bluuebunny/crossref_metadata_2025_split huggingface dataset:
P062 Accessing the prep population: what is the best service model?
Authors: Shaw Jozef , Dufaur Laurence , Bayley Jake 
Published: May 2024

IntroductionPre-Exposure Prophylaxis (PrEP) is effective to prevent HIV infections. Optimal service models for delivering this intervention are as yet unclear. We looked at our dedicated PrEP clinic in East London to identify who was accessing our service.MethodsRetrospective case note review collected demographics, PrEP use, STI rates and ‘chem’ use from January to November 2016. Data was analysed with STATA.Results116 visits from 54 patients were returned with a median age 42 years (IQR 32 – 44.5). 90% were white. Of these 54 patients, only 27 started PrEP and engaged in care. For our population, there were lower than expected rates of STI’s (6% for CT and 9% for GC – any site) and a median of 4 partners in the preceding 90 days; much lower than encountered in the PROUD trial. 40% (21/54) had used ‘chems’ at some point, with 21% (4/21) of those ‘slamming’ (using intravenously) in the last 3 months. Routine urinalysis showed 30% abnormalities, but no subsequent abnormal uPCR.DiscussionAs the interest and use of PrEP grows, new service models may have to be developed to accommodate this population. We saw varying levels of engagement with patients who were predominantly white with low sexual risk. Young MSM were also underrepresented. Engagement with BME and MSM communities, along with drug services, may be needed to inform effective delivery of this intervention to those most at risk.
P064 Audit of post-exposure prophylaxis with associated risk profiles at the gay men’s health services, dublin, 2016
Authors: Moloney Geraldine , O’Dea Siobhan , O’Sullivan Colm , Clarke Susan 
Published: May 2024

IntroductionThe incidence of HIV infection is rising in Ireland, reaching a rate of 10.6/100,000 people in 2015. MSM is the most common route of transmission, reported as 50.9% of new diagnoses. There is a comparative surge in requests for HIV post-exposure prophylaxis (PEP) in Gay Men’s Health Services (GMHS), Dublin: 44% increase in 2016, vs. 2015. In 2016, a PEP proforma was devised for consistent clinical assessment of PEP requests and decisions.MethodsWe performed a retrospective review of all PEP requests from June-December 2016, following the introduction of this proforma. We investigated exposure types, reported use of condoms, alcohol, drugs, and partners STI status. We assessed appropriateness of PEP decisions in accordance with national guidelines, and compared risk profiles to published findings from 56 Dean Street.Results116 PEP assessments occurred in this time, with the specific proforma. All were evaluated as appropriate for PEP. GMHS attendees had same median age (31 years) as those of Dean Street. However, GMHS attendees reported significantly elevated risks of no condoms used (73 vs 54%; p <0.0001), more recreational drugs (30 vs 20%; p = 0.01), with an additional 13% using both drugs and alcohol. GMHS attendees reported more IAI, and significantly less group sex activity (3.5 vs 11%; p =0.02). Partner’s viral or bacterial STI status was rarely known.DiscussionPEP is appropriately assessed and provided for GMHS attendees. High risk sexual behaviours are common, requiring comprehensive HIV prevention strategies for the continuing epidemic.
P067 All better now?: completing the audit cycle for pepse in the edinburgh gum service
Authors: Pollitt Helen , Raha Durba 
Published: May 2024

IntroductionOver 2014-2015 in the GUM clinic in Edinburgh we audited PEPSE (post exposure prophylaxis for sexual exposure) as per 2011 BHIVA guidelines. The initial audit results showed that we fell short of the BHIVA auditable standards, most noticeably for proportion of prescriptions within recommended criteria, completion of PEPSE course and STI testing. Based on the results of the audit and the updated 2015 BHIVA guidelines, changes were incorporated into a new local PEPSE pathway. Changes included more detailed patient discussion about whether PEPSE is recommended, providing full 28 day course at first visit if indicated and STI screening at initial visit. We have re-audited PEPSE prospectively August 2016 onwards to see if there was improvement in the standards after the new local guideline was implemented.MethodThe following and demographics were documented on Excel Spreadsheet for patients who were prescribed PEPSE and compared with the results of the original audit.ResultsFor the initial audit in 2014–2015 n= 100, for the re-audit in 2016 at the time of submission n=80.Abstract P067 Table 1PEPSE AuditPercentage of patients with (%)2014–20152016BHIVA guidance recommendation (2011/2015)Baseline HIV test8190100Prescriptions that fit recommended indications557190Prescriptions administered within 72 hours of exposure8310090Prescriptions within 24 hours of exposure364490Completion of 4-week course of PEPSE4749 completed,19 ongoing,32 unknown or incomplete75STI screen518090DiscussionThe results suggest marked improvement, though we still fall short of the auditable standards.
O12 LGV testing: are we identifying all cases in a timely manner?
Authors: Maxwell Alexandra Z , Cliff Penelope R , White John A 
Published: May 2024

