referral data to the MI clinic was compared with an audit of referrals to the general sexual health psychology clinic. The latter receives referrals from sexual health; a proportion of total referrals to this service include clients who engage in high risk sexual activity.

Methods

The MI clinic was publicised by presenting the clinic at teaching and multi-disciplinary clinic meetings. Patient leaflets outlining the service were distributed across clinic rooms. A survey of staff was carried out to assess potential need for the service. A comparison audit of referral data to the MI clinic vs the general sexual health psychology clinic over a 6-month period was carried out.

Results

A comparison of the average number of referrals per month to the general psychology service vs the MI clinic was carried out. The MI clinic averaged 30% more referrals per month than the general sexual health psychology service. A survey of referrers showed that 67% of staff who were aware of the MI service reported that they had patients who would benefit from the service.

Discussion

These results highlight the need for a specific service to address sexual risk taking. Further research is required to investigate whether MI is an effective intervention in this area.
P128 The acceptability of using soccer clubs as venues for chlamydia screening in young men: results from a qualitative study
Authors: Saunders J M , Sutcliffe L J , Hart G J , Estcourt C S
Published: May 2012

Background

Many non-clinical, including sports, settings have been used in an attempt to screen more men for Chlamydia. While feasible there is very little research exploring their acceptability among users of these settings.

Objective

We explored the acceptability of, and the best way to deliver, Chlamydia screening in soccer clubs among young men who play amateur soccer.

Methods

18 semi-structured, face-to-face interviews with men aged between 18 and 35 who play soccer in London-based non-professional leagues. Interviews were carried out from October to December 2011 and analysed using a framework approach.

Results

Soccer clubs are acceptable venues to access Chlamydia screening because they offer several potential benefits over screening in traditional settings. Importantly they are discreet testing venues and allow screening to take place within the context of normal daily routines. Having testing kits handed out to all team members by a senior member of the club (captain/coach/manager) or a visiting health care professional (HCP) meant that no one would feel singled out for testing and overcome barriers to asking for, or collecting a kit from central collection points. While some men preferred to use the test kit there and then and return samples to a collection point at the club, others preferred to use kits at home and return samples to the laboratory by post. However, concerns about confidentiality and test tampering meant that some men favoured a visiting HCP to coordinate testing rather than a member of the club.

Conclusion

Soccer clubs appear to be acceptable venues for young men who play soccer to access self-collected testing kits for Chlamydia. Processes for accessing, using and returning test kits should be discreet, easy and quick. We will be developing testing pathways in soccer clubs to pilot in six London clubs during the 2012–2013 season.
P129 Improving clinical standards in GU medicine: a retrospective audit ofNeisseria gonorrhoeae
Authors: Sharp S R , Allan S
Published: May 2012

Objectives

This was a retrospective analysis of clinic performance in the management and treatment ofNeisseria gonorrhoeae(GC) according to BASHH guidelines.

Methods

All cases of GC diagnosed at our clinic between 1 January and 30 June 2011 were identified. The case notes were reviewed and assessed against current BASHH criteria. This was compared to data collected in the same clinic from 1 January to 30 June in 2007, 2008 and 2009. The number of cases identified for 2007, 2008, 2009 and 2011 was 41, 61, 78 and 75 respectively.

Results

Criterion2007 (%)2008 (%)2009 (%)2011 (%)CR1 >95% of genital GC cases should be cured by first line therapy779610097CR2 100% patients with GC should be screened forChlamydia trachomatisor receive presumptive treatment10010010098.6CR3 100% patients should have at least one documented interview with a partner notification trained health professional82959292CR4 100% patients identified should receive written information about STI's and their prevention32648161CR5 100% treated patients should have a test of cure (TOC)–––36CR6 For each case at least 0.6 sexual partners should be verified as having been satisfactorily managed within 4 weeks0.410.330.360.5

Discussion

The number of cases cured by first line therapy improved by 20% between 2007 and 2011, but had decreased by 3% from 2009 to 2011 (CR1). The percentage of patients seeing a health advisor remains the same as in 2009 at 92% (CR3). Supply of written documentation dropped by 20% since 2009 (CR4). Chlamydia screening or treatment decreased by 1.4% from 2009 due to one case (CR2). TOC was poor at 36% but this was due to the guidelines during the data collection time period not requiring a TOC (CR5). Sexual partner notification was still below the expected 0.6 (CR6).

