bluuebunny/crossref_metadata_2025_split huggingface dataset:
P083 How do HIV testing initiatives impact on HIV testing rates and diagnosis in primary care?
Authors: Rickwood Lucinda , Perera Sean , Soni Suneeta , Dean Gillian 
Published: May 2024

IntroductionUndiagnosed HIV leads to late presentation, increased morbidity, and contributes to onward transmission. It is estimated that in our area approximately 17% of those living with HIV are undiagnosed. Little is known about the impact of National HIV Testing Week (NHTW) initiatives in general practice (GP). In 2016 we implemented a ‘pop-up’ message alerting GPs that it was NHTW, with a ‘one-click’ pathway to adding an HIV-test to bloods requested for other reasons.MethodsNumber of HIV tests carried out in GP and new HIV diagnoses made were collected between 20thAugust 2016 and 20thFebruary 2017 and separated into the time period spanning 3 months pre-NHTW, NHTW itself and 3 months post-NHTW.Results464 HIV tests were performed in 37 GP practices in the pre-NHTW period (approx. 36/week), 96 test during NHTW and 534 tests in 3 month post-NHTW (approx. 41/week). 1 HIV-diagnosis was made in GP during the pre-NHTW period (c.f. 20 across all services), no new diagnoses in NHTW and 1 case (7 across all services) in the 3 month post-NHTW period.DiscussionTesting initiatives result in greater awareness across the city and an increase in HIV testing, which was sustained, although no increase in new HIV diagnoses. The decrease in HIV diagnoses in this study reflects the national trend of a reduction in HIV diagnoses despite increased testing; this is attributed partly to the efficacy and increased use of Pre-exposure prophylaxis (PrEP).
P087 Information gaps for HIV positive patients detained in immigration referral centres (IRCS)
Authors: Scofield Sara , Priestley Cecilia , Fowler Jane 
Published: May 2024

IntroductionHIV is over-represented in this high risk, vulnerable population. Detainees often have complex health needs which present challenges to chronic disease management. Transfer of information between care providers is crucial to maintain appropriate management of these vulnerable patients. We aimed to look at the information shared between health care providers for detainees referred to our HIV service.MethodsWe reviewed all referrals from the local IRC to our HIV service between September 2014 and January 2017, looking at information provided on the IRC referral letter and supplied by their previous care provider.ResultsOut of 24 referrals, the notes were available for 17. CD4 count, HIV RNA and HAART regimen were missing from 9, 10 and 1 of the IRC referrals respectively. Information was missing about adherence in 9, treatment interruption in 10, and co-medications in 11 referrals. 9 reported requesting information from previous HIV provider; this was not received in 4 cases. In the 11 cases where information was received from the previous HIV care provider, information was not included on co-medications in 8, hepatitis B status in 6, hepatitis C status in 8, resistance testing in 5, and HLAB*5701 status in 6 summaries.DiscussionWe highlight the need for standardised information transfer between care providers in these patients. In Dec 2016 we devised a form to send to previous HIV service providers to collect the required information for safe prescribing prior to their GUM appointment. We plan to review whether this improves the quality of information received.
P088 Antiretroviral treatment algorithm compliance: a regional audit and survey
Authors: Howe Bridie , White Conrad , Bushby Stephen , Lavender Thomas , Price Ashley , Foster Jonathan , Elawad Babiker , Hussey Jane 
Published: May 2024

IntroductionIn 2015 BHIVA introduced new treatment guidelines and NHS England produced an algorithm for antiretroviral (ARV) treatment initiation, with a requirement to have regional and local multidisciplinary team (MDT) arrangements to aid decision making.Methods6 services within our regional clinical HIV network carried out a retrospective audit of 20 (or total if fewer) cases started on ARVs in 2015, and completed a survey of each centres MDT arrangements. Data from each centre was collated and analysed regionally.ResultsLocal MDT arrangements varied widely in number and composition of professionals. All centres reported a change in practice and discussed non-first line regimens. 98 case notes were included. 43/98 started due to CD4 <350, 17 for primary HIV infection or symptoms, 16 for Treatment as Prevention, and 14 patient choice. An increase in abacavir/lamivudine based regimens was seen after algorithm instigation in April 2015. Mental illness, HIV viral load >100K, patient choice and shift work were the commonest reasons for choosing non-first-line regimen. 90% overall compliant with the NHS England treatment algorithm.DiscussionMDT arrangements and interpretation of the algorithm varied in our network. Prescribing practices have changed throughout the region since algorithm introduction. Further work is needed as a network to ensure standardised ARV prescribing for both cost and equity of patient care.
P090 Formalised look-back in newly diagnosed hiv to identify missed opportunities in other clinical settings: first get our own house in order!
Authors: Horn Kate , Ramsden Sophie , Fernandes Arnold 
Published: May 2024

