bluuebunny/crossref_metadata_2025_split huggingface dataset:
P140 A need to reinforce the importance of pregnancy testing and correct antibiotic regimen: a re-audit of pid management against bashh guidelines
Authors: Burridge Joanna , Aziz Najia , Mani Reena 
Published: May 2024

IntroductionBASHH guidelines (2011) for the management of pelvic inflammatory disease (PID) recommend one of two antibiotic regimens for outpatient treatment. In addition, patients should be offered a pregnancy test and full screening for sexually transmitted infections (STI).Aim(s)/objectivesTo review PID management across the sexual health clinics, comparing it to the previous year’s audit and BASHH guidelines.MethodsData was retrospectively collected from December 2015 until March 2016. Data collected included whether pregnancy was excluded, STI screening, antibiotic regimen used, provision of written information, partner notification, and outcome at any follow up.Results51 patients were identified, 2 were excluded due to treatment by their GP. 100% of cases had at least one sign or symptom suggestive of PID. 47/49 (96%) of cases had STI screening; 41/49 (84%) had a HIV screen as part of this. Pregnancy was excluded in 22/49 (45%) of cases. A BASHH recommended antibiotic regimen was used in 28/49 (57%) of cases. Of the 21 of non-compliant cases, only 4/21 had a documented allergy or intolerance that precluded standard treatment.DiscussionSince the last audit, recommended antibiotic treatment for PID has improved, but remains low at 57%. Pregnancy exclusion was low at 45%, compared with 70% at the last audit. Differences in how healthcare professionals record information on the electronic system could partially account for this. Actions have been taken to improve treatment and pregnancy testing by giving individual feedback to the clinicians, with a re-audit planned to assess the outcome of these interventions.
P141 Management of sexual assault in a nurse-delivered sexual health service
Authors: Funi Rita , Richards Catherine , Obeyesekera Sharmin , Theodore Cecelia 
Published: May 2024

IntroductionComparing April 2014 to March 2015 with the same period in 2013–14, has seen an increase of 32% in the number of serious sexual offences reported to Police in our county.We audited management of complainants of sexual assault attending our nurse-delivered sexual health service against BASHH auditable outcome measures (guidelines 2011) and other factors relevant to improving the quality of sexual assault aftercare offered.MethodsRetrospective study November 2014 to November 2015.50 case notes were identified from two sites within our service – 23 from Site1 and 27 Site2. In addition to BASHH auditable outcomes, we included data such as: Time from assault to attendance, History of previous assault, Disclosure at time of attendance, Police report at attendance & Attitude to reporting at end of consultation, documentation of follow up plan re medical and psychosocial support/referrals.Results33/50 (66%) complainants were <25 years. Nearly 40% attended within the first 7 days, half of these within 3 days, 35/50 (70%) within 6 weeks of assault. Compliance with BASHH outcomes reached 100% in baseline STI screening and documentation of child protection needs, 84-92% for essential history components, 90% Hepatitis B offer, 79% Emergency contraception, 74% FME and 70% PEP offer. Self-harm assessment 76%. Documentation of physical injury 20% and offer of prophylactic antibiotics 2%.DiscussionWe have re-designed our proforma to more readily capture poorly documented information. A review use of skill mix, training updates regarding forensic time scales/pathways for early intervention were undertaken, with algorithms included in updated proforma.
P148 Female genital mutilation – when do you call 101?
Authors: Seneviratne Kanch , Boog Katie , Cooper Susan , Munatsi Shereen , Carlin Elizabeth 
Published: May 2024