Conclusions

Current BASHH targets were missed in all six criterion. In criterion 1, first line treatment was not prescribed with explanatory documentation in two cases. However in both these two cases the culture proved to be sensitive to the antibiotics used. In criterion 2, one case resulted in the target being missed. This patient had refused all tests, but presumptive treatment was not prescribed. Poor written documentation accounts for the failings in criteria 3 and 4. This may have been due to the recent introduction of electronic patient records. It is hoped that recent improvements to the system may improve these figures. Future audits should show an improvement in TOC as the new guidelines are adopted. Finally although criterion 6 has not met the BASHH target this year, it is a significant improvement on previous years results.
P13 New HIV diagnoses in a busy inner-city cohort: How far have we come?
Authors: Haidari G , Tsemunhu P J , Mazhude C , Dukoff-Gordon A
Published: May 2012

Background

Our service is located in a high HIV prevalence area (6.2/1000), and a large proportion of late presentations. We have widened the availability of HIV testing as a major strategy to reduce HIV related morbidity and mortality in our population.

Aims/Objectives

To assess the evolving trends in demographics, clinical and laboratory findings of newly diagnosed HIV patients in our busy inner city clinic. To develop HIV testing strategies further with the implementation of current NICE guidance that recommends testing all medical admissions, and assess the potential future impact of this on presentation patterns in our cohort.

Methods

Retrospective case note review of 92 consecutive new HIV diagnoses between 2009 and 2011. Data were collected on demographics, clinical stage, CD4 count, source of referrals, and drug resistance. Findings were compared to previous data sets in the same clinic over three audit periods between 2003 and 2011.

Results

The proportion of males newly diagnosed has increased from 33% (2003) to 51% (2011), and the median age of all diagnoses has crept up to 39.5 years from 36.7 years. The proportion of referrals from primary care is now the largest (51%). Very late presenters (CD4 <200), remain high in our population at 53%, and this is well above the national average of 30%. Primary drug resistance is 16%, currently double the national average.

Discussion/Conclusions

There continues to be a high rate of very late presenters in our cohort. Strengthening current interventions and implementation of NICE guidance will be essential in an effort to reduce late diagnoses.
P14 Pathways to HIV diagnosis and treatment among migrants and their partners in India
Authors: Rai T , Lambert H S , Ward H
Published: May 2012

Background

An estimated 2.3 million people are living with HIV in India. Although free testing and treatment is available, <20% of HIV-positive people access treatment at its antiretroviral treatment (ART) centres. Short-term labour migrants have been identified as at risk of acquiring and transmitting HIV.

Aim

To explore the pathways to HIV testing and treatment for people with a history of short-term circular migration, and their partners.

Methods

A qualitative study at an ART centre in northern India, using in-depth interviews. Data were analysed using framework and thematic content analysis.

Results

34 people were interviewed, 20 men and 14 women. Men commonly reported becoming unwell while working away from home and enduring a prolonged period of sickness during which they received various temporary symptomatic treatments from private medical providers. Their HIV was only diagnosed and treatment started when their illness overwhelmed them and they returned home as a consequence of a medical or financial emergency. In contrast, female participants were more likely to be tested following a positive diagnosis of their husband. Individuals who were now on ART felt insecure about migrating again given the instability of the migrant labour market and fears about ability to adhere to treatment at destination.

