bluuebunny/crossref_metadata_2025_split huggingface dataset:
P081 The cost of cost-saving HIV drug switches in a small DGH HIV unit
Authors: Street Kerry , Priestley Cecilia , Scofield Sara 
Published: May 2024

IntroductionIn July 2016 NHSE circulated a letter regarding Commissioning for Value and antiretroviral drug switches. The letter noted that ‘These switches have been identified as not needing to recall patients to clinic or to introduce additional monitoring arrangements unless clinically indicated or the patient requires further support’. However the e-GFR decreases after starting cobicistat and checking at 4/52 is recommended.MethodsPatients suitable for antiretroviral drug switches were identified by pharmacy, a total of 50 patients (53% of our cohort). A review of the outcomes up to Jan 2017 was undertaken.ResultsEleven patients switched successfully from Kivexa to generic abavavir/lamivudine. Fifteen switched from Atripla to Truvada/efavirenz. Of these, four switched back due to side effects. In one case 4 months of drugs, costing £1384, were wasted. Two patients did not tolerate Rezolsta (AKI & diarrhoea). There were ten extra visits for safety bloods. The first prescription for the switches for all regimens was for two months to minimise waste. Additional staff time was required to generate the prescriptions, and the additional deliveries cost £1215 to date.DiscussionSwitches from Atripla to Truvada/efavirenz and from PI/r to PI/cobicistat involved additional costs in terms of staff time, delivery charges and drug wastage. In December 2016, we decided to halt the switches to PI/cobicistat, as it was felt that the cost savings were insufficient to compensate for the additional workload, and also it might be a challenge to switch patients back to two drugs when generic darunavir and atazanavir become available.
P085 An audit of nice guidance PH33; increasing the uptake of HIV testing in black africans
Authors: Jones Bethan , McCathie Radhika 
Published: May 2024

IntroductionIn 2015, Wolverhampton had the highest rates (15.8 per 100,000) of newly diagnosed HIV in West Midlands and In the West Midlands incidence rates in the black African ethnic group remain much higher than those for other ethnic groups, with a relative risk of 34 compared with the white group in 2015. This clearly shows the importance of the NICE Guidelines PH33 which was published in 2011 which aimed to increase the uptake of HIV testing in Black Africans and we wanted to audit this guidance.MethodsA list of patients classified as being of Black African ethnicity who were admitted to the Acute Medical Unit at Royal Wolverhampton NHS Trust between April 2015 and January 2016 was obtained. Their medical notes and blood test results were retrospectively analysed for evidence of testing or any discussion of HIV tests.Results50 case notes were retrospectively reviewed. An HIV test was not offered in 87% of admissions despite 15% of them presenting with signs of clinical indicator diseases. Only 6 patients were offered a test during their admission, of which 5 of them accepted. 1 of these tests was HIV positive and the patient was referred for further care to the HIV service within the trust.DiscussionThere remains a barrier to HIV testing in high risk populations in non-GUM settings despite NICE guidance published several years ago. Recommendations include the need to identify existing barriers by surveying doctors and providing education on how to overcome them, and the addition of prompts on clerking proformas may encourage universal testing.
P098 Evaluation of the performance of HCV AG in routine screening for hepatitis C in high-risk populations
Authors: Houlihan Catherine , Vora Nina , Waters Laura , Ghosh Indrajit , Gilson Richard , Nastouli Eleni 
Published: May 2024