IntroductionReporting cases of FGM in those aged under 18 years became mandatory in 2015. Protecting those who have been affected and safeguarding those at potential risk is paramount.AimsTo evaluate staff knowledge of FGM and the volume of FGM seen in two neighbouring sexual health services.MethodsClinicians were asked to complete a questionnaire assessing their knowledge and understanding of the FGM care pathway. Case notes of women with a FGM code since its introduction in 2014 were reviewed.ResultsForty-six clinicians completed the questionnaireTwenty-two women, aged 24–59 years, were identified with a FGM code, 91% were of Black African ethnicity.Abstract P048 Table 1Female Genital MutilationDo you understand the care pathway/management of FGM?PercentageAction taken if < 18yr with FGMNo13%Unable to provideNo22%Appropriate action describedYes52%Appropriate action describedYes13%Limited understanding of required actionOverall, 74% of staff were aware of the need to ask about other daughters, social services referral and police contact. A quarter were unable to summarise appropriate action plans, of particular concern in this group were those who felt they understood the care pathway. Only a fifth stated that they coded genital piercings as FGM.DiscussionThere is a clear knowledge gap in actions and coding required in relation to FGM. Over 80% staff recognised this and requested training. Plans are underway to deliver this and close the gap as a priority. A flow chart for quick reference has been developed and will be available at the conference.
P149 Patient involvement in sexual health service delivery
Authors: Meyrick Jane , Gray Debra , Jones Abigail 
Published: May 2024

IntroductionSexual and reproductive health and HIV (SRHH) services face unique PPI challenges, as the anonymity and confidentiality required by service users can be a barrier to attracting patient input. PPI could improve sexual health services, through increased trust in services and the ability to tackle sexual health inequalities. However, specific practical guidance on how to address PPI in sexual health and the evidence to support it is sparse.MethodsThis research aimed to begin building an evidence base for PPI in sexual health services through: 1) an audit of PPI in SRHH in the Bristol region; and 2) a parallel survey of potential users of sexual health services about their experiences of PPI. For the audit, 18 SRHH organisations from all those in the region invited complete a short online survey, representing a range of different service providers. For the online survey, 96 sexually active young people were recruited through a convenience sample.ResultsSexual Health patients are reluctant to get involved in PPI work, often because of embarrassment. PPI work was highly variable with some reliance on customer satisfaction approaches. Patients reported not being asked for feedback and wanted to know what PPI is for. Services cited under-resourcing and a lack of time as barriers to improving PPI work.DiscussionImproving the use of patient’s voice in sexual health needs through clarity of purpose (measured against outcomes), better communication with patients, and the exploration of flexible methods that respect patients’ needs for anonymity. Next steps will be outlined.
P152 Staff satisfaction improvement work: actively asking, listening and responding to the concerns of our staff
Authors: Hartley Anna , Williams Andy , Symonds Merle , Barter Janet , Apea Vanessa 
Published: May 2024

IntroductionContract tendering and service integration has resulted in great uncertainty for sexual health staff. Our service has recently integrated with sexual and reproductive health (SRH) and is currently under tender. We aimed to review and address the satisfaction of our staff.MethodsAn online survey was disseminated to staff at our sexual health service.Results73% of staff responded: 13 doctors, 9 nurses, 6 technicians, 15 health advisors/psychologists, 8 receptionists, 8 administrators, 3 anonymous. On a scale of 1–10, staff rated: feeling valued 5.9; enjoying work 6.4; day-to-day support 5.7. Scores were lower among receptionists (4, 4.1, 3.6 respectively). 61% felt day-to-day issues were dealt with in a timely manner. Cascade of information from management to staff was deemed ‘too little’ by 53%. 34% stated they did not have the opportunity to contribute to decisions affecting them. Staff found it easier to raise concerns with their line manager (6.7/10) than with management (5.7/10). These scores were lower among receptionists (3.6/10, 4/10 respectively).DiscussionImprovement work is addressing the issues raised by our staff. Initiatives include: Staff Member of the Month Award; Daily team huddle actively including receptionists, addressing day-to-day issues; Psychology session with receptionists to better understand their concerns; Clinic has relocated to be next to reception (rather than on a different floor); A buddying system for incoming SRH staff; Regular integration emails from management and whole team briefings.DiscussionOur survey demonstrates the need to actively ask, listen and respond to staff’s satisfaction, especially during such uncertain times.
P154 How well are we managing lymphoma in our HIV cohort over 5 years: a regional audit in three main HUBS
Authors: Malik Seema , Porree Mickaela , Patel Raj , Samraj Selvavelu 
Published: May 2024

