bluuebunny/crossref_metadata_2025_split huggingface dataset:
P063 Pepse from the emergency department: reducing missed opportunities for patient follow up
Authors: Megarity Stephen , Rafferty Paul , Quah Say 
Published: May 2024

IntroductionPEPSE is one method of reducing HIV transmission in higher risk groups. It is commonplace for PEPSE to be delivered from the Emergency Department (ED) out-of-hours. PEPSE delivered outside of GUM can be met with challenges in regard to follow up; resulting in missed opportunities for health promotion, education and STI testing.MethodsRetrospective case-note review of ED episodes from 1/4/2015–31/3/2016. Demographic information and data collected compared with audible outcomes (BASHH 2015 PEP guidelines).Results37 patient episodes identified; 97% male with a mean age 28.2 years. 86% of these episodes occurred out-of-hours with 84% receiving PEPSE within recommended indications (standard 90%). 81% of patients prescribed PEPSE had an HIV test within 72hours (standard 100%). In regard to follow up, 59% of all patients attended for STI testing (standard 90%). There was a 9% rate of STIs reported in those attending for follow up. 51% of all patients had an 8–12 week HIV test (standard 75%). There was 1 new HIV diagnosis reported. Introduction of an ED staff education programme and e-referral pathway has resulted in a 24% increase in patients attending for STI testing. In addition, 100% of patients using pathway had an HIV test within 72 hours and 100% of PEPSE prescriptions were within recommended indications.DiscussionTargeted quality improvement strategies can have a significant impact on PEPSE outcomes for higher risk groups. Improved follow up within GUM after PEPSE prescription in ED has increased opportunities for diagnosis and treatment of STIs, vaccine provision and patient education.
P065 The gmi community coaching model – coaching HIV self-testing and self-sampling within high risk MSM
Authors: Dunkley Yasmin , Wang Dee , Worrall Steve , Skipper Karen , Evans Andrew 
Published: May 2024

IntroductionIn light of moves towards online provision of HIV services, e.g. self-testing, or online self-sampling, the GMI Partnership wanted to understand whether there was a way in which community based organisations could support and incorporate trends towards online provision of services, as well as understand the knowledge of at risk communities in light of changes, through the provision of community coaching on self-testing and self-sampling. The GMI Partnership provides sexual health promotion and HIV prevention services to 76,000 high risk MSM across London each year, as well as in-depth interviews with at least 4,000 MSM each year.Methods2888 online surveys identified existing literacy re- HIV self-testing and self-sampling in MSM (targeted via dating apps.) Recognising that literacy was limited, GMI provided community coaching on self-testing with MSM in high risk venues, to identify whether the intervention was more likely to engender comfort with new technologies (200 quantitative interviews).ResultsHIV literate MSM do not understand the difference between self-testing and self-sampling.The community coaching model ensures high levels of confidence and acceptability in self-testing technologies.DiscussionCommunity testing models can complement self-testing and self-sampling.There will always be clients for whom online provision of new technologies will not work.Scalability of the model within African groups (community based intervention).
P066 Risk reduction’ referrals to a specialist london HIV and sexual health psychology service
Authors: Coffey Caroline , Jovanovic Mirjana , Forjaz Vera 
Published: May 2024

IntroductionConsidering the low number of referrals of ‘risk reduction’ patients to the HIV and Sexual Health Psychology service in comparison to number of patients presenting with sexual risk taking at referring sexual health clinics, we implemented a ‘sexual wellbeing’ service development initiative in 2016.We aimed to compare all the ‘risk reduction’ referrals in 2014 to 2016 in order to reflect on the impact of the service developments implemented in 2016.MethodsA retrospective case note review was conducted to identify referral rates to psychology over a 1-year period in 2014 and 2016. Age at referral, referral outcome and number of sessions were included.ResultsThe number of referral increased fivefold from 2014–2016. In 2014, 23 patients were referred. The mean age at referral was 32. 16 patients opted in to the service, 13 engaged in assessment/therapy. The mean number of sessions attended was 5. In 2016, 115 patients were referred. The mean age at referral was 36. 72 patients opted in and 48 patients engaged in assessment/therapy. The mean number of sessions was 3.40 patients are still engaged with the service and will complete an intervention.DiscussionThe service development initiative has resulted in a significant increase in the number of referrals to psychology. Further service initiatives are ongoing to address the continuing low number of patients opting in and engaging with psychological interventions.
P068 Prep for ireland? an ngo policy paper to inform discussion on legalising the availability of prep in ireland
Authors: Nolan Ann , Mulligan Niall 
Published: May 2024