IntroductionBASHH recommendsLymphogranuloma venereum(LGV) testing ofChlamydia trachomatis(CT)-positive specimens from men who have sex with men (MSM) presenting with proctitis, and all rectal CT from HIV-positive MSM. Until recently in England, LGV testing was only available as a referred test at the Sexually Transmitted Bacteria Reference Unit (STBRU). In July 2016 we implemented a validated in-house version of the STBRU LGV PCR on all CT-positive specimens from MSM, regardless of symptoms or HIV status. We assessed the time from specimen collection to result (turnaround time, TRT) and defined clinical features of LGV cases.MethodsFrom July 2016 to March 2017 we reviewed all positive LGV tests, recording patients’ demographics, HIV status, chemsex behaviour, presence of symptoms and LGV result TRT.ResultsWe conducted 587 LGV tests on CT-positive specimens from MSM, of which 50 (8.5%) were positive. Median age of LGV cases was 38 (range 23 to 65), 28 (56%) were Caucasian, 38 (76%) were HIV positive and chemsex behaviour was reported by 20 (40%); 12 patients (24%) had a past history of LGV. Nine (18%) cases were asymptomatic and three of these were HIV-negative MSM. The mean TRT was 12 days (range 8 to 20); compared with 35 days (range 15 to 118) in the six months prior to in-house testing.DiscussionLGV continues to occur mainly in HIV-positive MSM as symptomatic proctitis. Testing all CT-positive MSM increased detection of LGV compared with following BASHH guidelines, and in-house testing reduced TRT significantly.
P080 Dramatic reductions in new hiv diagnoses for MSM in england are not uniform for all ethnicities in a large london clinic
Authors: Bayley Jake , Williams Andy , Singh Selena 
Published: May 2024

IntroductionAlong with many other GUM clinics, we are seeing a reduction in new HIV diagnoses in MSM. Our clinic is based in East London and sees MSM of all ethnicities. Preliminary data analysis suggests that this reduction may not apply to the BME MSM population.MethodsWe analysed HIV testing rates from our large London GUM clinics. HIV tests, along with demographic data, sexual risk and ethnicity are collected routinely. We then compared positivity rates between ethnicities in 2015 and 2016.ResultsOver 2015 and 2016 there were 48,512 HIV tests performed, of which 12,248 (25%) were on MSM. There was a slight decrease in the number of HIV tests in MSM from 6,688 in 2015 to 5,560 in 2016. We saw a significant reduction in the numbers of new HIV diagnoses in MSM from 43 in 2015 to 25 in 2016. This reduction in new HIV diagnoses was seen in those of white ethnicity (from 30 in 2015 to 15 in 2016) and black ethnicity (from 5 to 3). However, this reduction was not seen in Asian MSM (2 diagnoses each year).DiscussionNew diagnoses of HIV are declining in MSM, likely due to treatment as prevention and PrEP. However, it appears that these significant drops are not uniform. Asian MSM may be less likely to engaged with traditional GUM services. Targeted work is needed to engage this group and help reduce HIV diagnoses further.
P082 Implementing and sustaining hiv testing in acute medicine – results from the first 2 years
Authors: Gann Hugh Mc , Mclaren Jos , Baggott Amy 
Published: May 2024

IntroductionLeeds is an area of high HIV prevalence of 2.3/1000 and in accordance with National UK guidelines for HIV testing we introduced routine opt out HIV testing to the acute medicine unit at St. James’s University hospital in January 2015. Opt out testing is offered to patients between 16 and 65 years of age admitted to any of the acute medical areas.MethodsEnsuring high testing rates in this busy environment with rapidly changing medical staff is challenging and we have used a number of interventions to help sustain a high testing rate. These include providing weekly feedback and training to the acute medicine doctors and nurse practitioners, an electronic prompt on the Ordercoms pathology system and for patients who have blood tests in the emergency department, the facility to have HIV testing performed on samples sent to biochemistry. We employ a 0.5 WTE nurse to support this project.ResultsBetween January 2015 and February 2017 there have been 11,715 eligible patients admitted of which 7263 (61%) patients underwent HIV testing. HIV testing was highly acceptable to patients with almost no patients refusing the offer of an HIV test. 16 patients (0.22%) had a positive HIV test and 2 partners were subsequently tested positive. 10 of the 16 patients had a very late diagnosis with a CD4 count <200 cells/mm3and we identified many missed opportunities for earlier diagnosis. 2 patients had primary HIV infection and would almost certainly not have been tested otherwise.
P092 National hiv testing week 2016: increasing hiv awareness and testing opportunities through a coordinated national event
Authors: Kifetew Chamut , James Cary , Dobb Paul 
Published: May 2024

