bluuebunny/crossref_metadata_2025_split huggingface dataset:
P110 Development of a web-based partner notification network linking general practice, CASH services and community pharmacy with specialist GUM services
Authors: Sutcliffe L , Symonds M , Roberts T , Mercer C , Estcourt C 
Published: May 2012

BackgroundPartner notification in primary care is problematic and of limited effectiveness despite enthusiasm from primary care providers to engage with sexually transmitted infection (STI) management. Often it relies on the clinician informing the patient to advise his/her sex partners to attend a sexual health clinic for investigations and treatment despite evidence suggesting that only around half of sex partners informed in this way receive treatment. Many of those referred on to a sexual health clinic by a GP fail to attend and follow-up is infrequent.AimTo develop a robust, web-based tool for managing partner notification for patients diagnosed with bacterial STIs in primary care with broad geographical and service applicability for use in our Accelerated Partner Therapy randomised control trial in primary care.MethodWe applied a user-centered design approach to develop a web-based partner notification tool linking different types of community sexual health providers with the specialist GU service. The approach included a pre-design phase using discussions with primary care health professionals, and sexual health clinic health advisers, to determine their needs, current activity and work habits, to ensure that the web-based tool would be successfully integrated in their daily work practice. The web-tool was designed to our specifications by a bespoke software company.Results and DiscussionWe have designed a secure, simple to use web tool that allows users in a variety of settings to easily initiate, manage and monitor partner notification. A major advantage of this platform compared to other visualisation tools is its web-based format, which requires no software installation or data downloads. Data are collected in real time, and all partner notification outcomes are recorded. The platform is extendable to facilitate centralised partner notification within sexual health clinical networks across many different heath care providers.
P112 Texting or talking? Which works better to reduce hazardous drinking by sexual health clinic attendees?
Authors: Baguley S 
Published: May 2012

BackgroundHazardous drinking is associated with an increased risk of catching an STI, getting pregnant unintentionally, being sexually assaulted and sexually assaulting someone else. An Alcohol Brief Intervention (ABI), a type of motivational interview, has been shown to reduce hazardous drinking in men over the age of 25. There is an paucity of evidence of the benefit in younger people or in women. Texting has been shown to be useful in supporting smoking cessation, weight reduction and diabetes control. There have been no studies of its potential value in reducing hazardous drinking or its consequences.AimTo compare the effect of texting vs an ABI on hazardous drinking and associated sexual illhealth amongst attendees at an urban sexual health clinic.MethodsPotential subjects are being recruited from a city sexual health clinic. Initial screening is done using the Alcohol Use Disorder Identification Test - a self-completed questionnaire marked out of 40. Consenting subjects are then randomised to texting (12 texts over 4 months), an ABI or a leaflet and then followed up by phone at 4 months. At follow-up, subjects are rescreened for hazardous drinking and asked about incident STIs, regretted sex, sexual assault, use of emergency contraception and for their evaluation of the intervention method.ResultsTo end of January 2012, 6279 attendees have been screened of whom 2554 were hazardous drinkers and 799 have consented to take part in the study. (The target sample size is 1090). By the time of the conference, all subjects will have been recruited and most results will be available.ConclusionThis is the first RCT of texting for hazardous drinking and should inform national policy in this area.
P115 Learning from patients to redesign an HIV service
Authors: Kegg S , Goddard S , Russell J 
Published: May 2012