IntroductionSince the introduction of antiretroviral therapy, the life expectancy of HIV infected patients has increased significantly. As the incidence of opportunistic infections accounting for HIV related deaths has declined, malignancies now account for an increasing proportion of these mortalities, with lymphoma presenting second most commonly. In order to determine whether HIV positive patients with lymphoma are receiving best care, patients from three hubs within the region were reviewed.MethodsData was collected retrospectively from HIV positive patients with lymphoma from 1stof January 2010 to 31stof December 2014.ResultsTotal number of patients in the study was 25 across the three centres with 8,12 and 5 patients from each centre. All patients underwent the recommended diagnostic procedures for diagnosis and 96% received appropriate imaging for staging. Of the 20 patients where documentation was available, 70% were diagnosed with stage IV lymphoma and 50% had the International Prognostic Index (IPI) score of 3 or more. 5-year survival rate was 72% and in those followed up for a minimum of 2 years the 2-year progression free survival rate was 100%. 28% patients died during the study period, 43% of whom had a late diagnosis.DiscussionManagement of lymphoma within three centres in the region is in line with current best practice guidelines. In order to improve the survival further, early diagnosis and treatment of HIV were identified as crucial factors necessitating increased awareness of HIV testing.
P158 Benefits of disintegration of a hiv service from a sexual health service?
Authors: Street Emma , Short Lindsay 
Published: May 2024

IntroductionWith an imminent split of our HIV service from an integrated sexual health service we felt it a timely opportunity to address anonymised blood testing in the HIV service.Historically patients have had routine monitoring for HIV under their GUM number unless pregnant or have requested specific bloods under their name. Continued isolation of the HIV service, while complying with HIV patients wish for enhanced confidentiality, can have a negative impact on their care- increasing clinical risk and duplication of tests. As our patient age they require multidisciplinary input to manage comorbidities so integrated working is essential.MethodsPatients were provided with an information leaflet about the service change and completed a survey/consent form starting in December 2015. If patients agreed to the switch this was implemented for their subsequent bloods.ResultsOur cohort size in 2015 was 394 – 2/3rdare male and over half MSM. So far 301 patient questionnaires have been analysed.Results show 93% of patients have consented to changing to named bloods with a generally positive feedback to this change. We will present the results looking at the differences between those that consent and those that do not.DiscussionResults suggest that the majority of patients are not concerned about loss of anonymity through switching to named blood samples. Switching to named blood samples is one small step in reducing the isolation of HIV care.
P163 Haart prescribing and bhiva standards of care for people living with hiv audit
Authors: Holwell Robert , Killeen Dawn , Ladipo Zana 
Published: May 2024

IntroductionWe audited our service against the BHIVA 2013 Standards of Care for People Living with HIV, BHIVA treatment guidelines for HIV-1-positive adults 2015 and North West 2015 treatment algorithm for HIV-1-positive adults 2015.MethodsThis is a retrospective audit involving the review of all patient notes (84). 64 patients were excluded as they were started on medication before 2013.Results40% of all patients had a CD4 count of more than 350 when they were started on medication and 10% had a CD4 count of <200. Only 5% had HIV related symptoms. 15% were started as prevention of transmission.30% (6 in 20) of patients were started on treatment on/after 2015. Only 17% (1 in 6) of these patients had been prescribed treatment according to the North West 2015 algorithm (The patient was given Kivexa based therapy when they could have had Truvada). First line therapy according to BHIVA 2015 guidance was prescribed in 100% of patients (Standard of care target >75%).100% of patients adhered to their medication within the first 3 months (Standard of care target >95%). None of the patients who had viral loads done had experienced virological rebound (Standard of care target <2%).DiscussionWe are 100% compliant to the BHIVA treatment guidelines while only 17% compliant to the North West algorithm. To improve our service and make it more viable, we will update our proforma according to the North West algorithm, which reflects the availability of cheaper generic drugs and NHS England guidance.
P167 Pilot feasibility trial of targeted sexual risk reduction interventions within sexual health settings in england – the santé project
Authors: King Carina , Llewellyn Carrie , Anstee Sydney , Clark Laura , Bailey Julia , Pollard Alex , Abraham Charles , Burns Fiona , Rodger Alison , Copas Andrew , Shahmanesh Maryam , Gilson Richard 
Published: May 2024

