bluuebunny/crossref_metadata_2025_split huggingface dataset:
P197 Young Asian sexual health: what can young Indian, Pakistani and Bangladeshi people tell us about their beliefs, attitudes and behaviours regarding sexual health and sex and relationships education?
Authors: Reynolds-Wright J , Alice N , Michelle M , Kanabar H 
Published: May 2012

IntroductionYoung people's sexual health in the UK has been a concern for public health policy and, despite falling teenage pregnancy rates, sexually transmitted infections (STIs) among young people have shown an increase. The numbers of Asian teenagers engaging in sexual intercourse is reportedly lower than their Black counterparts, however, there is some evidence that Asian young people are more likely to report “regretful intercourse”, “unequal willingness” and higher rates of anal intercourse, and so are still at risk of STIs through their behaviour.Methods16–25-year-old South Asian people were recruited from schools, universities and community organisations to participate in focus group (FG) or individual interviews. The Topic guide was developed following a literature review, steering group discussions and pilot FG. Following each FG or interview, emergent themes were explored in subsequent discussions. Ethical Permission was granted by NHS South Yorkshire Research Ethics Committee.ResultsNVivo 8 software was used to code, organise and support thematic analysis. A total of five FGs and six interviews have been completed and analysis indicates five over-arching themes: (1). Formal sex and relationships education (SRE) (2). Informal SRE (3). Relationships (4). Barriers to access of SRE and sexual health services (5). Future developmentConclusionSouth Asian young people have distinct health education needs that are underpinned and informed by their ethnic, religious and cultural background. In order to deliver the best level of care to this group, awareness of these needs is essential.
P2 Audit of clinical stage at presentation and factors contributing to antiretroviral therapy delay, in HIV patients in rural Kenya
Authors: Hussey R 
Published: May 2012

BackgroundThe 2010 WHO guideline, “Antiretroviral Therapy for HIV Infection in Adults and Adolescents” states that those with HIV and CD4 counts ≤350 cells/mm3, should start antiretroviral therapy (ART), regardless of symptoms. Those with WHO clinical stage 3/4 should start ART irrespective of CD4 count. In a small hospital north west of Nairobi, an HIV clinic, which is fully funded, provides ART to over 4000 patients. Patients are assessed on WHO clinical stage and CD4 count for ART eligibility.AimTo audit a random sample of 100 patients attending the clinic and determine the WHO clinical stage at diagnosis, the number eligible for treatment at diagnosis and factors causing delay in ART initiation.MethodRetrospective audit of 100 case notes. Recording patient gender, age, date of diagnosis, WHO stage, CD4 count, length of time from diagnosis to ART initiation and reasons for delay of treatment. “Counselling” is compulsory pre-treatment, usually over 3 weeks. “Patient default” is defined as patient non-attendance.Results82/100 patients were eligible for treatment at diagnosis. WHO clinical stage at diagnosis: 1–26, 2–17, 3–34, 4–5. Length of time between diagnosis and treatment: <28 days: 21/82, >28 days: 61/82, range: 4–861 days, mean: 102 days. Reasons for delay in those >28 days: TB diagnosis/treatment: 21, counselling: 18, patient default: 23 (see abstract P2 table 1).Abstract P2 Table 1WHO clinical stage of HIV infection at diagnosisWHO clinical stage at diagnosisNumber of patients12621733445Conclusion82 of 100 HIV positive patients chosen at random were eligible for treatment at presentation, as per WHO guidelines. The majority of these patients were WHO stage 3 at presentation (41%). Length of time from diagnosis to ART initiation varies greatly and this is likely multifactorial. A significant number of patients (74%) did not commence ART within 4 weeks of diagnosis. The most common reason for this was patient non-attendance. In this setting, stigma attached to HIV diagnosis, extreme poverty and lack of education contribute to both late presentation and a delay in treatment initiation.
P20 Potential impact of updated UK guidelines for use of post exposure prophylaxis following sexual exposure in a London sexual health service
Authors: Snell L , Edwards S G , Benn P D 
Published: May 2012