Discussion

Diagnosing and treating HIV infection early is an important way to slow down the spread of the epidemic and targeting those at greatest risk should be a priority. However, despite migrant-focussed awareness campaigns, migrant workers and their partners are not accessing testing and treatment until they become sick. The cultural preference for private treatment, the insecurity of migrant work and gender differences in health-seeking behaviour delay early diagnosis and treatment initiation.
P141 Marketing sexual health in a brand conscious world: can we make services more accessible to young people?
Authors: Hum O , Lee R L
Published: May 2012

Background

Adolescents are media-savvy and extremely brand conscious. Much promotional material for sexual health services is poorly designed. Little has been written about how this may influence their acceptability among young people.

Objectives

A new CaSH service was set up in primary care. In order to make the service appealing and accessible to adolescents, a graphic designer was recruited to create concepts and ideas for the look of the new service.

Methods

Following a broad search of current CaSH websites and leaflets nationally, many were found to be poorly designed and configured, using cliched teenage imagery and language. Focus groups were set up with local young people. Six possible logos were presented, first using the suggested service name in words only, then gradually introducing each of the logo options in colour. Opinions were sought at each stage.

Results/Discussion

There were widely differing views about most of the designs. Any perceived use of teenage slang, or reference to sexual health or the NHS, was rejected. Leaflets were also seen as irrelevant and boring, and leading to possible breaks in confidentiality. One logo was favoured unanimously. A poster and website were designed based on this logo to develop the brand further. In place of a leaflet, a business style card was designed, bearing only a logo and website address, enhancing the services' confidentiality. The website is the key portal for adolescents to gain information in both a confidential and informative way. Promotion in schools and pubs has led to high brand recognition. Informal feedback from service users has shown a high acceptability of the cards and the logo is perceived as contemporary and relevant.

Conclusion

With brand-conscious adolescents it is worth taking care about branding of services. More research is needed to see whether approval of the brand translates into increased acceptability among teenagers, and thus into increased usage of the clinic.
P146 Invest to save in the South West: benchmarking current expenditure against sexual health and identifying local population needs
Authors: Turner K , Adams E A , Adams E A , Womack J , Macleod J , Horner P J , Wilson A ,   Office for Sexual Health
Published: May 2012

Background

Funding of sexual health services will move from PCTs to local authorities, so there is an urgent need to understand the current spend on sexual health (SH), and implement existing evidence to deliver cost-effective services.

Aims

The aims of this project are to estimate the spend on, and demand for, sexual health services in the South West region, to support local commissioners in evaluating their spend, to identify priorities for investment using local data, and to enable preparations for transferring commissioning responsibility to the local authority.

Methods

Data collection templates were developed to capture the commissioning spend and relevant sexual health data needed to estimate outcomes including the total spend per trust and the spend per adult. This was supplemented by routine data. Each area was analysed separately, and averaged across the South West.

Results

Overall the total SH spend in the South West was £46.4 million in 2010/2011, excluding HIV treatment. Over half was allocated to GUM and SRH attendances. Chlamydia screening activities accounted for 8% of the total spend. The average SH spend per person aged 15–44 years was £24 (range £14–£38). There were 142 293 chlamydia screens carried out at an average cost of £27 per screen and 8,825 chlamydia diagnoses costing £437 per positive identified. There were substantial increases in the availability of long-acting reversible contraceptives and the availability of over the counter emergency contraception during the study period.

Discussion

There was large variation between PCTs in the relative spend on different services according to local organisation and their progress towards full integration of sexual health services. Areas with higher spend tended to have higher burden of disease, and were more likely to be urban. This project brings together the total spend on sexual health and population need and will help PCTs in their transition to local authority funding.
P148 “Fast-track” STD services in an urban STD clinic: increased clinical capacity, but reduced opportunities for same-day treatment
Authors: Stoner B , Reno H , Brethauer C , Spear D , Knaup R
Published: May 2012

Background

Public health sexually transmitted disease (STD) clinics in the US continue to face service cutbacks due to financial pressures. “Fast-track” services (urine-based screening without a physical examination) allow for greater patient throughput, but may impede provision of same-day STD treatment.

Objectives

(1) to demonstrate the extent to which fast-track implementation leads to increased service capacity; and (2) to document the percentage of fast-track cases with STD requiring further treatment.