Background/AimsOur HIV cohort more than doubled between 2004/11 with no increase in clinic capacity or staffing. Some of our service users have complex health needs—related to delayed HIV diagnosis, poor adherence to ART and co-morbidities—but an increasing number are stable on treatment and more than half have their medication delivered to their home. We are reviewing our service model to focus on the needs of our complex patients but at the same time providing a responsive, quality service to the stable patients. A key part of this review is to elicit our patients' views on the current service and how it might be improved.MethodsA self-administered questionnaire completed by HIV+ service users.Results50 people completed a questionnaire and 76% described their current health as good to excellent. 43% were attending appointments 3–4 monthly, with 39% attending more frequently. 72% wished to continue to be seen at the same frequency. Most (76%) reported that appointments were available at suitable times. Barriers to clinic attendance included poor car-parking (44%) and lack of transport links (13%). A majority (84%) have access to a personal computer and 53% have a webcam—of these 50% would value an online consultation. 32% would consider HIV monitoring by their GP and 33% would like to receive some of their care in this setting. Of the people currently receiving ART delivered to their home 35% would like monitoring to be performed by the individual delivering the medications.ConclusionsMost patients are satisfied with the current model of care and may be reluctant to be seen less often. However there is a softening in the reluctance to involve GPs in HIV care and a willingness to consider models using newer technologies and care at home. We have reviewed our clinic template increasing the number of early and late appointments and are actively developing pilots to explore new ways to deliver care to increase choice and flexibility for our patients.
P119 Integrated care in sexual health: a novel training programme to engender culture change for trainees in primary and secondary care specialties
Authors: Bradbeer C , Mears A , Kulasegaram R 
Published: May 2012

BackgroundChanges in the NHS dictate that staff in general practice (GP), public health (PH), SRH and GUM work closely together. This integration cannot be achieved by processes and structures alone. It requires a substantial change in attitude and understanding between the protagonists.AimTo develop a training programme to increase trainees' understanding of the philosophy and ways of working of other disciplines involved in delivering sexual health care, so as to facilitate collaboration and integrated working.MethodsThe day-long programme, first held in February 2011, was delivered to 21 specialist trainees reaching the end of their training in GUM, SRH, PH and GP. The London Deanery funded the innovation and invited participants from among its trainees. Each day was structured to cover: understanding population health; an update on the future of the NHS; workforce planning; involving patients and public; developing services, financial considerations and examining patient pathways. There was humorous stereotyping of specialties followed by group work to dispel misconceptions and understand each other's viewpoint. Speakers represented all invited disciplines and included a senior manager, a third sector leader and a member of the government's Listening Forum. A detailed evaluation of the day included an interval questionnaire after 4–8 months.ResultsTwo training days have now taken place; a third is oversubscribed for February 2012. Trainees said it was excellent, they found it inspiring and thought provoking. They requested more workshops which have been incorporated. Interval evaluations showed trainees had undertaken joint working and used their learning to prepare for consultant interviews. The model has now been used by London Deanery in related generic training programmes for other professionals and other disciplines.ConclusionThis model programme delivers effective training in leadership and culture change.
P125 The association between condom proficiency, condom problems and STI risk among Scottish MSM
Authors: Goodall L , Clutterbuck D , Flowers P 
Published: May 2012

BackgroundThe effectiveness of condoms in preventing sexually transmitted infections (STI) including HIV depends on consistent and correct use.AimsTo examine associations between demographics, STI risk, condom proficiency, condom problems and STI acquisition among MSM and to direct discussion and debate towards thinking about how and why it might be important to improve condom use skills.MethodsCross-sectional surveys of MSM were conducted in GUM clinics and commercial gay venues in Summer 2010. The self-completed, anonymous questionnaires recorded data on socio-demographic variables, numbers of unprotected anal intercourse (UAI) partners in the preceding year, STIs diagnosed over the previous year and self-reported condom problems and condom proficiency.Results792 respondents provided data with an overall response rate of 70% (n=459 clinic sample, n=333 community). Number of UAI partners was the strongest predictor of self-reported STI acquisition over the previous 12 months. Demographic characteristics were not associated with self-reported STI diagnosis. However, condom proficiency score was associated with self-reported STI acquisition in the previous 12 months. Condom problem score was also associated with self-reported STI diagnosis in the clinic but not community sample. Condom problem score remained associated with STI diagnosis after adjusting for number of UAI partners with logistic regression.DiscussionThis study identified a measure of condom use associated with likelihood of STI diagnosis when controlling for number of UAI partners. Targeting those who experience condom problems may improve overall frequency and consistency of condom use among MSM; in turn reducing likelihood of STI acquisition. This could involve developing condom problem scales into screening tools for STI risk. Accordingly we encourage further research to determine the value of condom use training as a potential intervention to improve sexual health among MSM.
P127 An audit of the management of complainants of sexual assault compared with the British association for sexual health and HIV (BASHH) 2011 guidelines
Authors: McGranahan M , Gupta N , Goold P 
Published: May 2012