BackgroundUpdated UK guidelines for post exposure prophylaxis following sexual exposure (PEPSE) outline new thresholds for when PEPSE is recommended (R), considered (C) or not recommended (NR).Aim/ObjectiveWe compared practice and outcomes according to 2006 and 2011 guidelines.MethodsRetrospective review of electronic patient records between 20 January 2011 and 7 November 2011. Information regarding presentation, recommendations and outcomes were collected. Risk estimates were compared with guidelines. Blood abnormalities were classified grades I-IV. Data were analysed using Microsoft Excel.ResultsOf 325 requests to a London sexual health service, PEPSE was issued on 281 occasions to 268 patients. Gender: male n=258, female n=10, median age: 32 years, sexual orientation: men who have sex with men n=236, heterosexual n=25, not recorded n=7. Risk exposure: unprotected anal (n=263) and vaginal (n=26) intercourse. Source details: HIV+ n=112 (40%), on antiretroviral therapy n=31, viral load known 40 (14%) (<50 n=26, >50 n=14). 71 (26%) reported taking PEPSE ≥ once (range 1–5) previously. 99% commenced PEPSE within 72 h (median 30). Comparing those classified as R (n=258) and C (n=21) according to 2006 guidelines, 27 (10%) were reclassified NR using 2011 guidelines. Completion of 28 days PEPSE was reported in 59% cases, 100% adherence in 87%. Eight stopped early due to side effects (n=4) or the source tested HIV- (n=4). 148/268 (55%) had ≥1 blood abnormality, grade I-II (n=196) and grade III-IV (n=29). 1 patient developed acute interstitial nephritis. 196/268 (73%) underwent ≥1 screen for sexually transmitted infections; chlamydia (n=27), gonorrhoea (n=17), syphilis (n=4) and hepatitis B (n=1). Of 243 due 4-month follow-up, 52% have tested HIV− (n=122) and HIV+ (n=4).ConclusionsWe report high rates of repeat PEPSE, side effects/blood abnormalities and poor completion rates. Updated guidelines may result in a modest reduction in the use of PEPSE.
P24 Regional experience of indications for switching patients to raltegravir and maraviroc and success after regimen change
Authors: Clarke E , Bhardwaj A , Sundaram S , Rowen D , Foley E , Samraj S 
Published: May 2012

BackgroundIn small centres there is wide variation in the accessibility of raltegravir (RAL) and maraviroc (MVC) as they are not on the formulary of several trusts. Individual PCT funding is sought on a named patient basis, a time consuming process leading to potential delays in treatment.ObjectivesTo identify common clinical indications for treatment change to RAL or MVC. To formulate prescribing criteria on the basis of these in order to seek approval from the District Prescribing Committee and streamline treatment provision.MethodsRetrospective case note review of patients started on RAL or MVC attending six HIV clinics within a regional network between 2008 and 2010 and collection of data on reasons for treatment change.Results40 patients were reviewed, 37 of whom started RAL and 3 MVC. Multiple factors contributed to therapy change. 22 patients (55%) had resistance to other antiretrovirals or treatment failure and 20 (50%) had significant side effects or intolerance to other drug classes. Other factors included cardiovascular risk (20%), co-infections (18%) and co-morbidities (18%). 14 patients were reviewed for immunological response following treatment. Two were excluded (one unrelated death). Of the remaining 13 patients, 46% had a suppressed viral load prior to starting RAL, and 92% were suppressed after 12 months of treatment.ConclusionsThis study demonstrates that identifying common indications for switching to RAL and MVC within a regional network supported the process of formulating criteria to prescribe these newer drugs. This unified approach within the region led to improved and timely access to these drugs thereby improving outcomes for patients at small centres. The agreed prescribing criteria were in instances where combination therapy was not possible due to intolerability, side effects, allergies, resistance, drug interactions, co-morbidities, or HIV-2 (for RAL).
P25 Epidemiological treatment for chlamydia co-infection in MSM With a presumptive diagnosis of urethral gonorrhoea in S. Australia
Authors: Khaw C , Li B , Waddell R 
Published: May 2012

