bluuebunny/crossref_metadata_2025_split huggingface dataset:
P224 Agile, design led approach to online service development
Authors: Howroyd Chris , Baraitser Paula , Courtenay Molly , Parry Glyn , Holdsworth Gillian 
Published: May 2024

IntroductionSexual health services lead innovative thinking in the NHS with integrated service provision, online access and testing in non-traditional venues. Agile design-led thinking creates services that are intuitive, easy to use and valued by users (both staff and patients). It offers an alternative to pre-specifying a whole system (waterfall approach) frequently associated with unpredicted problems, identified late and requiring costly fixes.MethodsSH:24 uses an agile, design-led approach to service development delivering value by: Focusing on user need (understanding and empathising rather than assuming); Reducing cost (failing quickly, cheaply); Reducing risk (avoiding unnecessary, costly development); Creating tangible, visual, measurable outputs early (promoting understanding, collaboration and buy-in). Our agile, design-led approach included extensive user involvement; building the minimum from cycles of build, test, learn; responding to feedback, continuously improving and optimising.ResultsThis presentation will provide three examples describing the contribution of agile to development of:1. Self-sampling kit instructions which delivered 76–84% return rate2. User friendly information pages on contraception – 2000 hits daily3. Online chlamydia treatment – 95% uptakeWe will demonstrate the added value of design and agile for these examples.DiscussionAn agile design led approach is championed by Government Digital Services - it involves re-framing issues as opportunities and rapidly iterating thinking by building and testing user centred prototypes - this approach minimises cost and risk while improving user experience - an approach that could add value in NHS services.
P229 Hsv management in pregnancy at a joint antenatal-genitourinary clinic in a large maternity hospital in dublin, ireland – a model of care
Authors: Lynn Niamh , Murphy Sinead , Cunningham Orla , Lynam Almida , Lyons Fiona , Mulcahy Fiona 
Published: May 2024

IntroductionThe ultimate goal of HSV management in pregnancy is to prevent perinatal transmission and, where possible, to facilitate vaginal delivery.MethodsData was collected from antenatal charts of 107 women who reported a history of HSV or who had a documented outbreak during that pregnancy. Descriptive column statistics were used in excel for data analysis.ResultsFrom May 2013 to Feb 2017, 107 Women were seen in the clinic for management of HSV in 108 pregnancies. Median gestation at referral (82/108) was 23/40 (range 2–39/40). Mean age 33yr (range 18–45). 91 (85%) European. 9(8%) HIV+. 82 (76%) reported prior history. 96 (89%) had type-specific serology sent of which 89 (92%) HSV IgG +ve. 28 (31%) HSV 1 & 2 positive, 47 (52%) Type I positive only, 12 (13%) Type 2 positive only, 2 were weak + and not typed. 69 (63%) had STI testing, 100% negative. 4 of the 107 (80%) had primary HSV in that pregnancy. 67 received HSV prophylaxis; 66 valaciclovir; 1 aciclovir. Mean gestation starting prophylaxis was 36/40 (range 20 – 39). Data on mode of delivery on 82 of 107 (76%) pregnancies; 59 (71%) vaginal, 24 (29%) lower segment caesarean sections, none for HSV. Median gestation at delivery of 84 pregnancies 39/40 (range 29 – 41). To date no cases of perinatal HSV transmission have been reported.DiscussionThere is good compliance with Irish guidelines on HSV management in pregnancy. HSV2 remains an issue. This combined clinic facilitates good compliance with standard guidelines for HSV management in pregnancy. This model of care should be available across all antenatal settings.
P235 An audit of the care of msm attending an outer london integrated sexual health service
Authors: Dass Kavita , Fletcher Emma , Quartin Marcia , Kirlew Yasmyn , Thamby Rajah , Browne Rita 
Published: May 2024