IntroductionNational HIV Testing Week (NHTW) is an annual event co-ordinated by HIV Prevention England (HPE) which aims to increase HIV testing in England, as well as to increase awareness and acceptability of HIV testing among key populations. It takes place each November in the lead-up to World Aids Day.MethodsDigital and print promotion of: the event and postal testing services, as well as digital interactive information tools which seek to reduce barriers to testing. Provision of printed resources, including customizable and community-language posters to promote local testing events. A post-event evaluation to assess the effect of the campaign was also completed by the organisations involved.ResultsFor NHTW 2016, 100 organisation representatives responded to the post-event evaluation. 65% agreed that NHTW increased their capacity to impact their community/clients. The biggest impact was through increasing awareness of the importance of HIV testing in the local community (86%), followed by delivering more HIV tests (57%). Of those organisations who provide HIV testing, 33% provided at least twice as many tests in testing week compared with a regular week.Nearly 320 organisations ordered 400,931 NHTW resources. 211 testing events were registered on the website and 5,740 HIV home-sampling kits were ordered by the public, driven by social media and mobile app advertising.DiscussionNHTW is a high-impact event which promotes HIV testing, uniting community, clinical, government and statutory stakeholders. The campaign in the future will hope to engage more partners and keep amplifying local HIV testing and raising awareness.
P096 HIV testing in tertiary healthcare settings – staff beliefs and concerns
Authors: Weber Martin , Barrett Afra , Finnerty Fionnuala , Richardson Daniel 
Published: May 2024

IntroductionUndiagnosed HIV remains a problem in the UK. Locally, we have an extremely high prevalence of HIV (>8:1000). BASHH, BHIVA and NICE recommend routine HIV testing in medical admissions in areas of high prevalence. We wanted to identify current practices and knowledge of HIV testing in our large acute urban hospital trust.MethodsAn electronic survey of clinical staff was distributed via email and Trust website in November 2016.Results42 responses were collected from 21/42(50%) nurses, 6/42(17%) medical staff and 15/42(36%) other staff. 33/42 of responses were from non-traditional settings (non-GUM, HIV, ID). 39/42(93%) agreed that HIV testing should be part of regular healthcare and most (32/42(76%)) agreed that it does not interfere with other healthcare services and (24/42(57%)) that they have the resources to perform a test 30/42 (75%) feel comfortable in discussing HIV with patients and 20/42 (71%) feel comfortable in offering and performing an HIV test. 18/42(43%) said they believed patients would be offended by offering an HIV test. 14/42(34%) do not know if patients receive adequate pre-test information, while 20/42 (48%) said patients are not receiving adequate post-test information. 17/42 (41%) do not know if test results are being given in an appropriate and confidential manner to patients.DiscussionOverall clinical staff believe that HIV testing is a good idea and does not interfere with the provision of regular health care services. However the clinical teams offering tests need more information on what pre and post-test discussion is required and how patients receive results.
P099 TV or not TV: using naats to improve the cost effectiveness of testing
Authors: Oxenham Chantal , Palmer Kayleigh , Narayana Srinivasulu , Browne Rita 
Published: May 2024

IntroductionIn April 2016, we changed from TV culture to BD Viper NAATs testing and from testing all women to only testing women who were symptomatic, STI contacts, had previous TV and male contacts of TV.MethodsLaboratory data and SHHAPT codes retrospectively identified all patients diagnosed with TV between 1 May – 30 November 2016. Electronic patient records (EPR) were reviewed and data analysed in Excel.ResultsThere were 96 new diagnoses, 93 females and 3 males, median age 31 (IQR 24–40). 66% Black Afro-Caribbean; 3 were sex workers. 91% symptomatic, 22% had STI co-infection, 26% bacterial vaginosis, 7% candida and 32% previous TV.Wet prep microscopy (WPM) detected 65% of symptomatic cases. Treatments were Metronidazole or Tinidazole.The audit standards our service achieved (BASHH performance standards target- 97%) were: 100% received appropriate antibiotics, 51% written information receipt documented, 90% had partner notification recommended (PN) and 28% PN confirmation.Abstract P099 Table 1Cost analysis summary2015 (Culture)2016 (NAATs)Tested30541859Positive84117New infections7396Cost£19,851£15,486DiscussionTV NAATs cost more than culture but changing our protocol reduced the overall cost while increasing the number of new diagnoses; enabling us to target testing to patients at highest risk. 35% (27) were missed on WPM. 9.3% (9) were asymptomatic and detected because of testing as contacts of TV/sex worker/cervical cytology detection. Recommendations include: staff training to improve completion of PN and modifying our EPR fields to improve documentation of leaflets having been given.
P108 Closing the audit cycle after updated proctitis guidelines: are we treating too much or too little?
Authors: Gostick Benjamin , Bayley Jake , Singh Selena 
Published: May 2024