IntroductionPrEP is illegal in Ireland and the issue of the introduction of PrEP has not been adequately researched within an Irish context. This paper, due for completion in April 2017, examines the question, ‘Should PrEP be introduced to Ireland?’MethodsA comprehensive literature review on PrEP has been completed, to be followed by key informant interviews with national and international stakeholders to ensure coherence with national policy, to capture multiple perspectives and priorities, highlight implementation and operational difficulties, and off-set unintended consequences.ResultsThe results of this paper will focus on PrEP within five key areas – Public Health Effectiveness, Adherence, Feasibility/Knowledge/Willingness to take PrEP, Risk/Risk Compensation, and Cost/Cost Effectiveness. The findings will contextualise PrEP within key populations of MSM, PWID, as well as Sex Workers and will inform Irish policy makers’ decision making by providing input to debates on the pros and cons of introducing PrEP to Ireland.DiscussionIt is argued that PrEP adds to the package of proven HIV prevention options already available and is recommended by UNAIDS for use in conjunction with other prevention methods. However PrEP is frequently not seen in value-neutral public health terms and is a contested intervention along economic, ethical, and rights-based axes. This paper examines PrEP in detail in order to inform discussion on its potential introduction within Ireland.
P070 A retrospective audit of the provision of pepse in a community sexual health clinic
Authors: Draeger Elenor , Vonau Barbara , Clark Sarah 
Published: May 2024

IntroductionWhen setting up a specialist GUM clinic within a community sexual and reproductive health service we started offering Post Exposure Prophylaxis (PEPSE) to eligible patients. The patient pathway was to start PEPSE in our service, then attend the HIV clinic in the hospital for all related follow-up appointments.AimsTo audit our practice against the 2011 BHIVA guidelines for the use of PEPSE.MethodsOur electronic record was interrogated for consultations coded as PEPSE between January 2013 and July 2015. 78 records were found, of whom 5 did not receive PEPSE. Thus 72 records were audited.ResultsAbstract P070 Table 1PEPSE AuditNumber (%)Audit StandardSettingHIV test within 72 hours72 (100)100%CommunityPrescription fits indication72 (100)90%CommunityPEPSE within 72 hours72 (100)90%CommunityCompleting 4 weeks PEPSE21 (29.2)75%HospitalFull STI screen58 (80.6)90%HospitalHIV test 12-weeks post PEPSE18 (25%)60%HospitalThe BHIVA standards were met in all categories that were implemented in the community GUM clinic, but were not met in any of the categories that were implemented in the hospital setting.DiscussionWhile it is encouraging that PEPSE was initiated successfully in our clinic setting, the follow-up data was disappointing. Following the results of this audit all patients who start on PEPSE in our community clinic are now followed up in the community.
P074 Significant efficacy and long term safety difference with taf-based str in naïve adults
Authors: Arribas Jose , Thompson Melanie , Sax Paul , DeJesus Edwin , Clark Amanda , Das Moupali , McCallister Scott 
Published: May 2024