IntroductionMen who have sex with men (MSM) remain a high risk group for HIV infection, increased rates of syphilis, LGV and gonorrhoea indicating high levels of risky sexual behaviour. The aim of this audit was to measure care against BASHH recommendations for testing for STIs in MSM (2014) and local guidelines to ensure high quality accessible services for MSM.MethodsData were collected retrospectively from electronic patient records of all MSM first attendances across all clinics between 1 January 2015 to 30 June 2015 (N=96) and data analysed using SPSS and Excel.Results79% (76/96) of MSM were from our local borough; age range was 16–65 with highest attendance in the 25–29 years age group; 43% were from BME communities. 100% were offered STI screening, 91% accepted (87/96) and 47% had a STI diagnosed. 80% of MSM had a comprehensive assessment undertaken while 65% had a record of vaccination status. PEPSE discussion was recorded for 76% of eligible patients. 100% of suitable patients were offered HIV testing (n=88/96), 90% (79/88) tested with a positivity rate of 2.5% (2/79).DiscussionThe service is highly accessible to local MSM, STI testing offer exceeded the BASHH recommendation of 97% and uptake of 91% exceeded the BASHH recommendation of 80%. Uptake of HIV testing met the BASHH recommendation of 90% but improvements are needed in PEPSE and PREP discussions and determining Hepatitis B status in all eligible clients. EPR has been revised and staff training undertaken to address and improve on this.
P238 Working the streets – targetting migrant sex-workers through dedicated outreach
Authors: Braunholtz-Speight Jane , Turner Emily , Wallace Harriet , Schoeman Sarah , Evans Amy 
Published: May 2024

IntroductionSex-workers do not always engage with traditional healthcare settings and migrant sex-workers are a growing vulnerable group. Our city uses a ‘managed approach’ to sex-working, with focus on identifying exploitation and trafficking. This gives a unique opportunity for outreach.Aim(s)/objectivesProvide accessible sexual healthcare, health promotion and contraception to sex-workers not accessing care. Evaluate this outreach service after one year.MethodsA partnership was established between the Integrated Sexual Health service and a local Third Sector Sex-work Project. Sex-workers were offered STI testing, treatment, HepB vaccination and contraception in an outreach setting (own homes/workplaces, charity premises, streets).Results (at one year):129 sex-workers seen (289 contacts); 70/129 (55%) were migrant (majority Romanian), 113 contacts; 70% previously unknown to sexual health services. Contraception was extended over the first year and provided to 25 sex-workers; Hep B vaccination offered to all. 45 infections identified in 28/70 (40%) migrants (compared with 26 infections in 21/59 (36%) non-migrant sex-workers): 33/45 Chlamydia: 20 extra-genital (5 pharyngeal, 15 rectal); 5/45 Gonorrhoea (all extra-genital); 8/45 Trichomonas Vaginalis. 27/28 successfully treated (1 moved away). 4 women had re-infection on interval rescreening (all Chlamydia). 1 case of chronic HepB, 1 chronic HepC, no cases HIV or syphilisDiscussionThis new outreach service successfully targeted a vulnerable group with a disproportionately high STI burden (40%). Use of a dedicated outreach team achieved trusted relationships with sex-workers. Secondary benefits included a 250% increase in women identifying as sex-workers accessing mainstream clinics.
P245 Monitoring the uptake and early impact of targeted hpv vaccination among men who have sex with men (msm) attending gum and hiv clinics in england
Authors: Checchi Marta , Mesher David , McCall Mark , Chau Cuong , Panwar Kavita , Beddows Simon , Soldan Kate 
Published: May 2024

IntroductionMSM are at high risk for HPV infection and associated disease (genital warts and anal, oropharyngeal, and penile cancers). Additionally, MSM will receive little or no herd protection from the existing national vaccination programme for females. Following Joint Committee on Vaccination and Immunisation (JCVI) advice, a targeted HPV MSM vaccination pilot was introduced in GUM and HIV clinics across England from June 2016. We present plans for monitoring vaccination uptake and surveillance of infection and early disease outcomes.MethodsUptake (of three doses over a two year period) will be monitored via two existing surveillance and reporting systems: the Genitourinary medicine clinic activity dataset (GUMCADv2) and the HIV and AIDS reporting system (HARS). A seroprevalence study conducted in selected clinics for validation of these data will be considered in due course.Early impact of targeted HPV vaccination of MSM on the epidemiology of HPV infection will be detected by HPV DNA testing of rectal swabs (residual specimens following chlamydia testing) from MSM attending selected GUM clinics, starting with largely baseline collection in 2017.Expected early effects on genital warts diagnoses will be monitored (via GUMCADv2). A decline in HPV-associated cancers is not expected to be seen for some years.DiscussionA comprehensive surveillance strategy has been established to evaluate targeted HPV vaccination of MSM at GUM/HIV clinics. During the pilot, uptake will be the main outcome measure available, and surveillance systems will be established and baseline data collected to evaluate the outcomes of national implementation on infection and disease.
P247 An audit of hepatitis b and c testing in a sexual health service – an opportunity for cost saving
Authors: Bhaduri Sumit , Hanson Lucy , Spice William 
Published: May 2024