IntroductionHIV late diagnosis is one of three key indicators on sexual health in the Public Health Outcomes Framework. The British HIV Association (BHIVA) Standards of Care for People Living with HIV advocates the use of ‘look backs’ in the case of late and very late diagnosis of previous engagement with health care services to identify missed opportunities and areas for shared learning and development.MethodsFurther to the look-back exercise undertaken on late and very late diagnoses presenting 2012–2016, we extended the use of the standardised look-back tool to ALL new diagnoses from late 2016 onwards.ResultsIn addition to anticipated missed opportunities being identified in the late and very late presentations, we identified 2 missed opportunities in much earlier presentations from within our own service! They related to failure to repeat the HIV test at test of cure (TOC) for gonorrhoea and subsequent Hepatitis vaccination appointments. In both cases the initial negative HIV test had been within the potential window period.DiscussionAs a result of the look-back exercise we have learnt a valuable lesson about the fallibility of our own service and shared the learning within our multi-disciplinary team. We have encouraged all to remember to re-visit the sexual history and timing of sex in relation to testing at ‘quickie’ follow up visits for vaccination or TOC and repeated education about window periods.We shall continue to utilise the look-back tool in all new HIV presentations and encourage colleagues to do likewise to maximise on identifying learning opportunities.
P093 HIV testing for hospital inpatients in a priority area
Authors: Pool Erica , Vickers Laura , De’Ath Tom , Cubbon Marc 
Published: May 2024

IntroductionDepartment of Health advises that HIV testing should be routinely offered to patients in priority areas; where prevalence ≥1–2/1000, such as Brighton. We sought to increase HIV testing in the Cardiology department. Local microbiology department advises HIV testing on all inpatients with suspected or proven infective endocarditis (IE), as such we investigated testing in this group.AimAssess the proportion of patients with suspected or proven IE offered a HIV test at baseline, and following an intervention to promote testing.MethodsPatients with IE are discussed at a weekly multi-disciplinary team (MDT). We retrospectively reviewed MDT meetings from June – November 2016 (cycle one). Data on HIV testing were extracted from MDT proforma and hospital results system. Initial results were presented to cardiology junior doctors and testing encouraged. We prospectively reviewed MDT meetings and HIV testing in the 10 weeks after the intervention (cycle two).ResultsIn cycle one, 29 patients (25 males, 4 females) had suspected or proven IE, 16 (55%) were tested. In cycle two the proportion of patients tested for HIV decreased; of the 8 patients with suspected/proven IE (6 males, 2 females); 2 (25%) were tested, 6 (75%) were not.DiscussionHIV testing rate decreased by 46% between cycles, representing multiple missed opportunities for testing. The reason for this trend is not clear but barriers to HIV testing remain, including poor awareness of indications to test, uncertainty around consent, and assumption of low risk. We plan further interventions to increase HIV testing locally.
P103 A psychosexual needs assessment of patients attending five london sexual health clinics
Authors: Malik Aiysha , Grayer Justin , Gibson Stuart 
Published: May 2024