BackgroundThe revised BASHH guidelines for the management of sexual assault were published in 2011. Introduction of a new electronic patient record (EPR) at a sexual health clinic provided an opportunity to audit the management of sexual assault.AimsTo review the clinical care of complainants of sexual assault against the auditable outcome measures identified in the guidelines.MethodsThe EPR of patients attending between 1 August 2010 and 31 July 2011 was searched using the term “assault.” Cases reporting a sexual assault for the first time were included and reviewed against the auditable outcome measures. Demographic data and sexually transmitted infection (STI) test results were recorded.Results236 records were identified but 99 cases fulfilled the inclusion criteria. Of the 14 auditable outcomes, only HIV risk assessment reached the 100% standard and seven achieved above 60% concordance (offer and provision of HIV post-exposure prophylaxis, emergency contraception, follow-up tests, forensic medical examination, hepatitis B vaccine and detailed history of assault). Child protection assessment was documented in 57% of under-19s. 28% had the recommended STI tests and 16% were offered STI prophylaxis. There were no self-harm risk assessments documented. STI prevalence was: Gonorrhoea 8%, Chlamydia 9%, HIV 2%, Hepatitis C Virus and Trichomonas 1%.ConclusionLow STI testing rates overall are explained by Hepatitis B and C testing not previously being a requirement unless there was a specific risk identified. The clinic conducts an automatic risk assessment for under-16s but not for under 19s. STI prevalence was high. A sexual assault pro-forma will be recommended and improved documentation is required.
P130 Antibiotic resistance profiles ofNeisseria gonorrhoeae(GC): a comparison of data 2007–2011
Authors: Sharp S R , Allan S 
Published: May 2012

ObjectivesThis was a retrospective analysis of antibiotic use and resistance profiles of GC at a UK GU clinic.MethodsAll GC cases at our clinic between 1 January to 1 June in 2007, 2009, and 2011 were identified. The case notes were assessed for antibiotic resistance. The number of cases identified was 41, 78 and 75 for these respective years. Data on diagnostic method was also collected last two cohorts.Results63%, 56%, and 69% of patients diagnosed with GC were male in 2007, 2009, 2011 respectively. In 2011 the mean age of patients was 26, and the median 23. 19.5%, 8% and 12% were men who have sex with men (MSM) in 2007, 2009, 2011 respectively. First line antibiotics each year were as per BASHH guidelines (see abstract P130 table 1).Abstract P130 Table1Antibiotic resistance profiles2007 (%)2009 (%)2011 (%)Percentage of GC fully sensitive to antibiotic testing panel466759Percentage of GC fully sensitive to antibiotic testing panel271520Reduced susceptibility to two antibiotic groups151016Reduced susceptibility to three or more antibiotic groups1225DiscussionIn 2011 the antibiotic sensitivity was unknown in 41%, it was 35% of cases in 2009. In 2011 27% of all cases were culture negative despite positive NAAT test. In 15% of all cases no culture was performed. Those without positive culture were diagnosed by NAAT, and in one case microscopy. Of those positive by NAAT alone 52% were female, compared to 75% in 2009. In 2011 54% with positive NAAT alone had co-currentChlamydia trachomatisinfection, compared with 40% of all GC patients. 100% of females with GC in 2011 were NAAT positive, compared with 69% in 2009. 83% of males with GC in 2011 were NAAT positive compared with 80% in 2009.ConclusionsThis data suggests that the levels of resistant gonorrhoea within our clinic reduced between 2007 and 2009, but has since risen in the last 2 years. This would indicate the need for the recent change in first line antibiotics. This could be a reflection of the changing percentages of MSM in the cohorts, which have altered in line with our antibiotic sensitivity. A large number of patients diagnosed with GC are culture negative. This may reflect the high sensitivity of NAAT or a high rate of false positive NAAT. It is interesting that a large proportion of those positive by NAAT alone are co-infected.
P131 Sexual health for the British Forces in Germany [BFG]—a Nurse-led service
Authors: Littler J E , Baker D P , Loader P , Singh S , Desai M , Bradbeer C S 
Published: May 2012