Methods

Demographic, behavioural, and clinical data analysis from fast-track service delivery in St. Louis County STD Clinic (urban St. Louis, Missouri, USA) from January 2009 to August 2011.

Results

Implementation of fast-track services resulted in an increase in clinic throughput of 34.8 patients per month, and a decrease in patients turned away without care (5.6%). Most fast-track patients were male (65.9%), reflecting general clinic demographic trends. Infection rates among fast-track patients were 9.6% forChlamydia trachomatisand 0.7% forNeisseria gonorrhoeae; these patients were contacted by telephone and instructed to return to clinic for treatment. Effective treatment was documented for 67.0% of infected patients.

Conclusion

Implementation of fast-track services resulted in increased clinic capacity. However, substantial staff time and effort were required to ensure adequate treatment for those testing positive for STD. Enhanced risk assessment prior to fast-track screening may help identify those patients who will benefit from full STD clinical examination and same-day treatment.
P150 Females under 16 attending GUM
Authors: King M , Priestley C J F
Published: May 2012

Background

The government set out a number of sexual health targets in the white paper “Choosing Health” 2004 and include. A reduction in the under 18 conception rate, An increase in the percentage of people aged 15–24 accepting chlamydia screening. Young people need to be able to easily access sexual health services in order to prevent, diagnose and treat sexually transmitted infections (STIs) and gain advice and contraception to protect against unintended pregnancy. A significant proportion of patients under the age of 16 are seen, who may have child protection concerns or be vulnerable. We wanted to examine the reasons for their attendance.

Aims

In female patients under the age of 16 attending the integrated sexual health clinic, to identify. The reasons for attendance. STI diagnosis and treatment. Contraceptive use and provision. The degree of sexual risk-taking in under 16s, including sexual history, condom use, requests for post coital contraception and pregnancy testing, and the number of pregnancies. Other child protection concerns, including age at first intercourse and age of sexual partner, and parental awareness of their sexual activity. Other factors that contribute to vulnerability and risk-taking in, including alcohol and drug use, mental health issues, low self esteem, homelessness and chaotic life style.

Methodology

Service provision was reviewed in comparison to the DoH standards. 50 sets of records were analysed.

Results

Reasons for attendance Contraception 80% PCC 60% Pregnancy Test 20% Sexual Screening 42% Recommendation: (1) development of integrated sexual health clinics, (2) PCT commissions a local, accessible abortion service, (3) develop links with other drug alcohol services, (4) combine sexual history sheet with the under 16s proforma, (5) Improve education about LARC in schools to promote uptake, (6) encourage a self-taken chlamydia swab or urine sample in those who decline full STI screening.
P151 How effective is targeted outreach?
Authors: Sellors V , Akers A , Bostock E , Dutton R , Apoola A
Published: May 2012

Background

The national sexual health strategy recommends that services should meet the needs of local communities and identifies where service developments are needed most. The financial pressures of the health service and the operational pressures of trying to meet a 48-h target make it difficult to establish targeted outreach projects to reduce the burden of STIs and the uptake of STI/HIV screening and testing in hard to reach groups.

Methods

A needs assessment was carried out with relevant partner organisations and an outreach project with sexual health advisors was developed. The needs assessment identified three areas for targeted outreach: brothel services for heterosexual men, sauna for MSM and youth offender services. A health advisor outreach clinic was established and staffed 1–4 times a month. Outcome data from the clinics are presented.

Results

The youth offender service clinic was the most successful outreach with 32 patients seen over 17 sessions (23 males and nine females). There were 15 males tested in the sauna over 18 sessions and four female sex workers tested in two clinic sessions. STIs were identified in 20% of all patients seen (two cases of Gonorrhoea, six cases of Chlamydia, two cases of syphilis). The mean percentage of patients seen in the outreach clinics who had never been to the GUM clinic was 71% (75% in brothel, 84% in YOS, 34% from sauna).