IntroductionThe aim of this psychosexual needs assessment was to investigate the prevalence and range of sexual problems; to understand the distress, causal attributions and functional impairment associated with these; and to explore patients’ service-related needs, in a sample of patients attending sexual health clinics in London.MethodsQuestionnaires were disseminated to patients attending five sexual health clinics in London, over a one week period. Nine hundred and thirty four patients responded to the questionnaire. Patients were aged 29.4 years (SD=8.8) and predominantly female (61.4%).Results31.1% of patients indicated they were experiencing a sexual problem. Premature ejaculation, delayed ejaculation, or difficulty having an orgasm were the most prevalent problems reported by patients (13.5%). Female and male patients did not differ in their report of overall sexual problems (32.5% and 28.6%, respectively), however more women reported sexual pain (14.8%, X2=11.3,p=.001) and male patients reported difficulties with hypersexuality (9.5%, X2=25.2,p<.001). The majority of sexual problems had commenced within the past year, however orgasm, chemsex and hypersexuality problems were longer-standing (>1year). Associated distress was reported by 79.5% of patients. Emotional reasons were attributed as the most likely cause of sexual problems (21.1%). Male patients reported higher functional impairment (U=1862.0, z=2.3,p=.02). Patients were interested in a range of interventions, and expressed preference to be supported in a sexual health clinic (67.8%).DiscussionThe findings present implications for the provision of psychosexual services in sexual health clinics.
O15 A service evaluation comparing home-based testing to clinic-based testing for chlamydia and gonorrhoea in birmingham and solihull
Authors: Banerjee Prita , Thorley Nicola , Radcliffe Keith 
Published: May 2024

IntroductionPublic Health England recommends that local authorities should work towards making STI testing more accessible. Since August 2015, sexual health services in Birmingham and Solihull area (Umbrella) have provided online home-based testing.MethodsWe conducted a retrospective analysis of the clinic and online database to identify patients who undertook home-based and clinic-based testing in the Birmingham and Solihull clinics between January and June 2016.ResultsAbstract O15 Table 1Home based v clinic based testingHome-based testing (n=9258)Clinic-based testing (n=19193)P valueAge16–24 >256033 (65%)3225 (35%)9654 (50%)9539 (50%)<0.001Gender Female Male Transgender5986 (65%)3258 (35%)14 (0%)10861 (57%)8306 (43%)26 (0%)<0.001Ethnicity White Black/British Black Asian/British Asian Other: Not specified:6648 (72%)892 (10%)558 (6%)920 (10%)240 (3%)7996(42%)4026 (21%)2167(11%)2160 (11%)2844 (15%)<0.001Asymptomatic7408/9258 (80%)9729/19193 (51%)<0.001Return rate4476 (48%)–Prevalence rates382/4476 (9%)2141/19193 (11%)<0.001Treatment rate174/382 (46%)1663/2141 (78%)<0.001DiscussionHome-based testing appears to be popular among asymptomatic, younger (16–24 years), white and female patients, with poor overall return rates. There may be a need for promotion of this method of testing among ethnic minorities. The current method of recall needs to be reviewed to improve treatment rates in the home-based testing group.
P111 Reaching out – gum in the general practice setting
Authors: Watt Joanne , Streeter Thomas , Ashton Susan , Battersby Cara , Herbert Sophie 
Published: May 2024

IntroductionProviding accessible GU services in rural areas is difficult. Providing a service in General Practice (GP), close to patients’ homes may increase access (particularly to those who might not otherwise test) and avoid the perceived stigma of attending a GUM clinic. A GUM service was set up in 2008 within a general practice setting (syndromic management), in an area of high need (HIV prevalence 2.58 PHE 2015).We aim to describe the outcomes of running a GU clinic within GP.MethodsDemographic, attendance and diagnoses data was collected and analysed from 2008–2016.ResultsA total of 1081 patients were seen (1826 attendances) with a median of 200(186–221) per year. 604 diagnoses of infection were made (33.1%). 922(85%) lived in the town where the clinic was held. 53.8%(582) had never been seen in GU in our county before compared with 32.6% in the hubs. 440 (41%) were men of which 40(9%) were MSM. Mean age for attendees was 29 (28 at the main GU hub). Total number <20 year olds fell from 2007-2016 but those aged 21–35yrs and 45–60yrs increased. Table 1 shows the distribution of GUMCAD diagnoses. There were 426 DNAs (18.9%), 42% were follow-ups. Overall HIV testing was refused in 15.5% cases, (30% in 2007 but 7% in 2016).DiscussionIn rural areas where transport links are limited, a GU clinic run in GP offers an efficient, anonymous service. Services can be offered in this setting with few extra resources providing an alternative point of access for patients.Abstract P111 Table 1GUM in general PracticeDiagnosisn=604% all diagnoses% all patients% attendancesChlamydia19031.4%17.5%10.4%Gonorrhoea71.2%0.6%0.4%Syphilis10.2%0.09%0.05%HIV10.2%0.09%0.05%Other40667.0%37.6%22.2%
P121 Choose to test
Authors: Syred Jonathan , Howroyd Chris , Holdsworth Gillian , Spelman Kes , Baraitser Paula 
Published: May 2024