IntroductionAt Week(W) 48, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) was statistically noninferior to E/C/F/tenofovir disoproxil fumarate(TDF) for the proportion of subjects with HIV-1 RNA <50 copies (c)/mL and had significant improvements in renal and bone safety endpoints. We report W144 data.MethodsARV-naïve participants randomised 1:1 to receive E/C/F/TAF or E/C/F/TDF. W144 viral suppression (HIV-1-RNA <50 and <20 c/mL) by FDA snapshot analysis, pre-defined bone and renal safety, and tolerability endpoints are reported.Results1,733 HIV-infected adults were randomised and treated: 15% women, 43% non-white, 23% viral load (VL) >100,000 c/mL. Median baseline characteristics: age 34 years, CD4 count 405 cells/µL, and VL 4.58 log10c/mL. At W144, E/C/F/TAF met pre-specified criteria for both non-inferiority and superiority to E/C/F/TDF by FDA snapshot algorithm (HIV-1-RNA <50 and <20 c/mL) (Table 1). Mean decrease in BMD was significantly less in the E/C/F/group for lumbar spine and hip (Table1). Multiple measures of renal safety were significantly better for participants on E/C/F/TAF (Table). No cases of renal tubulopathy in the E/C/F/TAF group vs 2 on E/C/F/TDF. No participants on E/C/F/TAF had renal-related discontinuations vs 12 on E/C/F/TDF (p<0.001). Participants on E/C/F/TAF had greater increases in lipids.DiscussionE/C/F/TAF was significantly superior than E/C/F/TDF, driven by fewer participants on E/C/F/TAF with no W144 data. E/C/F/TAF continued to have a statistically superior bone and renal safety profile compared with E/C/F/TDF, demonstrating significant safety advantages over E/C/F/TDF through 3 years of treatment. Individuals on E/C/F/TAF had greater plasma lipid changes, but proportions starting lipid-lowering therapy were comparable.
P078 User participation in the development of HIV self-testing services: results of co-design workshops
Authors: Pilarski Nicole , Peralta Carlos , Rodriguez Liliana , Dean Gillian , Soni Suneeta , Llewellyn Carrie , Vera Jaime 
Published: May 2024

IntroductionNovel ways to encourage HIV testing are urgently needed. In Brighton, the use of a digital vending machine to distribute free self-test kits to men who have sex with men (MSM) using saunas is being piloted along with a campaign to increase awareness of self-testing.MethodsVolunteers attended design workshops and designers attended an LGBT community meeting. Participants completed a questionnaire and discussed visual concepts for the campaign. Workshops utilised tools such as personas (creating ‘characters’ to explore theoretical individuals’ thoughts and behaviours), construction of user journeys, and mock-ups of vending machine design and interaction.ResultsThere were 11 respondents; 8 aged <25, two 25–34 and one 45–64 years. Eight had previously tested for HIV. Two had self-tested. Themes relating to concerns with self-testing were: perceived reliability or ‘faith in the results’; tests being ‘done properly’; familiarity with self-testing; fear of needles or blood; STI screening; support if test positive. Factors encouraging HIV self-testing were: awareness; accessibility; confidence in ease of use. Key themes relating to visual campaign options were: sense of community and support; clinical versus community settings; giving clear information. Participant discussions using personas included targeting appropriate populations for self-testing and framing the campaign within the ‘gay scene’.DiscussionFew participants had previously self-testedKnowledge and generating a ‘sense of a testing community’ were the most important factors for promoting self-testing. Collaboration with designers and communities ensures a user-centred approach to HIV self-testing.
P079 Are patients with unexplained blood dyscrasias being tested for hiv?
Authors: Biddle Kathryn , Evans-Jones John 
Published: May 2024

IntroductionThe purpose of our audit was to determine whether our hospital is following the BHIVA National Guidelines (2008) and testing for HIV in patients presenting with unexplained blood dyscrasias.MethodsOur initial sample consisted of all inpatients coded as having lymphopenia, thrombocytopenia or neutropenia between 1/1/16 and 1/11/16. We excluded patients with a known cause of cytopenia and those with mild cytopenias (platelets >80, neutrophils >1, lymphocytes>1). In our final sample of 82 patients, we used the electronic ordering system to collect patient and admission information and to determine whether a HIV test was ordered.Results37% of patients with unexplained blood dyscrasias were tested for HIV. 60% of patients with neutropenia were tested compared with 42% with thrombocytopenia, 25% with lymphopenia and 20% with mixed cytopenias. Patients with lower blood counts were more likely to be tested for HIV. Patients were more likely to be tested for HIV if they were admitted under the haematology team (55%) compared with those admitted under general medical (31%) or surgical teams (27%). HIV testing declined with increasing age of patients with 67% of those aged under 30 being tested compared with 60%, 56%, 22% and 0% of patients between 31–50, 51–70, 71–90 and over 90 respectively.DiscussionWe found that the majority of patients with unexplained blood dyscrasias were not tested for HIV. Our study highlighted several factors that influence whether testing is performed. These include the nature and severity of cytopenia, patient age and the admitting medical team.
P084 Are we considering HIV enough? an audit investigating routine use of HIV screening for patients aged 18–50 presenting with community acquired pneumonia to a provincial hospital
Authors: Rees Joanna 
Published: May 2024