Discussion

The targeted outreach has revealed a high level of STIs (20%) in the target group as assumed. The targeted outreach service should reduce the rate of STIs by appropriate treatment, partner notification and counselling. Recording of testing has missed out on the recording of educational activities and other health promotion carried out at sessions. Targeted outreach will help to improve access to those who don't normally attend, improve patient care and help reduce STIs in the community.
P152 Is it feasible to offer a chlamydia test of cure at the same time as routine gonorrhoea test of cure in patients with both infections?
Authors: Colver H , Palfreeman A
Published: May 2012

Background

BASHH guidelines recommend routine test of cure (TOC) for gonorrhoea by nucleic acid amplification technique (NAAT) 2 weeks after treatment if asymptomatic, while it is advised to defer chlamydia TOC until 6 weeks after treatment initiation. Chlamydia TOC is recommended only during pregnancy or if there is clinical suspicion of ongoing or re-infection, although there have been recent concerns about the efficacy of single dose azithromycin therapy. Many patients are co-infected with gonorrhoea and chlamydia, and with dual-platform NAATs it is simple and cost-effective to obtain chlamydia and gonorrhoea results from the same sample.

Aim

To identify whether it is feasible to perform chlamydia and gonorrhoea NAAT TOCs simultaneously within 42 days of treatment in dual-infected patients.

Methods

38 patients with chlamydia who had repeat NAAT tests within 42 days of initiation of treatment were identified using clinical coding and pathology results. Demographic details, treatment type and time elapsed from initiation of treatment to TOC were obtained from patient notes.

Results

36/38 (94.7%) of chlamydia TOCs taken 41 days or less since the initiation of treatment were negative, including 8/8 (100%) of tests taken 14 days or less since chlamydia treatment. One positive test was from a male, the other from a female, 21 and 17 days after treatment respectively. Both were treated with azithromycin. The male patient denied sexual contact since treatment, and it was unclear whether the female patient was at risk of re-infection.

Conclusions

95% of patients in a clinical setting tested negative for chlamydia within 42 days of treatment. Performing a NAAT TOC for chlamydia and gonorrhoea simultaneously in dual-infected patients is therefore feasible, and is a cost-effective and convenient way to reassure patients that both infections have been eradicated. More work is needed to establish the cause of ongoing chlamydia positivity within 42 days of treatment.
P154 Who is most affected by stigma of an integrated service?
Authors: Sauer U , Singh A , Pittrof R
Published: May 2012

Background

Stigma of sexual health services creates barriers to access to care but it is not known if it affects all groups service users equally. Targeted stigma reduction requires this information.

Objective

To determine which user groups of a level 3 One Stop Shop (OSS) sexual health services perceives the service as stigmatised.

Method

Application of a validated quantitative tool to assess stigma among 200 unselected patients attending a OSS in outer London. We defined that the service was perceived as stigmatised if at least one moderately positive response indicating stigma was given.

Results

The service was perceived as stigmatised by 55% (111/200) of patients surveyed. Stigma of the service was more felt by men (25/39 64%) than by women (84/160; 53%) and or those who classified themselves UK black (29/46; 63%) rather than UK white (19/66; 57%). Young men (age <26 years) (12/20; 60%) perceived the service as less stigmatised than older men (13/19; 68%) while younger women (<26 years 57/111; 51%) found the service more stigmatising than older women (>25 years 27/49; 55%). Perception of the service as stigmatised was more prevalent among first time service users (48/84; 57%) than among those who have been there before (59/109; 54%) and among women attending for sexual health (SH) only (40/60; 66%) or for SH and contraception (FP) (11/20; 55%) than among women attending for FP only (29/56; 52%) than. None of these differences reached statistical significance.

Discussion

Our survey shows that integrated services are perceived by as stigmatised by over 50% of service users. While this perception was even more prevalent in some subgroups it is more likely that the perceived stigma is a characteristic of the service than the subgroup. To address this we propose to change the image of the service to one that promotes a healthy life stile—including a healthy sexual life.
P158 Understanding the very young people attending sexual health services; their clinical needs and socio-demographics
Authors: Astill N , Fargie F , Wilson-Brown B
Published: May 2012

Background

Research has shown links between earlier age at sexual intercourse and higher sexual risk-taking and substance abuse, as well as between earlier pregnancy and an unhappy childhood. We wanted to investigate the clinical needs and behavioural risk factors of our local cohort of very young people.