IntroductionThere are currently no national guidelines for the management of proctitis. Given the rising rates of STI’s, we modified our current guidelines and audited the outcomes pre and post-guideline change.MethodsRetrospective case note analysis was performed on all patients who were coded as proctitis (C4NR) before and after the guidelines were modified. We collected information on demographics, HIV status, symptoms, investigations, treatment and outcomes.ResultsWe returned 64 patient records over 67 visits, 39 pre and 25 post-guideline changes. 31% (20/64) were HIV positive. Commonest presentations were PR bleeding (49%), rectal discharge (44%) and diarrhoea (28%). 55/64 (88%) had rectal microscopy, with 42/55 (76%) having pus cells present; of these 3/42 (7%) had GC seen on microscopy. There were very low levels of urethral STI rates (just one case of each), but high rates of rectal GC and CT (24% and 13% respectively). LGV was positive in 5% (3/54) and rectal HSV was found in 25% (10/40). There were more HSV swabs sent before versus after guideline modification (19/40 versus 21/27, p=0.01).DiscussionThe audit has shown that the addition of HSV swabs and treatment into the guideline had a positive effect, with more cases of HSV proctitis being diagnosed and treated. Our guidelines were also modified to include LGV treatment, but given the low prevalence this may be rationalised. On-going work around coding is also planned as many were coded as proctitis without rectal microscopy.
P112 Retrospective study of the results of taking of blind swabs versus speculum-assisted swabs in women with vaginal discharge
Authors: Dolan Zac , Ahenkora Abena , Gebru Eden , Brook Gary 
Published: May 2024

IntroductionAlthough a speculum is generally recommended to aid the taking of swabs for microscopy in women with vaginal discharge, many women dislike this and ask for a blind swab, in which a plastic loop is inserted high into the vagina to take a sample. We have agreed to this for some women and have therefore retrospectively looked at the diagnostic rates for each method.MethodsWe looked at 150 consecutive women clinically coded as ‘TS’ (microscopy performed) in 2015 and 2016 and looked at the proportion of women tested by each method and the vaginal-discharge-causing infections diagnosed.ResultsIn 2015, 129 women had clear documentation of the method used of which 120 (93%) where speculum-taken and 9 (7%) were ‘blind’. In 2016, of 101 women with documentation of the method used 52 (51%) were speculum-taken and 49 (49%) were ‘blind’. The diagnostic rates for each infection are given in the table.Abstract P112 Table 1Blind.v. speculum testingMethod used to take sampleTotal number of women tested by each methodTVBVCandidaBV + CandidaBlind583 (5%)18 (31%)9 (16%)*0**Speculum1728 (5%)75 (44%)58 (34%)*24*** P=0.008** P=0.0001DiscussionThe blind swab method appears to be accurate in the diagnosis of TV and possible BV, but is clearly inferior in the diagnosis of candida and mixed candida/BV infections.
P119 A comparison of the clinical safety of independent nurse prescribing (INP) and use of patient group directions (PGDS) by nurses in uk sexual health clinics
Authors: Black Adam , Courtenay Molly , Gage Heather , Norton Christine , Franklin Bryony Dean 
Published: May 2024