IntroductionScreening high-risk populations for hepatitis C (HCV) using antibody (anti-HCV) does not immediately distinguish resolved and active infections and may miss acute infections. HCV core-antigen (HCVAg) screening has been introduced in laboratories supporting some UK sexual health clinics. We evaluated Abbott Architect’s automated HCVAg immunoassay for HCV screening.MethodsTesting was introduced in May 2015 for those reporting HCV risk in the past 6 months, and annual screening for all HIV-positive individuals. HCVAg-positive samples were tested in duplicate, then tested for HCV–RNA. Few samples were tested for both HCVAg and HCV-RNA in the initial few months. Results for all tests performed May 2015–April 2016 were reviewed.Results5132 samples were tested for HCVAg. 113/5132(2%) were HCVAg positive. 139 samples had both HCVAg and HCV-RNA tested. Using HCV-RNA as the gold standard, HCVAg sensitivity was 99%; positive predictive value 63%. Specificity was 39%; negative predictive value 96%.Abstract P098 Table 1Evaluation of HCV Ag testHCV-RNA detectedHCV-RNA not detectedHCVAg+ve7141**HCVAg-ve1*26The HCVAg negative/HCV-RNA positive individual had low viral load (130c/ml).Of the 41 HCVAg positive/HCV-RNA negative individuals; 30(73%) were retested later and were HCVAg negative and HCV-RNA or anti-HCV negative. 3(7%) were persistently HCVAg positive but HCV-RNA negative; 7 had no follow up samples; 1 subsequently became HCV-RNA positive.DiscussionThe specificity of HCVAg in our cohort is lower than that published in a recent systematic review (93% sensitivity/99% specificity). False positive results cause distress for patients and additional laboratory costs, however the increased sensitivity for acute infection may lead to earlier diagnosis in high-risk populations.
P106 The inbetweeners: 16 & 17 year olds attending SRH are vulnerable
Authors: Forbes Kimberley , West Richard , Cassidy Seán , Daniels David 
Published: May 2024

IntroductionLegally, 16 and 17 year olds can consent to sex but may still be vulnerable to sexual exploitation; opportunities to identify vulnerability may be lost when transitioning into adult services.MethodsIn the financial year 2015–16 there were 1975 attendances of 998 individuals <18 at a sexual & reproductive health service. A risk assessment proforma was used in 98.8% (n=505/511) of those 16 or under and 72.9% (n=355/487) of those aged 17. These were analysed using an electronic report.Results DiscussionUsing arisk assessment proforma with16 and 17 year olds enabledstaff to recognise vulnerabilities related to child sexual exploitation, 53% of all concerns were among this age group. When transitioning to online and adult services care modelsshould include assessment to identifyvulnerabilities such as pre-existing involvement with social care, older partners & mental health difficulties. Staff should be competent in managingdisclosures and have aworking knowledge of social care, referral thresholds and pathways within local networks for those at risk of CSE.Abstract P106 Table 1The inbetweenersUnder 16 n=205Age 16 n=300Age 17 n=355New safeguarding concern14 (7%)8 (4.3%)8 (3.8%)Known to social care52 (34%)61 (20%)70 (20%)> 10 sexual partners2 (1%)9 (3.2%)14 (4.2%)Age of current or last partner 18–24 years9 (4.3%)66 (23.8%)195 (58.9%)Age of current or last partner 25 years or >04 (1.4%)5 (1.5%)Mental health difficulties47 (23%)63 (21%)93 (26%)
P107 Exploring the awareness and acceptability of screening methods for anal intraepithelial neoplasia (AIN) in the HIV-positive men who have sex with men (MSM) population
Authors: Johnson Maximilian , Mulka Larissa , Richardson Daniel 
Published: May 2024

IntroductionRates of AIN and anal squamous cell carcinoma (SCC) are increasing worldwide, particularly within high-risk populations, such as HIV-positive MSM. Although screening programmes for AIN exist, evidence supporting their benefit is currently limited and ongoing studies will provide crucial data regarding their efficacy.Aim(s)/ObjectivesTo determine awareness of AIN and acceptability of potential screening methods in a large HIV-positive MSM cohort with high rates of anal SCC, to assist in the development of future services and to evaluate a patient information leaflet.MethodsA patient information leaflet was designed providing information about AIN and screening methods. Respondents read the leaflet and completed a survey determining both its usefulness and attitudes towards screening services.Results172 HIV-positive MSM completed the survey with a modal age-range of 45–54. 146 (84.9%) read the leaflet and found it useful. Though only 23 (13.4%) were previously aware of AIN, 119 (69%) were concerned. 23 (13.4%) self-examined regularly though 88 (51.2%) were not aware of self-examination. However, 119 (83.2%) were willing to self-examine and 142 (99.3%) would accept examination by a healthcare professional. Support for a screening programme was strong with 143 (83.1%) of respondents stating they would be willing to participate.DiscussionIn this well-informed HIV-positive MSM population, awareness of AIN and screening methods is low, however self-examination and screening is acceptable. It appears that our information leaflet is a useful tool to raise understanding and promote self-examination.
P126 Characterising admissions to a specialist HIV inpatient centre: demographics, diagnosis and ideas for service development
Authors: Bentley Alexander , Lawrence David , Roche Mark , Richardson Daniel 
Published: May 2024