BackgroundRates of up to 30%Neisseria gonorrhoeae(NG) andChlamydia trachomatis(CT) co-infection occur in men. Historically, Men who have Sex with Men (MSM) were considered to have a low incidence of CT. However, increasing prevalence of CT and NG in MSM, especially asymptomatic anorectal infection is a reality. Despite well-established guidelines providing presumptive co-treatment for CT to patients with treatment indications for NG, various centers in Australia differ in their approach to management in MSM. At our Clinic, epidemiological treatment for CT had only been given to heterosexual males with a presumptive diagnosis of urethral gonorrhoea.AimThis study was to determine if the local prevalence of CT co-infection in MSM justifies epidemiological treatment when a presumptive diagnosis of urethral gonorrhoea is made.MethodsA retrospective review of case notes data, analysed for NG and CT co-infection in male patients was made over a 10-year period from 2001 to 2010. Data analysis was performed using STATA (V.10).ResultsThe proportion of heterosexual males who were NG smear positive and also found to be CT positive was 33/274 (12%) CI 8.4% to 16.5%. The proportion of MSM who were NG smear positive and found to be CT positive as well was 22/207 (13.4%) CI 9% to 18.8%.ConclusionBased on this study, the guidelines at our Clinic were changed. All MSM with a presumptive diagnosis of NG infection are now given epidemiological treatment for CT infection as heterosexual men.
P27 An audit on the management of pelvic inflammatory disease (PID)
Authors: Chan S Y , Hegazi A , Beardall A , Hay P 
Published: May 2012

BackgroundThe 2005 (revised in 2011) UK national guidelines on the management of PID state two auditable outcomes: (1) Proportion of women receiving treatment with a recommended regimen—target 95%. (2) Proportion of named male contacts screened for infection and/or treated—target 0.4 (large urban centres) or 0.6 (other centres) per index case. The guidelines also recommend patients with moderate or severe PID are reviewed after 72 h and all patients are reviewed after 2–4 weeks.AimsTo audit the management, follow-up and partner notification (PN) of PID in our clinic.MethodsRetrospective notes review of PID cases presenting between December 2009 and July 2011. Data were collected on drug treatment, follow-up and PN. Cases with a sexually transmitted infection (STI) were compared to cases with no STI identified.ResultsOf 130 PID cases identified, 58 had an STI diagnosed of whom seven hadNeisseria gonorrhoeae(GC) and 57 hadChlamydia trachomatis(CT). Six cases had both GC and CT. One patient had no documentation of drugs prescribed and one received only Doxycycline (see abstract P27 table 1).Abstract P27 Table 1Management of patients diagnosed with PIDSTI identified (n=58)No STI identified (n=72)Partner notification (PN) Partner notified21 (36.2%)19 (26.4%) Partner notified and treated20 (34.5%)5 (6.9%) PN recommended6 (10.3%)0 No documentation of PN31 (53.5%)53 (73.6%)Treatment prescribed Doxycycline and metronidazole46 (79.3%)59 (81.9%) Macrolide and metronidazole6 (10.4%)7 (9.7%) Ofloxacin and metronidazole (GC cover)5 (8.6%)5 (7.0%) Cephalosporin prescribed (GC cover)40 (69.0%)44 (61.1%)Follow-up Follow-up advised in 3 days00 Follow-up advised in 2–4 weeks47 (81%)69 (95.8%) Follow-up attended47 (81%)29 (40.3%)ConclusionBASHH guidelines recommend GC cover for all PID cases but the proportion receiving this was 72.9%. All cases diagnosed with GC received GC cover. PN rates did not reach national recommendations and this may be related to diagnostic uncertainty especially when no STI is apparent. PN was better in cases with a STI where health advisers were involved than in cases without an STI, seen by doctors. No patients were advised to return for follow-up within 3 days but the majority returned within 2–4 weeks. Those with an STI diagnosed were significantly more likely to attend follow-up p<0.0001.
P29 An audit of HIV partner notification practices in the North East
Authors: Dolan G , Foster K , Kain K 
Published: May 2012