Aim

To investigate the socio-demographic and clinical characteristics of all under 14-year olds attending sexual and reproductive health services in Glasgow over a 1-year period from 1 August 2009 to 31 July 2010.

Method

Data analysis by retrospective case-note review.

Results

81 under 14s attended a total of 142 times over the year. The mean age was 13.2 years; the youngest 11 years old. 70.4% were female. 61.7% were sexually active. 63% attended for contraception, half of these requesting condoms; 14% for a sexual health screen (SHS) and 14% for a pregnancy test (PDT). 32.1% of the whole cohort were already known to social services; for sexually active females this proportion increased to 49%, and for those requesting a PDT it was 58.3%. Substance abuse was documented in 26% of all those who were sexually active, a third of those requesting a PDT, and half of those requesting a SHS. 4/9 sexually active 12-year olds had a history of sexual abuse. Two clients had previous pregnancies reported; one had a sexually transmitted infection diagnosed. Only 24% of sexually active clients were documented as using any contraception, including condoms. Of the 71 clients with documentation, 18.3% had child protection concerns.

Discussion

Significant risk factors are evident especially related to substance, sexual and domestic abuse. A large proportion of under-14s attending sexual health services are known to social services suggesting a history of family and/or school problems. The importance of assessing all potential socio-demographic risk in young people is highlighted, especially in those who are sexually active, requesting pregnancy tests or sexual health screens.
P16 What were the reasons for low CD4 counts in patients starting antiretroviral (ARV) medication?
Authors: Baugh A , Apoola A
Published: May 2012

Background

Our ARV Network's 2009 audit highlighted the large proportion of patients with a CD4 count <350. A re-audit was designed to provide more information on patients with CD4 counts in this range.

Methods

We conducted a retrospective review of case notes for all patients in the network starting ARVs in 2010. For analysis of CD4 counts the cohort was divided into two groups; those diagnosed within 1 year of starting treatment and others.

Results

114 patients started ARVs in 2010 from four centres in our network. 62 (54.4%) were male. Mean age was 38.4 years (range 17–62). Ethnicity data showed only 37.7% were white with the majority being Black (54.4%). 6 (7.0%) of 85 patients had a major NNRTI resistance mutation. Mean nadir CD4 count was 222 (range 5–610). 101 (88.6%) patients had a CD4 count under 350. 106 reasons for low CD4 count were recorded. 65 patients (64.3%) had low CD4 counts because of late diagnosis, 15 (14.8%) had declined ARV when initially offered while 10 (9.9%) had been lost to follow-up. The patients starting Rx within 1 year of diagnosis (no=67) had a lower mean nadir CD4 count compared to those diagnosed earlier (no=47) (162 cells vs 271 cells, p<0.5). There was no difference between the two groups in the number of patients having a pre-treatment resistance test, the mean CD4 rise 6 months after treatment initiation and the proportion of patients having an undetectable viral load 12 months after treatment initiation. At 6 months the mean CD4 count had risen from 222 at treatment initiation to 360, but 54 (47.4%) still had a CD4 count under 350. The main reasons for this were poor immune recovery in 80.7%, poor adherence 7%, poor attendance 5.3%.

Discussion

A proportion of our cohort started ARVs with a low CD4 count mainly due to late diagnosis. This is an important barrier to ARV initiation and needs to be addressed and our audit data would support the need for extra support and resources directed to earlier HIV diagnosis.
P161 Routine three-site NAAT testing in MSM increases pharyngeal and rectal diagnoses of chlamydia and gonorrhoea
Authors: Dufty N , Herbert S , French P , Mercey D
Published: May 2012

Background

BASHH and Health Protection Agency guidelines acknowledge the increased sensitivity of Gonorrhoea (GC) NAAT testing compared to culture at extragenital sites. Chlamydia (CT) NAAT testing is also the test of choice at these sites. Routine three-site GC and CT testing in MSM was implemented at a genitourinary medicine clinic using urethral, pharyngeal and rectal sites.