IntroductionEffective antiretroviral therapy has reduced HIV inpatient admissions and patients are increasingly admitted with non-HIV related pathologies. Increasing pressure on NHS hospitals emphasise the need to minimise admissions, maintain patient flow and understand how inpatient facilities are used. We aim to review the demographics and causes of acute medical admissions to a single HIV-specialist unit.MethodsRetrospective analysis of patients admitted under the HIV team at a single referral centre including demographics, reason for admission, length of stay and discharge destination.Results114 patients admitted in 2016. Median age 46 years (range 18–79). 86% male. 14/114 (12%) were newly diagnosed with HIV. 24/114 (21%) admitted with HIV-associated illness, 16/114 (14%) with AIDS-defining illness, 59/114 (52%) with non-HIV associated illness. Respiratory infections were the commonest cause of admissions with 14/114 (12%) cases of PCP and 27/114 (24%) of lower respiratory tract infections. 16/114 (14%) admissions were secondary to drugs and alcohol. Median length of stay 7 days (range 1–135). Discharge destination was home 89/114 (78%), a bespoke HIV-intermediate care facility 19/114 (17%), other healthcare facility 3/114 (3%) and 3/114 patients (3%) died.DiscussionInpatients were younger and had a much longer length of stay when compared with the average for acute internal medicine. Majority of admissions were for non-HIV associated illness suggesting adequate viral suppression for most patients. Service adaptations are needed to address the high incidence of mental health disorders, importantly drug/alcohol addiction. We also highlight the importance of a HIV-intermediate care unit to aid rehabilitation and facilitate discharges.
P127 Is there a need for pelvic ultrasound within an integrated sexual health service?
Authors: Pinto-Sander Nicolas , Rela Mariam , Yarrow Kate 
Published: May 2024

IntroductionSexual health services see a number of women who once infection is excluded, may require the use of pelvic ultrasound to aid diagnosis. Without in-house scanning facilities, they often end up on a convoluted route involving several appointments across clinical specialities.MethodsThis observational study examined two consecutive years of referrals for pelvic ultrasounds from a busy integrated sexual health service, where in-house scanning was not available. Information from referrals to radiology was gathered from an imaging database where indication and outcomes were analysed from scan reports.Results190 patients were scanned with a mean age of 31. 184/190(97%) were outpatients. 79/190(42%) were scanned for pelvic pain, and 42/190(22%) for coil related concerns. 141/190(74%) of scans had normal findings. Of coil related referrals, only 1/42(2%) needed intervention. 19/190(10%) of pelvic ultrasounds had incidental findings not requiring follow up, and 30/190(16%) had findings requiring intervention or follow up.DiscussionIn this study, all coils with ‘lost threads’ were found to be intrauterine – and therefore could be managed within an integrated sexual health service. Only a small number of those scanned needed onward referral or follow-up. With scanning expertise and resources, patients would be seen more quickly, with a reduction in appointments and fewer referrals. This would result in improved patient satisfaction and reduced costs to the NHS. The set-up costs would be offset in the long-term by keeping patients out of the acute setting.
P128 Exploring chemsex in the north east of england
Authors: Gilmore Katherine , Loberg Anna , Knox Joanne , Chauhan Mayur 
Published: May 2024

