bluuebunny/crossref_metadata_2025_split huggingface dataset:
P129 Improving clinical standards in GU medicine: a retrospective audit ofNeisseria gonorrhoeae
Authors: Sharp S R , Allan S 
Published: May 2012

ObjectivesThis was a retrospective analysis of clinic performance in the management and treatment ofNeisseria gonorrhoeae(GC) according to BASHH guidelines.MethodsAll 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.ResultsCriterion2007 (%)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 weeks0.410.330.360.5DiscussionThe 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).ConclusionsCurrent 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

BackgroundOur 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/ObjectivesTo 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.MethodsRetrospective 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.ResultsThe 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/ConclusionsThere 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

BackgroundAn 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.AimTo explore the pathways to HIV testing and treatment for people with a history of short-term circular migration, and their partners.MethodsA qualitative study at an ART centre in northern India, using in-depth interviews. Data were analysed using framework and thematic content analysis.Results34 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.DiscussionDiagnosing 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

BackgroundAdolescents 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.ObjectivesA 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.MethodsFollowing 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/DiscussionThere 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.ConclusionWith 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

BackgroundFunding 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.AimsThe 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.MethodsData 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.ResultsOverall 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.DiscussionThere 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

BackgroundPublic 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.MethodsDemographic, 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.ResultsImplementation 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.ConclusionImplementation 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

BackgroundThe 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.AimsIn 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.MethodologyService provision was reviewed in comparison to the DoH standards. 50 sets of records were analysed.ResultsReasons 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

BackgroundThe 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.MethodsA 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.ResultsThe 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).DiscussionThe 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

BackgroundBASHH 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.AimTo identify whether it is feasible to perform chlamydia and gonorrhoea NAAT TOCs simultaneously within 42 days of treatment in dual-infected patients.Methods38 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.Results36/38 (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.Conclusions95% 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

BackgroundStigma 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.ObjectiveTo determine which user groups of a level 3 One Stop Shop (OSS) sexual health services perceives the service as stigmatised.MethodApplication 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.ResultsThe 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.DiscussionOur 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

BackgroundResearch 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.AimTo 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.MethodData analysis by retrospective case-note review.Results81 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.DiscussionSignificant 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.