IntroductionThere is evidence from RCTs that brief behavioural interventions can have modest but valuable impacts on sexual risk behaviours and STIs in young people and men who have sex with men (MSM). Implementing these nationally could reduce STIs, but has not yet been done. Santé aims to adapt and pilot a package of evidence-based risk reduction interventions, and assess the feasibility of conducting a large-scale effectiveness trial.MethodsFollowing a systematic literature review, mixed-methods evaluation of existing practice, and patient and provider preference, a process of Intervention Mapping was used to adapt effective interventions and create an intervention package for MSM and young people. Triage algorithms were developed using routine surveillance data. A pilot cluster trial is running in eight sexual health clinics. Quantitative process data and qualitative interviews with patients and providers will assess feasibility.ResultsThe intervention package is a triage algorithm which directs patients into a low-intensity digital intervention or high-intensity one-to-one behaviour change consultation. No identified digital interventions were available for piloting; therefore, patients are directed to suitable health promotion websites. An intervention manual incorporating a Five Step Pathway was developed for the one-to-one consultation, detailing the behaviour change elements. Preliminary pilot results will be available in June 2017.DiscussionThe pilot will identify issues that need addressing to make a large trial feasible. Although intended to be deliverable within existing clinic resources, current service changes threaten the viability of such innovations. Further adaptation and development of digital resources will be needed prior to implementation.
P168 Data analysis of a self-completed questionnaire for patients within a men-having-sex-with-men clinic
Authors: Bayman Philip , Gilson Rebecca 
Published: May 2024

IntroductionThe questionnaire was created to discover the characteristics of the MSM population attending a clinic dedicated to their sexual health needs. It covered reasons for attendance, risk factors for sexually transmitted infections and blood-borne viruses transmission and usage of post-exposure prophylaxis and pre-exposure prophylaxis. The data would be used for adaptation of the clinic.MethodsThe questionnaire was given to clinic attendees for a 75 day period in 2016 and kept anonymous by a unique client number. The collated data was analysed and reproduced in graph and table form for categories split into reason for attendance.ResultsAcceptability of the questionnaire was high at 99.2%. The data analysis showed a large asymptomatic client population (57%) attending the clinic for sexual health screening. For contacts of infection, HIV and gonorrhoea were the most prevalent. For STI and BBV infection risk factors, 15% of clients did not use condoms, while 49% of clients did not know a sexual partner’s HIV status. Use of PEP was low but showed a majority using it since 2015, while there were 5 users of PrEP.DiscussionThe study showed a majority low-risk MSM population using the dedicated clinic. The survey has influenced clinic redesign with the introduction of test-only clinics for the low risk cohort. However the clinic may not be seeing the high-risk patients who would benefit from senior medical input rather than just a sexual health screen. Data showing usage of PEP and PrEP has given a baseline for comparison in future studies.
O22 Acceptability of HIV self-testing among men who have sex with men attending a sex on premises venue in brighton: a cross sectional survey
Authors: Amlani Aliza , Dean Gillian , Soni Suneeta , Peralta Carlos , Llewelyn Carrie , Vera Jaime 
Published: May 2024