IntroductionRecreational drug use is higher in men who have sex with men (MSM) with use of psychoactive drugs facilitating group sex sessions (chemsex). Public health implications include increased sexual risk taking with potential for HIV/STI transmission and associated physical and mental health harms. Our aims were to assess the extent of chemsex in the North East of England to inform local/national policy and tailor service provision.MethodsA regional self-administrated survey was conducted in five sexual health/HIV care providers and a local LGBT and young people’s charity in the North East over a three-month period. All service users were invited to complete an anonymous paper or online survey about chemsex.ResultsThis is provisional data from 954 surveys. 18 respondents reported engaging in chemsex (mean age 37 years,) 71% of which took place in the North East. 94% were male and 78% of these identified as gay (17% heterosexual, 6% bisexual.) 33% were HIV positive, 60% had a previous STI and 13% were ‘slamming’ (injecting.) 9% of all male respondents who identified as gay, had engaged in chemsex.DiscussionData suggests that although chemsex is relatively uncommon in the North East, it is more prevalent in the MSM population and those who are HIV positive. Screening for chemsex in these groups should be standard practice and included in UK national guidance. Consequently service provision can be tailored to address local need by simple interventions or instigate clear pathways into specialist services.
P130 A comparison of demographic characteristics and workloads of independent nurse prescribers (INP) and nurses using patient group directions (PGDS) in sexual health clinics
Authors: Black Adam , Courtenay Molly , Gage Heather , Norton Christine , Franklin Bryony Dean 
Published: May 2024

IntroductionNurses legally deliver medication independently using INP or PGDs. Despite growing evidence of clinical application, there is limited sexual health research.MethodsINP and PGD nurses from five UK sexual health services completed a questionnaire, and recorded two weeks of clinical activity in a specifically designed diary, Aug 2015–Aug 2016.ResultsQuestionnaire response rate: 64% (61/95; INP=26/28, 93%; PGD=35/67, 52%). Respondents were mostly female (n=55/61, 90%), aged 35–44years (n=21/61, 34%). INP were mainly Band 7 or above (n=18/26, 69%), educated to Masters Level (n=16/26, 62%); PGD users were mostly Band 6 (n=24/35, 68.6%), educated to Diploma Level (n=13/35, 37%). INP had mean of 2.9 years more sexual health experience than PGD users (mean: INP=13.0; PGD=10.1years). Both groups reported access to medications was essential (n=56/61, 92%) and made their roles easier (n=60/61, 98%).Overall 61% (INP=17/26, 65%; PGD=20/35, 57%) of questionnaire respondents completed the diary. Of the total diary entries (INP=737; PGD=593), INP managed more ‘new’ care episodes (n=512/737, 70%) than PGD users (n=294/593, 50%). There was no difference in medication delivery frequency (INP=460/737, 62%; PGD=348/593, 59%; p=0.16). However, PGD users required additional medication delivery support from other healthcare professionals more often than INP (INP=419/460, 91%; PGD=240/348, 69%; p<0.01). PGD users had marginally shorter patient consultations than INP (mean 22.8 vs. 24.9mins). Mean consultation support was 8mins/consultation (both groups).DiscussionSexual health nurses require independent access to medication for their roles. INP are more likely to practice autonomously, but may spend longer with patients.
P131 An audit of home testing kits
Authors: Carozzi Becca , Barrett Sarah 
Published: May 2024

IntroductionUmbrella Health recently introduced sexually transmitted infections (STI) home testing kits for asymptomatic adults from Birmingham and Solihull. An audit was undertaken to consider patient demographics, service utility and effectiveness.MethodsAll patients registering for home testing kits between 1st– 10thMarch 2016 were included. Patient demographics, results and follow up were accessed from the laboratory and clinical database. Data was compared with a clinic comparator group of 50 randomly selected patients attending clinic during the same timeframe. Statistics were performed using Microsoft Excel.Results536 patients were included of which 331(61.7%) were female. 103(19%) of patients were symptomatic. 536(100%) of requested kits were distributed. 280(52%) nucleic acid amplification tests (NAAT) and 209(39%) blood samples were returned. 86(41%) returned blood samples were insufficient for analysis. 25(100%) patients with a positive result were informed via text. 10(40%) attended for treatment. 3(30%) agreed to contact tracing. Compared with the clinic attendees, users were younger (60% 16-24yrs cf 28%), more likely to be Caucasian (73% cf 44%), with lower rates of STIs (4.7% vs 16%). 16–24-year-old Caucasian females accounted for 17.5%(N=94) of the home-testing group.DiscussionHome STI testing kits are popular with 536 distributed with 10days. Patients requesting kits were more likely to be asymptomatic, younger, Caucasian and female with lower rates of STIs. Return rates may be improved by provision of a STI fact sheet and lancet change. Linkage of laboratory and clinical databases may improve governance. Low treatment rates need further investigation.
P134 Patient group directions use in sexual health
Authors: Manns Victoria 
Published: May 2024