IntroductionIt is known that a significant proportion of people within the United Kingdom are unaware of their HIV infection and late diagnosis is associated with HIV related Morbidity and Mortality. The British HIV Association recommend routine HIV screening for patients with an HIV indicator illness. This includes Bacterial Pneumonia, a condition commonly encountered in hospital departments throughout the United Kingdom.MethodsWe designed an audit to evaluate the use of routine HIV screening for patients aged 18-50 presenting to the Royal Devon and Exeter Hospital with Community Acquired Pneumonia. Using a coding search of all discharges between May 2015 and September 2015, 38 patients were identified. Inclusion criteria required each patient to have either a positive microbiological sample or consolidation present on a chest radiograph. Of the 38 patients identified, 7 were excluded who did not satisfy the minimum inclusion criteria.ResultsOf the patients audited, 21 patients (67.7%) did not receive routine screening during their inpatient stay. One patient who was not tested had received testing immediately prior to their acute presentation. Two patients who were not tested had a significant history of intravenous drug use, an independent indicator for routine HIV screening. Of the 10 patients (32.3%) that were successfully screened for HIV, no samples tested positive.DiscussionRoutine screening for HIV in all patients with bacterial pneumonia could aid early identification of HIV infection, reducing overall morbidity and mortality. This audit highlights the continuing need for raised awareness of routine HIV screening for patients with HIV indicator conditions, particularly, in areas of low prevalence of HIV infection.
P095 Late diagnosis of HIV in northern ireland
Authors: Todd Suzanne , Walker Eoin , Hunter Michael , Donnelly Claire , Dinsmore Wallace , Emerson Carol , Quah Say , McCarty Emma 
Published: May 2024

IntroductionLate HIV diagnoses (CD4 count <350 cells/mm3at diagnosis) across UK declined from 57% (2004) to 39% (2015) however a review within our region in 2013–14 revealed much higher proportion of late diagnoses than UK average, with multiple missed opportunities for testing in majority cases. Data was presented at educational meetings and feedback given to clinicians when delay in diagnosis occurred. We sought to assess impact on late diagnoses and mortality within our population.MethodsRetrospective chart analysis of new diagnoses from March 2015–February 2016 (Period 2) to determine proportion of late diagnosis, missed opportunities for testing and mortality. Comparison made with results of previous review during July 2013–June 2014 (Period 1).Results76 new diagnoses during period 1; 71 in period 2. Late diagnosis decreased from 59% (45/76) to 49% (35/71). Proportion diagnosed through GUM increased from 20% to 34%. Remainder diagnosed in other specialities, most commonly general medicine. Mode of transmission in period 1 and 2 respectively; MSM 49% vs71%, heterosexual 47% vs 23%, IVDU 7% vs 11%. Prior to diagnosis, number patients presenting to other settings with clinical indicator diseases significantly decreased from 84% (38/45) in period 1 to 49% (17/35) period 2. Mortality more than halved from 7% (4/45) in period 1 to 3% (1/35) period 2.DiscussionWhile there has been a decrease in number of late diagnoses and mortality rate, the proportion being diagnosed late remains higher than other UK regions. Opportunities for early testing are still being missed and ongoing education required.
P100 Prime: a web-based HIV risk reduction package for high-risk MSM
Authors: Taghinejadi Neda , Lau Rebecca , Amrapala Apichaya , McOwan Alan , Whitlock Gary 
Published: May 2024