IntroductionBASHH have recently updated guidelines as regards criteria for hepatitis B and C testing. Are patients accessing the service offered hepatitis B and C testing appropriately? Furthermore can this data be extrapolated to calculate potential cost reductions should audit data suggest overtesting.Methods100 case notes SHHAPT coded as T6 from 2 local clinics were scrutinised as to whether testing followed BASHH guidelines. In addition 50 case notes were randomly selected to ascertain whether a T6 code should have been applied.Results87/100 (87%) underwent hepatitis B testing of which 10/87(11%) were found to be inappropriate The reasons for testing in this 11% included sexual exposure in a low prevalence (mostly in Europe), saliva exposure, and a history of an ex-partner with multiple contacts – 38/100 underwent hepatitis C testing of which 14/38 (36%) were tested inappropriately—the reasons given included contact with men having sex with men(MSM) with no history of chemsex, contact with a HIV infected patient, sexual assault, sexual contact with an intravenous drug user and sexual exposure in Europe. In the audit of random selection of 50 casenotes- there were no cases of missed opportunities for hepatitis testing. Extrapolation of data showed that £1739 annually could be saved if all testing for hepatitis B and C was based on national guidance.DiscussionGiven the proven overtesting in the audit, guidelines are to be reiterated to clinical staff. It is hoped that this would translate to costs savings on an overstretched service pathology budget.
P248 Genital warts and treatment options: clinical audit
Authors: Patrick Helen , Jayasekara Niroshan , Fitzpatrick Colin , Finnerty Fionnuala , Wijerathna I , Murdock Rebecca , Richardson Daniel 
Published: May 2024

IntroductionGenital warts are a common presenting condition in sexual health clinics. There are different treatment options available within BASHH guidelines depending on the size and location of warts. Home treatment reduces follow up clinic attendance.MethodWe randomly selected 30 patients attending our integrated sexual health service with new genital warts and audited their management against local guidance that home treatment with Imiquimod should be used first line for 4 weeks, unless contraindicated.ResultsOf the 30 patients, 18 were male and 12 were female. 14/30 were prescribed Imiquimod only. 7 patients had Cryotherapy only and 9 were also given cryotherapy before Imiquimod. 9/11 who received cryotherapy requested this treatment. 6/11 had documented reasons why it was deemed appropriate to have cryotherapy (unable to apply cream themselves, site of lesion). Interestingly, all 9/9(100%) who had received combination treatment reported clinical resolution within 4 weeks. 6/7(86%) who had cryotherapy only clinically resolved after 3 consecutive applications. 11/14(79%) treated with Imiquimod only resolved within 4 weeks, one deferred. 11/19(58%) treated with Imiquimod experienced side effects and five patients (5/11) sought medical advice. There were no reported complications following cryotherapy application.DiscussionDespite imiquimod being the recommended first line initial treatment for genital warts in our service, some patients received cryotherapy treatment in isolation or a combination of imiquimod and cryotherapy. The patients receiving cryotherapy were likely to have requested this treatment and had less side effects. All patients who received imiquimod and cryotherapy had resolution of genital warts in four weeks.
O31 Explaining ethnic variations in sti diagnosis: results from britain’s third national survey of sexual attitudes and lifestyles (NATSAL-3)
Authors: Wayal Sonali , Hughes Gwenda , Sonnenberg Pam , Mohammed Hamish , Gerressu Makeda , Furegato Martina , Mercer Catherine 
Published: May 2024