IntroductionInterventions to target and test men who have sex with men (MSM) for HIV are crucial to reduce incidence. Accessing traditional healthcare services can act as a barrier to HIV testing. Testing in outreach settings, such as sex on premises venues (SOPV), may be more successful. This study aimed to determine the acceptability of HIV self-testing in MSM sauna clients.MethodsAn anonymous cross sectional, electronic/paper survey was conducted in a male SOPV in Brighton. Results were collated using Survey Monkey.ResultsA total of 281 clients responded. 23% were aged 25–34 years, 16% 35–44 years and 37% 45–64 years. 32% reported never testing for HIV; 56% had not tested in the last 12 months; 44% felt they were not at risk of HIV. 93% would consider collecting a HIV self-test at the sauna with 40% wanting to test there and then, and 53% preferring to test at home.DiscussionA significant number of MSM attending this SOPV felt they were not at risk of HIV, and had never tested for HIV or not tested for over 1 year. Despite this, most individuals found testing at the SOPV acceptable, and would consider HIV self-testing if it were available. Innovative methods to enable HIV self-testing in venues frequented by high risk MSM are urgently needed.
P177 D2B or not d2b: a regional multicentre survey in level 3 gum clinics of ‘other conditions requiring treatment’
Authors: Sanmani Leela , Priestley Cecilia 
Published: May 2024

IntroductionDiagnoses in patients attending GUM clinics are coded using SHHAPT codes. D3 is used for conditions not requiring treatment. It is often taken to mean a negative STI screen; however the code may not reflect the time or expertise required for a consultation with a high risk or anxious individual. The D2b code is used for ‘other conditions requiring treatment’ for which there is no other appropriate SHHAPT code. D2b codes did not attract funding in the SRH tariff.This survey aimed to identify the range of complex consultations and non-STI work seen in GUM clinics that were not captured by the coding.MethodsA retrospective case notes review of patients with a D3 or D2b code attending GUM clinics in 2011. Data was gathered on socio-demographic details, SHHAPT codes and other diagnoses, and outcome. The data was analysed using Excel.Results594 patients were included (339 D2b, 255 D3). The commonest diagnoses were genital dermatoses 129(22%). Other diagnoses included chronic pelvic and vulval pain (27), other gynaecological and urological conditions (23), prophylaxis of recurrent infections (33), psychosexual and complex consultations including high risk sexual behaviour, sexual assault, and safeguarding referrals (65).DiscussionFollowing this survey, a list of D2b sub-codes was developed for use in all the regional GUM clinics. Since then, SRHAD codes have been introduced for complex dermatology, urology, and gynaecology conditions. However the continued use of the D2B sub-codes for high risk patients and complex consultations provides valuable data to support commissioning.
P178 Traumatic recto-vaginal fistula after consensual sexual activity: a case series
Authors: Waite Kathryn , Webster Claire , Karandikar Sharad , Bowley Doug 
Published: May 2024

IntroductionConsensual vaginal intercourse may be associated with relatively minor genital injury, such as mucosal abrasions, tears or ecchymoses. More severe genital injury is more likely to be associated with rape or sexual assault by penetration with an object. Conversely, we know that the absence of genital injury does not mean that rape or serious sexual assault did not occur.MethodsWe report a small series of patients presenting with severe and life-threatening genital injury after consensual sexual activity.ResultsAn adult woman presented with lower abdominal pain and faeculent vaginal discharge after sexual activity with her intimate partner involving consensual and simultaneous insertion of two sex toys (oneper rectumand anotherper vaginam). She had sustained a 100mm defect in the posterior vaginal and antero-lateral rectal walls. Despite surgery and faecal diversion, she developed severe sepsis that required extended critical care.A second patient presented with faeculent dischargeper vaginamafter consensual, ‘conventional’ peno-vaginal intercourse. On examination, she was found to have a 30 × 20 mm low recto-vaginal fistula; on this occasion not associated with peritoneal contamination or serious septic response.DiscussionTraumatic recto-vaginal fistulae are rare with implications for both immediate morbidity and mortality and long-term physical and mental well-being. These cases demonstrate the extreme spectrum of genital injury that may be associated with consensual sexual activity. Recognition that this severity of injury can occur following consensual activity is important and our first patient’s story also highlights some of the public health implications concerning the use and regulation of sex toys.