IntroductionPatient Group Directions (PGDs) provide a legal framework for nurses (and other health professionals) to supply/administer medication without a prescription to facilitate speedy access to medications by patients. An audit was carried out to assess local compliance and use of PGDs (anti-infective and contraception) used with in a sexual health clinic.MethodsUsing Trust wide auditable criteria for PGDs, over a 6-month period (July to December 2016) 715/721 notes were audited. In particular documentation relating to administration/supply of medication and whether the PGD was used in accordance to PGD policy. These data were compared with a pervious audit (January to June 2016) where 306 notes were audited, which identified that 96% were used and documented correctly in line with policy.ResultsIn the audited notes (n=715) There had been an improvement with 99% of medications were issued/supplied and documented correctly in line with the PGD policy, compared with 96% in the previous audit. Those notes where practice did not meet the required standard related to documentation issues (lack of signature or indicating issued/supplied under PGD). All care provided met the eligibility requirements of the PGD.DiscussionThis audit highlights importance of auditing PGD use and having a system that records errors, to help improve patient safety and staff development. Additionally, this audit demonstrates that PGDs can be safely and effectively used within the sexual health setting. Comparison of the audits demonstrates increased PGD’s use, attributed to improved training and staff support.
P136 The evaluation of a stepped-care model for providing effective and cost-efficient psychosexual services within sexual health
Authors: Gurney Karen , Bullemor-Day Pip , White Kathy , Yates Michael , Jamieson Rhiann , Kiddy Caitlin , Der Walt Herman Van 
Published: May 2024

IntroductionIncreasing demand for sexual problems services plus reductions in commissioning have led to a need for high quality services delivered in a low-cost model within sexual health settings. A service redesign utilised a stepped-care model included the use of group therapy interventions as a first line treatment for erectile difficulties and painful sex. These interventions continued alongside existing MDT service provision.MethodsAll patients accessing the service in the first 12 months were given self-report outcome measures at key points of the intervention including quantitative and qualitative aspects of change. Results are compared between those accessing an erection difficulties group, a painful sex group and individual psychosexual therapy sessions.ResultsAbstract P136 Table 1Psychosexual intervention resultsInterventionIndividual(n=32)Erection Group(n=23)Pain Group (n=9)% significant change50%30%22%% change38%70%67%% reporting no change12%0%0%DiscussionFurther efforts to utilise group interventions for sexual problems may support the continued provision of psychosexual services in sexual health settings. Groups were evaluated favourably by service users and demonstrated considerable change. Qualitative feedback suggested distinct benefits of a group intervention over individual care. Those receiving a higher stepped intervention (individual sessions) may have been more complex and for others change in the problem in a traditional sense may not have been possible, however change was reported in other ways (i.e. affect in relation to the problem, relationship satisfaction).
P138 Can we reduce time to treatment by naming the infection in a results text?
Authors: Fearnley Nicola , Brady Sophie 
Published: May 2024

IntroductionPreviously patients testing positive for infections received a text (SMS) asking them to contact clinic. Often this led to missed calls, anxiety and delays in both communicating results and treatment. In June 2016 the wording of the text was changed to include the name of the infection and advice regarding how to access treatment.MethodsWe identified all patients attending our service with chlamydia or gonorrhoea infection between April and December 2016. We excluded those who had received treatment prior to confirmation of their test result (e.g. symptomatic, contacts of infection) and those who did not receive a results text. We reviewed the records of 200 consecutive patients (100 before and 100 after introduction of the new text) and compared time to treatment in the two groups.ResultsOld text recipientsmedian time to treatment was 2 days (d)/mean 3.3 (range 0–24d). New text recipients: median time to treatment was 2d/mean 3.9d (range 0–26d).DiscussionNaming the infection in texts has not led to a reduction in the time to treatment but the median time to treatment in both groups was short. Our health advisor team report anecdotal benefits following the new text including less time spent answering telephone calls therefore allowing more time for patient contact, beneficial since depletion of the health advising workforce. Additionally patients have been happy to agree to the text change in advance with a reported reduction in anxiety knowing the name of the infection.