IntroductionIn Britain, ethnic inequalities in STIs diagnoses persist. We hypothesised that these inequalities are associated with variations in sexual behaviour, which are influenced by differences in socioeconomic deprivation (SED) and mediated by substance use.MethodsData from 14,563 participants of Britain’s third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey (N=15,162), were analysed by gender and ethnicity: white British (WB, reference category), black Caribbean (BC), black African (BA), Indian, Pakistani, white other (WO), and mixed ethnicity (ME). Using multivariable regression we examined ethnic variations in reported STI diagnoses adjusted for age, partner numbers (last 5y), recreational drug use (last 1y), and SED, and calculated adjusted odds ratios (AOR).ResultsSED was higher in BC, BA, and Pakistani participants than other ethnicities (50% vs. 16%-38%, p<0.0001). compared with men from other ethnicities, BC and BA men reported higher partner numbers (p<0.0001), and concurrent partnerships (27% and 39% respectively vs. 4%–15%, p=0.001). compared with women from other ethnicities, ME women reported higher partner numbers (p<0.0001) and concurrency (14% vs. 2%–8%, p=0.0005). Recreational drug use was highest among WO and ME participants (26% vs. 4%-15% among other ethnicities; p<0.0001). Reported STI diagnosis was highest among BC men (8.7) and ME women (6.7%), and remained AOR high after adjustment for BC men (2.68, 95%CI: 1.13–6.34) and ME women (2.03, 95%CI: 1.11–3.68).DiscussionEthnic variations in sexual behaviours, mediators, and SED partially explain higher STI diagnoses among BC men and ME women highlighting need for holistic interventions addressing these broader determinants.
O37 Genital dermatology is a high proportion of the case load presenting to walk-in sexual health services across the united kingdom
Authors: Hartley Anna , Bates Christine , Fernando Imali , Basavaraj Serish , Pritchard Jillian , Edwards Sarah , Sethi Cindy , Goorney Ben , Vijeratnam Dayan , Parameswaran Sashidharan 
Published: May 2024

IntroductionPatients with genital dermatology (GD) conditions frequently present to sexual health services. Following service tendering, there are reports of contracts excluding provision of specialist GD services within sexual health. We aimed to review the case load of GD conditions presenting to walk-in sexual health clinics, to reach an understanding of the demand for these services within our specialty.MethodsMembers of the BASHH GD Specialist Interest Group collected data on the first 30 to 50 new symptomatic patients presenting to their sexual health walk-in service on 5thSeptember.Results382 patients presented to 9 services across England and Scotland. Of these, 164 (43%) presented with a GD condition. GD STI diagnoses (e.g. warts, herpes simplex) were excluded. 75 patients (20%) presented with non-STI GD conditions.Of these, 59% were male, 91% heterosexual. The modal age range and ethnicity were 18–25 year olds (36%) and white British (67%).GD diagnoses included: candida/tinea 17%, normal variant 11%, eczema 8%, non-specific balanitis 8%, irritant dermatitis 7%, vulvodynia 5%, lichen sclerosus 5%, lichen planus 3%, psoriasis 3%. 17% of cases required senior review. 33% had follow up: 32% by a Genitourinary Medicine consultant; 12% in a Genitourinary Medicine specialist clinic. 4% required skin biopsy.DiscussionOur study demonstrates that non-STI GD conditions constitute a high proportion of clinical presentations to walk-in sexual health services. Many cases require in-house senior input. Commissioners must recognise the burden of GD on services and the expertise required to ensure optimal management of GD within sexual health.
O04 Findings from the men who have sex with men (MSM) internet survey ireland (MISI): estimated proportion of MISI respondents eligible for pre-exposure prophylaxis (PREP)
Authors: Nic Lochlainn Laura , O’Donnell Kate , Hurley Caroline , Lyons Fiona , Igoe Derval 
Published: May 2024