IntroductionChoice is an increasingly important element of health care. We introduced choice of test into an online sexual health service.MethodsUsers were offered testing based on their risk profile (table 1) with an option to request additional tests. Routinely collected anonymised data were collected on choice of test.Abstract P121 Table 1Results from Choose to test<2424+BMEMSMGenital GC/CT*YesYesYesYesOral GC/CT*NoNoNoYesAnal GC/CT*NoNoNoYesSyphilisNoNoNoYesHIVNoNoYesYesResults2550 users ordered tests (30/10/16 – 19/12/16). 56% were <24, 10% were from black or ethnic minority (BME) groups and 17% were men who have sex with men (MSM). 1853 (72.6%) returned a test, 6.7% were positive for any STI. Of the non-BME/non-MSM users offered chlamydia/gonorrhoea testing, 66% chose to add HIV + syphillis testing. Of the BME/non-MSM users offered chlamydia/gonorrhoea + HIV testing, 71% chose to add syphilis testing. Of the MSM users offered chlamydia/gonorrhoea (genital, oral, anal) + HIV + syphilis testing, 85% chose this option. 6% chose to omit the HIV/syphilis test. User choice resulted in 611 fewer HIV tests, 596 fewer syphilis tests and 27 fewer chlamydia/gonorrhoea tests.DiscussionOnline service users actively exercise choice in STI test selection. The majority of users choose to test for chlamydia, gonorrhoea, HIV and syphilis regardless of what they are offered. User choice of test reduces the total number of tests offered online.
P123 Is there a relationship between the tendering history of a genitourinary medicine clinic and its accessibility?
Authors: Yekini Stephen , Khatun Azra , Agathangelou Gabriela , Rose Thomas , Foley Elizabeth , Patel Rajul 
Published: May 2024

IntroductionSince 2004, DH guidance has recommended that GUM clinics in England should endeavour to see patients within 48 hours of initial contact. Recent changes in service commissioning and the wider adoption of competitive tendering since 2013 has led to concerns about maintaining 48-hour access.AimTo establish whether there is a relationship between the tendering history of a GUM clinic and its accessibility.MethodsPostal questionnaires regarding tendering history were sent to lead clinicians of all 262 GUM clinics in the UK. Only questionnaires which were returned within a two-month window were analysed. Each clinic with a returned questionnaire was telephoned eight times by male and female researchers posing as patients with symptomatic and asymptomatic presentations. The researchers asked to be seen as soon as possible and recorded whether this fell within 48 hours.Results67 clinics (25.6%) returned their questionnaires on time. A chi-square test found no statistically significant difference between clinics tendered within the last five years (n=49) and the rest (n=18), regarding 48-hour access (86.5% and 86.2% respectively, p=0.916). Interestingly, 88% of contacts with clinics still undergoing a tender resulted in a 48-hour appointment compared with 100% of contacts with clinics which completed the process 3–5 years ago. However, this was not statistically significant.DiscussionThe negative effect of tendering on accessibility seems to be overstated. Moreover, if this effect does exist, it seems more pronounced during the actual tender, followed by an apparent boost in access. A larger study may be required to confirm this.
P125 Use of digital sexual health services by under-16s and an evaluation of safeguarding procedures
Authors: Bakhai Minal , Perera Sean 
Published: May 2024