Objectives

To compare the number of diagnoses of CT and GC before and after implementation of routine three-site NAAT testing for MSM.

Methods

Records were reviewed of MSM testing positive for CT or GC from the urethra, pharynx and/or rectum between 1 January 2010 and 1 April 2010 and compared to the same 3-month period in 2011.

Results

Number of cases: The proportion of GC cultures resistant to >1 antibiotic increased from 15.9% (18/113) to 41.8% (28/67), however cultures were only taken in 51.1% (138/270) of NAAT positive GC specimens (see abstract P161 table 1).

Abstract P161 Table 1

Comparison of CT/GC diagnosed

Q1 2010*Q1 2011*MSM attendances40633975MSM diagnosed166354Diagnoses of CT or GC199494CT (total)81225CT Urethra4369CT Pharynx032CT Rectum25113LGV1311GC (total)118269GC Urethra5845GC Pharynx11121GC Rectum49103MSM with infection at 1-site146 (88%)258 (72.9%) 2-site19 (11.4%)80 (22.6%) 3-site1 (0.6%)16 (4.5%)Diagnoses due to triple NAAT testing protocol (% of total):322 Pharyngeal CT32 (100%) Rectal CT106 (93.8%) Pharyngeal GC109 (90.1%) Rectal GC75 (72.8%)Diagnoses treated due to triple-site NAAT testing (% of total)234 Pharyngeal CT20 (62.5%) Rectal CT78 (69%) Pharyngeal GC76 (62.8%) Rectal GC60 (58.3%)*

Q1 1st January to 1st April.

Discussion

Pharyngeal GC, CT and rectal GC diagnoses increased with three-site NAAT testing, making the pharynx and the rectum the main sites of GC and CT infection. This increase in diagnoses has implications for clinical service provision. The increase in antibiotic resistance to GC has important clinical implications and when using routine three-site NAAT testing, cultures should always be taken prior to antibiotics being given.
P165 GUM/HIV trainees' experience and training needs in the management of patients disclosing sexual violence
Authors: Sacks R , Coyne K , Cybulska B , Dhairyawan R , Forster G , Emerson C , Mears A , Mears A , Shah R , Spice W
Published: May 2012

Background

Patients attending GUM clinics may disclose sexual violence. Are GUM/HIV trainees equipped to manage these cases?

Aim

To assess the experience and training needs of GUM/HIV trainees in managing patients disclosing sexual violence (SV patients).

Method

An e-survey was open to GUM/HIV trainees for 12 weeks from February 2011. Data were analysed in Excel.

Results

Of the 158 current GUM/HIV trainees, 44 (28%) completed surveys. All respondents managed SV patients and 59% managed ≥ 1 SV case/month. Of these, 98% had seen females, 66% males, 73% 16–17 years/olds, 34% 13–15 years/olds, 5% under-13s. All respondents routinely asking about SV saw ≥ 1 case/month vs 50% of those who rarely/never asked. Confidence increased with frequency of seeing patients: 96% (25/26) seeing ≥ 1 SV patient/month felt confident vs 67% (12/18) seeing <1/month. Confidence in managing female, male and under-18 SV patients was reported in 86%, 79% and 58% respectively. In the six units with a dedicated SV clinic two trainees had worked in one, overall, 92% would have liked to. Similarly, 14% had worked in a Sexual Assault Referral Centre, 81% would have liked to. Respondents had trained in safeguarding children, adult SV, chain of evidence, vulnerable adults and domestic violence in 92%, 82%, 76%, 64%, 32% respectively. Abstract P165 Table 1 details respondents' reported competencies and training availability in 2010 curriculum skills.