IntroductionUnder UK legislation, nurses independently prescribe or supply medications using PGDs, but evidence on safety in clinical practice is limited.MethodsClinical record review across five UK sexual health services, July–December 2015. Sample size quota stratified based on the number of INP/PGD practising nurses. Documented patient presentations, diagnoses, autonomy and safety/appropriateness of medication delivery were compared between INP and PGDs.ResultsFrom 1,851 (INP=711, 38%; PGD=1,140, 62%) clinical records, 50% (n=933) involved medication delivery. INP delivered medication more frequently (INP= 385/711, 54% vs. PGD=548/1,140, 48%; p=0.01). A total of 879 medication assessments were undertaken (INP=399, PGD=480), 69% (n=609/879) were ‘new’ care episodes. Past medical history, concurrent medications and allergy risk assessments were recorded >85% (n=755/879) of cases. INP managed more symptomatic presentations (n=181/399, 45%: asymptomatic n=121/399, 30%); PGD managed marginally more asymptomatic (n=221/480, 46%; symptomatic n=200/480, 42%). INP worked more autonomously than PGDs (INP=310/399, 78%; PGD=308/480, 64%, p<0.01). INP most frequently managed chlamydia (n=53/399, 13%), PGDs most frequently administered vaccinations (n=80/480, 17%). Nurses delivered 66 different products, 1,351 individual medicines, azithromycin being most common (n=231/1351, 17%). Overall, 88% (n=775/879) of episodes were assessed against guidelines as ‘safe and appropriate’ (INP=359/399, 90%; PGD=416/480, 87%). Main reason for not ‘safe and appropriate’ was lack of documentation (n=56/104, 54%). PGDs were, although clinically appropriate, used outside their limits in 5% (n=24/480) of consultations.DiscussionINP deliver medications more frequently and work more autonomously than PGD users. Both groups were comparable in safe/appropriate medication delivery. Improved documentation is recommended.
P132 An audit of the use of suppressive aciclovir in patients on stable art with suppressed HIV viraemia in plasma
Authors: Longley Imogen , Barber Tristan J , Selway Dean 
Published: May 2024

IntroductionBASHH guidelines state suppressive therapy for HSV in HIV+ individuals as aciclovir 400mg BD. Anecdotally some HIV+ patients report better control of genital HSV on different antiretroviral (ART) regimens. Previous studies have shown HIV protease inhibitors (PI) may induce antiviral effects against HSV. We audited our suppressive aciclovir (sACV) use in undetectable HIV patients on stable ART against BASHH standards. We noted frequency of genital HSV outbreaks in those on PI vs non-boosted ART regimens to see any signal that PIs may confer protection against HSV reactivation.MethodsPatients were eligible if they were receiving prophylactic aciclovir, male, 18–50 years of age, with HIV viral load below 50 copies/ml on current ART. The dose of aciclovir was recorded. We also collected information on: HSV outbreaks 1/10/16-31/1/17, ART regime, CD4 count, age/ethnicity, and duration of HIV infection.Results60 patients were identified. 47/60 patients were taking aciclovir 400mg BD. 13/60 were prescribed ACV 400mg OD only. For those on BD:Abstract P132 Table 1HSV suppression by ARTOutbreakNo outbreakPI/boosted111Non boosted629This gave a relative risk of HSV outbreak on a PI of 0.49 over the time studied.DiscussionOf eligible patients 78.3% of prescriptions met BASHH standards. Patients on sACV dosed at 400mg BD had a lower risk (RR 0.49) of symptomatic HSV recurrence if they were on PI based ART. This is important in the therapeutic management of co-infected patients and warrants further studies to better define the relationship.
P196 The cost to find one case of syphilis
Authors: Menon-Johansson Anatole , Artykov Ruslan 
Published: May 2024

IntroductionCost effectiveness is an important consideration especially in the context of constrained budgets. For the National Chlamydia Screening Programme, doubling Partner Notification (PN) was modelled to reduce the cost per diagnosis by £60 and improves gender equity (Turner et al, BMJ. 2011; 342:c7250. doi: 10.1136/bmj.c7250); however, it is not known how PN impacts on a less common but growing Syphilis epidemic. We therefore looked at the impact of PN for patients with Syphilis using a new PN tool.MethodsThe Syphilis diagnoses and testing for one year from February 2016-2017 were determined for two clinics, prices for testing and PN were derived from the integrated sexual health tariff (www.pathwayanalytics.com) and PN data was obtained from SXT (www.sxt.org.uk).ResultsThe Syphilis incidence was 257/30,641 and the cost of a full screen £75; consequently, the cost per Syphilis diagnosis was £8,941. Ten percent of patients coded as partners were found to be infected with Syphilis. The PN outcomes of 248 (96%) patients with early infectious Syphilis were known: 132 partners were verified as seen and tested (KPI=0.53), representing 13 new diagnoses. The cost to deliver PN was £4903 [248*(£17.33 tariff & £2.40 SXT)] and ten partners need to test at £750 [10*£75] to diagnose one case, making the overall cost per Syphilis diagnosis £5,653. PN initiated testing was estimated to reduce the cost per syphilis diagnosis by £3,288.DiscussionPN services reduce the cost to diagnose Syphilis and support case finding. More work is required to target testing and improve PN.