BackgroundBefore 2008 GUM provision in BFG comprised one central and two satellite GUM clinics. Run by a F/T consultant and 3 or 4 nurses, it covered an area the size of Scotland with little primary care input. Since 2008 Guy's and St. Thomas' [GSTT] and SSAFA Forces Help have held the contract to provide GUM services to the BFG population. The contract was for a nurse-led service with consultant cover provided remotely and through monthly visits from the UK.AimTo increase provision of screening and management of STIs across BFG by the new [reduced] staff.ObjectivesTo modernise the GUM service; to develop the 15 primary care medical centres across the region to provide level 1 and 2 GUM service, and to offer out-reach screening to soldiers and school children.MethodsThe labs replaced routine cultures and chlamydia PCR with dual NAATs making it cost neutral. We modernised the GUM service and encouraged testing, especially for HIV. Training for primary care providers included STIF courses. Once trained, GPs supported their nurses to deliver screens. The GUM nurses visited medical centres to encourage and support provision. We also instituted young peoples' services for schools and targeted screening to soldiers at Health Fairs.Results60 multi-professionals have attended our STIF courses, mean evaluation score is 4.4/5. We used figures from the lab servicing the majority of BFG. Despite a steep decline in the community [soldiers, their dependants and contractors] from 46k in 2008 to 36k in 2011, there has been a marked improvement in all measures of SH provision. The GUM workload has also risen and HIV tests have doubled.ConclusionsWe describe a successful, innovative, cost effective model for a nurse-led GUM service which could be used elsewhere. There is now a vastly increased availability of STI screening for our scattered, high-risk population. We will present data for 2008–2011 by age and gender (see abstract P131 table 1).Abstract P131 Table 1Characteristics of GUM service of British Forces in GermanyChanges in GUM service outcomes from 2007 to 201120072011CommentTotal population of BFG48k36k25% declineNew/rebook attenders2427215411.2% declineFollow-up patients116237767.6% declineTotal chlamydia tests in GUM*2149191610.8% declineChlamydia positivity rate16.8%11.6%30.1% decline in incidenceGonorrhoea diagnoses332427.3% decline in incidenceTests at Health Fairs*02397.5% chlamydia positiveGP Chlamydia tests*787141579.8% increaseChlamydia positivity rate7.4%6.1%17.6% decline*These tests were dual NAATs [chlamydia and gonorrhoea] from 2009.
P132 Management of symptomatic men in a level 2 sexual health service
Authors: Dearing N , Pammi M 
Published: May 2012

BackgroundWe established a young persons level 2 community sexual health service (YP clinic) to encourage access to care. BASHH STI Management Standards warrants in-house microscopy for managing men with dysuria and/or urethral discharge symptoms not currently available at this clinic.AimsTo determine percentage of men presenting with dysuria and/or urethral discharge, rates of Chlamydia in men attending with and without these symptoms and number of untreated men after their clinic visit.MethodsCase notes of all new male heterosexual patient attendances at the YP clinic from 5 January 2011 to 23 October 2011 were reviewed. The management of symptomatic men were compared retrospectively with the outcome to look for missed/untreated STIs (sexually transmitted infections).ResultsTotal 91 attendances. 23 patients (25%) were asymptomatic of which 5 tested positive for Chlamydia. Commonest symptoms were dysuria (29%) rash/skin problem (25%) or lumps (20%). 10 patients presented with dysuria only, 1 tested positive for Chlamydia. 16 patients presented with discharge and dysuria, 5 tested positive for Chlamydia. In patients presenting with other symptoms (46%) the following STIs were diagnosed: warts n=15, ulcers n=1, scabies n=1. Two patients tested positive for Chlamydia.Discussion43% of patients who did not report symptoms required treatment for an STI. Overall 23% of the dysuria and/or discharge group and 11% of patients without these symptoms tested positive for Chlamydia. 86% of the positive Chlamydia test results in the dysuria and/or discharge group had been treated in clinic compared with only 57% of positive Chlamydia results in the remaining patients.ConclusionThe absence of microscopy did not lead to more untreated Chlamydia infections in men with discharge and/or dysuria but denying symptomamtic young men the opportunity of being seen in the community may risk untreated infection, onward transmission and complication.
P133 Unwanted pregnancies after a GU consultation
Authors: De Burgh-Thomas A , Botly K , Morris G 
Published: May 2012