IntroductionDigital health is an increasingly popular way for young people to access health services. There is paucity of research exploring the use of e-health services by under-16s. As an online doctor service offering sexual health services to adults, we reviewed under-16s trying to access services and evaluated safeguarding procedures.MethodsA retrospective audit of under-16s trying to access e-sexual health services between January-December 2015.Results66 patients were identified, 71.2% female, mostly distributed in urban areas (13-fold increase from 2008-2013).The most frequently accessed services were emergency contraception (27.3%) and routine contraception (43.9%). 22.7% (n15) entered an incorrect date-of-birth. Along with answering a questionnaire online, of the remaining patients, 52.9% (n27) completed a safeguarding assessment with a doctor via telephone, 5.9% (n3) via online messaging, both guided by ‘Spotting- the-Signs’, 41.2% (n21) did not respond to requests for further information and could not be contacted. Safeguarding concerns were identified in 37.3% (n19) and referred to social services. All were directed to appropriate face-to-face services and advised GP follow-up.DiscussionOur data shows increasing access by under-16s to esexual health services. A significant proportion were identified as being at-risk of sexual exploitation. A telephone safeguarding assessment together with our online evaluation was effective for identifying safeguarding concerns. Alongside IT systems to prevent those trying to bypass checks online, many of our services (including contraception and emergency contraception) require attendance to pharmacy. This provides an additional opportunity to verify identity and screen for safeguarding concerns supporting the ongoing safety of young people.
P129 Designing sexual health services to meet the needs of young people in the uk: results from a qualitative study to inform discrete choice experiment (DCE) development
Authors: Jackson Louise , Ross Jonathan , Al-Janabi Hareth , Roberts Tracy 
Published: May 2024

IntroductionYoung people experience the greatest burden of sexually transmitted infections (STIs) in the UK. STI screening is now being provided in a wider range of settings such as GP surgeries, pharmacies, and via online services. It is important that screening provision reflects the preferences of young people from different cultural backgrounds. The specific aims of the study were: to explore the factors that are important to young people when thinking about and participating in STI screening in different settings; to examine the characteristics of screening services that influence choices about screening.MethodsQualitative methods were used to inform the development of a discrete choice experiment (DCE) to provide quantitative measurement and analysis of the choices made by young people in relation to STIs. A series of eight focus groups and 2 interviews were undertaken with 43 young people in specialist and community settings, with the inclusion of participants from different cultural groups. Discussions were transcribed and analysed using constant comparison methods.ResultsThe focus groups revealed a range of aspects of screening that were important to young people. The main themes identified related to stigma, understanding of STIs and risk, setting, interactions with staff, convenience and the nature of the screening test. Attributes for the DCE were developed around waiting times, setting, type of screening test, and staff attitude.DiscussionThe complexities and challenges involved in designing and delivering services for young people are highlighted, particularly in relation to reflecting the preferences of young people from varied cultural backgrounds.
P143 Establishing a regional management pathway for peri-anal and anal cancers and pre-cancers in a moderate prevalence hiv setting
Authors: Ogbonmwan Daisy , Hussey Jane 
Published: May 2024

IntroductionThere is a rising incidence of anal cancer and pre-cancer among people living with HIV (PLWH), largely thought to be driven by sexual transmission of the Human Papilloma virus. However, a wide difference in screening methods exists. BHIVA guidelines state centres should incorporate a pathway of managing suspected peri-anal and anal cancers and pre-cancers.MethodsOur aim was to collate data on current screening and referral methods for peri-anal and anal lesions within our region to guide establishing a regional management pathway.An online survey was sent to specialists involved in managing PLWH. This included trainees and Consultants in Infectious Disease and Genito-urinary medicine. They were asked the methods used, if any, in routine clinics for identifying PLWH with anal and peri-anal cancers and pre-cancers, and whether there was a local established management pathway.Results33% of respondents stated that they regularly screened PLWH for peri-anal and anal lesions; the majority by enquiring about symptoms or carrying out proctoscopy examination, largely in men who have sex with men and PLWH with known anogenital warts. Only one Infectious Diseases specialist felt comfortable in using a proctoscope, and 67% of clinicians did not feel that they could be involved in the annual surveillance of peri-anal and anal intra-epithelial neoplasia.DiscussionThe results have supported the need for the implementation of a peri-anal and anal cancer and pre-cancer management pathway within our HIV regional network, alongside further education and streamlining of screening within the region.