Abstract P165 Table 1Competent (%)Not competent, training available (%)Not competent, training not available (%)Emergency contraception counselling10000Referring to support organisations90100Prescribing STI/HIV/Hep B prophylaxis90100SV history taking and risk assessment in u-18s8947Forensic exam counselling/documenting injuries64297Documenting history/exam for medico-legal report461935

Conclusions

Wide variation exists in reported SV experience, training received and training availability, in the 28% of trainees responding. Regular accessible training is needed in identifying and managing patients disclosing SV.
P167 Management challenges of a trifecta (HIV, hepatitis C and syphilis tri-infection) and an update on HIV/HCV co-infection
Authors: Khaw C
Published: May 2012

This complex case is of an ageing HIV positive patient, who had been a management challenge to a multidisciplinary team over the past decade in Adelaide, South Australia. He had various comorbidities and had developed various other infections, mostly sexually acquired, complicating his management. The patient was diagnosed as HIV positive in 1985 and commenced on HAART in 1989. He relocated to Adelaide in 2002. His major issues at that time were sexual dysfunction and bipolar affective disorder. On routine screening mid 2005, his CD4 count had dropped. Liver function tests were abnormal with raised GGT, ALT and AST. Subsequently, he was found to be Hepatitis C positive (Genotype 3). He adamantly denied intravenous drug use but had unprotected anal intercourse with other men. He also had a Prince Albert ring inserted. The hepatitis C infection was apparently acquired sexually. He proceeded to have multiple sexual partners interstate and overseas. On return to Adelaide at the end of 2005, he was found to be syphilis EIA positive, RPR 1:32 and FTA IgG positive. He was treated with benzathine penicillin. Management of his hepatitis C initially involved changes to his HAART over the next 2 years before he finally decided to commence interferon and ribavarin therapy for his Hepatitis C co-infection. He was on treatment for 6 months, with close monitoring by the team psychiatrist in view of his psychiatric comorbidities. To date, he has maintained sustained virological response. An overview of HIV/Hepatitis C co-infection from recent literature review will also be presented.
P17 Four years of post exposure prophylaxis following sexual exposure (PEPSE) prescribing after sexual assault in a sexual assault referral centre (SARC)
Authors: MacDonald R , Groom T , Wardle D
Published: May 2012

Aim

We have reviewed 4 years of PEPSE use in our SARC and its follow-up and compared with BASHH guidance on PEPSE after sexual assault.

Methods

Retrospective review of SARC and GUM notes from 12 October 2007 to 12 October 2011

Results

1233 cases seen 127 given PEPSE, for two notes not available Age range 14–55 years mean 27. 81% were female. 51% were vulnerable. Ethnicity of assailants, 81 White European, 20 African, 5 Asian, 4 Dark European, 13 unknown. One man had PEPSE twice. Mean time till received PEPSE was 25 h range 3–168 h, 5 over 72 h. Using BASHH guidelines PEPSE wasrecommendedin 22%,consideredin 50% and 26% wasnot recommendedas either >72 h or low risk exposures. 87 returned at day 3 for review. 29 stopped PEPSE early. One was HIV positive at baseline, 12 due to side-effects, three felt the assault was low risk of HIV at review, 13 for other reasons. 27% returned for HIV test at 3 months, 14% at 6 months. No seroconversions seen. 17% completed PEPSE. 43 given PEPSE while on interacting drugs. Eight were identified and given appropriate management. Most common interaction was hormonal contraception.

Discussion

Completion rates for PEPSE were low and similar low rates have been seen in alike studies. No long-term side effects were seen but only 19% of interactions were identified. PEPSE is a risk reduction method and so clients should not be put at risk of serious drug interactions. 33 were given PEPSE for low risk exposures which is “not recommended” by BASHH. 10 of these accepted full PEPSE course. The decision to start PEPSE is often made under stressful conditions so GUM now review need for PEPSE after completing the starter pack. It is vital staff starting PEPSE prescribe within the guidelines and they and GUM staff consider interactions. We have created a proforma which reminds staff only to give within 72 h and review interactions. It also outlines HIV risks after exposure and hopefully make it easier to discuss this with the client.