AimsTo assess the contraception element of the consultation in patients seen in our GU service.ObjectivesTo assess the proportion of patients attending for termination that had been seen in the GU service in the year prior. Establish how many of these patients were recorded as having inadequate contraception. The proportion of patients identified as needing enhanced contraception that received any. Establish the accuracy of the GU pregnancy risk assessment.MethodsThe 1st arm reviewed the GU notes of the patients that had attended GU within a year of their termination. The 2nd arm reviewed notes from 100 sequential females attending GUM.Results67 of 820 (8.2%) women undergoing a TOP had attended GU in the previous year. Seven stated at consultation that they wanted to be pregnant, Three patients attended twice which gives a sample of 63. Retrospective assessment showed that in 8 (13.3.%) pregnancy may have been avoided by intervention in GU. 41 women (41/63)(65.1%) that went on to become pregnant and underwent a termination were identified at their GU visit as either not using any contraception or were relying on condoms that are known to be an inadequate contraceptive choice. This compared to 29% in the general audit of women attending GU. Despite identifying inadequate contraception enhanced contraception was not initiated in any of the patients that went on to become pregnant (1st arm) and in only 7% of the general audit of GU attendees (2nd arm). Concordance between pregnancy assessment recorded in the notes and retrospectively assessed was 43% (1st arm) and 62% (2nd arm) (see abstract P133 table 1).Abstract P133 Table 1Contraceptive data collection of BASHH auditable standardsBASHH standard1st arm2nd armDate of last menstrual period100%89%90%Contraception type recorded100%93%100%Contraception compliance recorded100%31%41%Pregnancy risk assessed100%68%79%DiscussionWe demonstrate that 93% of those identified as having urgent contraceptive needs leave without their needs having been addressed. We also demonstrate that contraception compliance is documented poorly. We will discuss changes that we have introduced to meet this service need.
P134 Reaching youth with out-of-facility HIV and reproductive health services
Authors: Denno D , Chandra-Mouli V , Osman M 
Published: May 2012

BackgroundMany young people, particularly those who are marginalised and most at risk for HIV and reproductive health-related problems, cannot or will not seek traditional facility-based health services. Policies and programs are being implemented to provide them with these health services in the community. We sought to systematically review the effectiveness of such community-based HIV and reproductive health service policies and programs delivered via outreach on increasing health service utilisation among adolescents and young adults (ie, among 10–24 year olds).MethodsA systematic literature review of literature published prior to March 2010 was undertaken to identify policies promoting or programs delivering HIV or reproductive health services in the community. We reviewed studies that evaluated uptake of services or commodities. Data from studies meeting inclusion criteria were qualitatively analysed.Results20 studies met inclusion criteria, including 10 containing comparative data (eg, before and after study or control study design). The studies generally demonstrated positive impact, although results varied across settings and approaches. The most successful approaches included mail-based chlamydia screening in the Netherlands, condom distribution via street outreach in Louisiana, home-based HIV counselling and testing in Malawi, and promotion of over-the-counter access to emergency contraception in various countries.ConclusionsOverall, the studies suggest that out-of-facility approaches can be important avenues to reach marginalised youth. Rigorous implementation research is needed to assess the true impact that such strategies can have. Determining ways to effectively reach adolescents and young adults with HIV and reproductive health services is crucial in reducing not only youth morbidity and mortality but also in mitigating adult disease burden.