IntroductionIn Ireland, HIV infection predominantly occurs among men who have sex with men (MSM). Combination prevention approaches, including pre-exposure prophylaxis (PrEP), are recommended to reduce the risk of acquiring HIV. We used the 2015 MSM Internet Survey Ireland (MISI), a large-scale community survey among adult MSM in Ireland, to estimate the proportion of MISI respondents eligible for PrEP.MethodsWe applied PrEP eligibility criteria from France to MISI variables. Where exact criteria could not be applied, the most similar form was used. French PrEP eligibility criteria include HIV negative MSM or transgender adults who had at least one of the following: condomless anal sex (CAI) with ≥2 different partners in the past six months; episodes of STIs in the past 12 months; used multiple post-exposure prophylaxis (PEP) treatment(s) or used drugs during sex.ResultsMISI included 3,045 MSM aged 18–64 years; 2,870(94%) were HIV negative or never HIV tested. In the past 12 months, 370(12%) reported CAI with ≥2 non-steady partners; 243(8%) reported an STI diagnosis and 181(6%) used drugs associated with chemsex. Four percent (n=119) were treated with PEP. Overall, 23% [95%CI(22–25)] of MISI respondents are eligible for PrEP.DiscussionAn estimated one in four MISI respondents met French PrEP eligibility criteria. Applying this estimate to the MSM population in Ireland, taking study limitations, those engaged in services and assumed PrEP uptake into account, would enable calculation of the number of MSM eligible for PrEP. This estimate will be useful for informing PrEP policy in Ireland.
UG1 Management of symptomatic patients attending open access sexual health walk-in clinics in the UK
Authors: Khatun Azra , Agathangelou Gabriela , Yekini Stephen , Rose Thomas , Foley Elizabeth , Patel Rajul 
Published: May 2024

IntroductionFollowing the NHS Act 2012, Sexual Health services (SHs) have been radically reshaped. Anecdotally many places report problems in maintaining open access services, particularly since local authorities became responsible for commissioning SHs as of 1 April 2013.AimsTo assess whether SH walk-in clinics can accommodate symptomatic patients and if there is a difference in waiting time between male and female patients. To determine whether the expectations of lead clinicians working in SHs concur with the experience of front line services.MethodsA postal questionnaire was sent to 262 UK SH clinics to assess lead clinicians’ predicted waiting times. Four researchers; 2 males and 2 females attended clinics as ‘patients’ reporting symptoms suggestive of an acute STI, clinic waiting time was recorded. 50% of clinics in each of the 17 BASHH branches were visited. SPSS v23 was used to analyse the data.ResultsOf the 131 clinics visited, 97.7% could accommodate symptomatic ‘patients’ on the same day. The observed waiting time ranged from 5-285 minutes. The median wait was 54 minutes respectively. There was no significant difference in waiting time between male and female ‘patients’ (p=0.110). 68/262 questionnaires were returned; 31 were from clinics which were visited. 13% of clinics underestimated the walk-in waiting time, while 23% over-estimated the walk-in waiting time, when compared with actual walk-in waiting time established during clinic visits.DiscussionDespite strains on SHs, most clinics visited could accommodate patients on the same day. However, there is discrepancy between lead clinicians’ expectations and services provided.
UG5 Designing, delivering and evaluating a teaching toolkit for pre-exposure prophylaxis in men who have sex with men
Authors: Langrish Alexander , Pool Erica , Richardson Daniel 
Published: May 2024

IntroductionResearch on the knowledge of PrEP in healthcare workers including third sector workers is limited, and their knowledge will be vital to future national rollout. The aim of this study was to design and evaluate a teaching toolkit on PrEP to educate healthcare professionals and third-sector workers.MethodsA 20 minute powerpoint teaching toolkit was designed and delivered to sexual health workers, third sector workers and medical students. A questionnaire was used to evaluate the toolkit, including perceived knowledge pre-toolkit, immediate post-toolkit, and >1-week post-toolkit.Results42 participants took part in teaching sessions. There was a 36% increase in mean perceived participant knowledge scores (maximum = 25) immediately after teaching (23.69), and a 26% increase >1-week after teaching (21.93) – when both are compared with a prior mean score of 17.45. This change in perceived knowledge increased significantly both immediately post and >1-week post when compared with pre-toolkit (Z = -5.351, p = <0.001; Z = -3.189, p = 0.001). Immediately after, 42/42 (100%) participants agreed they had some knowledge of the monitoring and tests for PrEP in comparison to 21/42 (50%) pre-teaching (Z = -4.753, p = <0.001). Overall 39/42 (93%) of participants strongly agreed it provided a good overview of PrEP, with 35/42 (84%) thinking it would help them to provide answers to those seeking to use PrEP.DiscussionPerceived knowledge of PrEP increased following toolkit use and importantly was sustained >1-week post-toolkit when compared with prior knowledge. Toolkits such as this can help educate future PrEP advocates.