IntroductionPrevious work has shown that HIV-negative MSM with the following characteristics attending our service have approximately a 10% chance of acquiring HIV in the following 12 months: rectal bacterial STI, early syphilis infection, previous PEP use. In May 2016, we introduced a web-based support package, PRIME, targeting such high-risk MSM to reduce their HIV risk and encourage more frequent STI testing with the aim of reducing their risk of HIV acquisition to below 5% per year.MethodsNotes review of the first 50 MSM recruited to PRIME between 19thMay 2016 and 7thJune 2016.ResultsBy the end of 2016, 1531 eligible MSM had joined PRIME. No one had left the service. Of the first 50 PRIME recruits, median age was 32 years. Median number of partners in the preceding 3 months was 5. Indication for joining PRIME was documented in 45 (39 PEP, syphilis 2, bacterial rectal STI 1, 2+ indications, 3). In the preceding 12 months 15 had been diagnosed with chlamydia and 10 with gonorrhoea. To 31stJanuary 2017, there is 18.8 person-year follow up for these individuals. The average frequency of STI screens per recruit increased from 2.7 to 7.1 per person-year follow-up. During follow-up the number of infections was: 7 chlamydia, 4 gonorrhoea. One individual tested positive for new HIV infection, 10 weeks after joining PRIME.DiscussionThe results show it is feasible to engage significant numbers of high risk MSM clinic attendees using online interventions such as PRIME. Early data suggests that the intervention has successfully increased STI screening in this group. Further follow up is required to see if the initiative has achieved its aim of reducing HIV seroconversion to below 5% per year.
P102 Integration of clinic services with online sexually transmitted infection (STI) testing (sh:24) in camberwell, se london: impact of active referral of asymptomatic testing online in 2016
Authors: Turner Katy ME , Zienkiewicz Adam , Looker Katharine , Barnard Sharmani , Brady Michael , Sa Joia da , Holdsworth Gillian , Syred Jonathan , Baraitser Paula 
Published: May 2024

IntroductionAn online service was implemented in an area with high burden of sexually transmitted infections and poor sexual health outcomes. The aim was to improve access and availability of sexual health, fully integrated within NHS services. This study looks at the impact of a change in management, whereby asymptomatic patients seeking STI testing in the GUM clinic were directed to the online service.MethodsWe compared clinic attendance in 2016 before (quarter 2, Q2) and after (quarter 3, Q3) the change in clinical practice. Individual level clinic attendance data were collated and summarised as simple STI test performed (chlamydia, gonorrhoea, HIV, syphilis) or complex service required. We also compared service use by age, ethnicity and sexual orientation. Changes in pattern of clinic attendance between the quarters were analysed using a Chi2test.ResultsAbstract P102 Table 1Changing pattern of GUM clinic use.Q2 (Before)Q3 (After)Total visits (valid code)6,9495,397Simple STI test4,044 (58%)2,823 (52%)Complex service4,785 (69%)4,083 (76%)Complex service & simple STI test2,8452,170There were significantly fewer simple STI tests (Chi-squared, p<0.001) and more visits requiring complex services (p<0.001) in Q3 versus Q2.DiscussionFollowing establishment of efficient online STI testing, the clinic changed its triage practice: asymptomatic patients seeking STI testing were directed to use the online service. The change appears to facilitate a higher proportion of more complex visits although the absolute number of visits has decreased.
P105 Characteristics of frequent attenders at a central london sexual health service
Authors: Farhat-Dominguez Sara , Stegmann Katrina , McOwan Alan , Nwokolo Nneka , Suchak Tara , Whitlock Gary 
Published: May 2024

IntroductionBASHH guidance recommends screening for STIs up to every 3 months for individuals at risk of HIV. Conversely, commissioning pressures aim to reduce inappropriate attendances. We describe below the characteristics and outcomes of frequent attenders at our service.MethodsNotes review of individuals with 4 or more new or re-book attendance episodes at a central London sexual health service between 1stApril 2015 and 31stMarch 2016.Results170 individuals received more than 4 new episodes of clinical care in a year; 145(85%) were male, 136 MSM. 21(12%) were female, 4(2.4%) transgender. 23(14%) of the patients were HIV positive, all MSM. Median age was 31 years. Median number of sexual partners in preceding 3 months was 6. 75(44%) disclosed chemsex activity in the preceding month.In the 12 months from April 2015, there were 442 new STIs in this population, an average of 2.6 per patient: 346 STI diagnoses were in the 147 HIV-negative individuals and 96 in the 23 HIV-positive individuals. In HIV-negatives, the diagnosis was a rectal bacterial STI in 36% and syphilis in 7%. 206 courses of PEP were prescribed; 25 individuals received 4 or more PEP courses. There were 5 new diagnoses of blood borne virus infections; 2 hepatitis C, both in HIV positive MSM, and 3 HIV.DiscussionThe majority of frequent attenders at our clinic had indicators of high risk sexual behaviour. The high number of STIs and PEP prescriptions implies that the frequent attendances are appropriate in this patient population.