BackgroundLate diagnosis of HIV not only carries a risk of poorer outcomes for the individual, but of ongoing transmission of infection. Effective partner notification (PN) is key to identifying sexual contacts that may have been exposed, providing the opportunity to offer necessary advice, support and testing.AimThis audit explored current PN practices across the North East in order to identify opportunities for improvement and inform future guidance.MethodsAll genitourinary medicine and infectious diseases clinics across the North East were asked to complete questionnaires for up to ten newly diagnosed cases of HIV between January and December 2010, and provide additional background information on PN arrangements. Data were analysed used EpiData version 3.1.ResultsSeven out of nine (78%) clinics responded. PN was discussed with 82% (46/56) of newly diagnosed patients and documented in the records of 77% (43/56). The time taken to complete all PN outcomes ranged from 0–29 weeks (median 1.5 weeks) and a mixture of methods were used to calculate the PN period. A total of 70 regular partners were recorded, 32 of which were tested and 44% (14/32) found to be HIV positive. 95 casual partners were recorded, nine of which were tested and none found to the HIV positive. Additional outcomes such as safe sex discussions and condom use were generally less frequently documented.Discussion and ConclusionAlthough this sample is relatively small, there was engagement from the majority of regional services, suggesting that it is likely to be representative of local practice. It is clear that there is variation in current PN practices between clinics, and there are a number of challenges which may be particularly pertinent to HIV infection. These findings will be used to inform local policy and standards with the aim of improving the quality of local services and ensuring accountability for actions.
P3 Differences between attitudes to HIV testing and HIV testing practice among hospital doctors
Authors: Taylor R , Pammi M , Venkatesan P 
Published: May 2012

BackgroundThe BHIVA/BASHH/BIS UK Guidelines for HIV Testing (2008) state that all acute medical admissions in high prevalence areas, and all patients with specific clinical indicator conditions (CICs) should be offered an HIV test.AimsAs our Acute Trust serves a Primary Care Trust with a high prevalence of HIV (2.35/1000), we aimed to explore the attitudes towards HIV testing among hospital practitioners, the actual practice of testing and whether this reflected physician's stated attitudes.MethodsAn electronic survey was circulated to all doctors within the Trust. The survey explored respondents' experience, awareness, knowledge, training requirements and willingness to expand HIV testing. A separate paper-based questionnaire was sent to Clinical Leads in selected specialties to explore local testing policy.Results214 responses were received from the online-survey. 76% had experience in testing, 73% felt they had necessary skills and 82% felt comfortable offering an HIV test. However, 45% had some concerns that their knowledge of HIV would be insufficient to answer patient questions. 99% favoured expanding HIV testing. The specialty survey revealed that only 20% of specialties had any departmental policy on testing. For one-third of AIDS-defining CICs only selective testing was offered. 7% of CICs would never prompt a test, 7% would always prompt a test and 86% would prompt testing only in selective circumstances.ConclusionsMost doctors agreed with the importance of expanding HIV testing and felt they had the requisite skills. However, despite this, the practice of HIV testing varied and did not meet with UK Guidelines. If efforts to expand HIV testing in our Trust are to succeed, we need to continue to support and engage clinicians, to initially focus on facilitating strong departmental policies for AIDS-defining conditions prior to widening scope to include other testing strategies.
P32 Partner notification (PN) within non-specialist services
Authors: Cunningham C , McCormick K 
Published: May 2012

BackgroundThe local board has the highest rates of diagnosis of genital Chlamydia in Scotland. PN is critical to breaking the chain of infection but there is a clear lack of consistency in its provision outside the specialist services.AimTo meet the NHS Health Improvement Scotland Standard 4.2 for Sexual health services; “Individuals are offered partner notification in all settings delivering sexual healthcare, including in primary care, youth services and community pharmacies”.MethodsA sexual health adviser was appointed to manage the positive Chlamydia diagnoses made out with the specialist services. This service commenced in March 2011 and coincided with the roll out of Chlamydia and Gonorrhoea PCR testing to these areas. Providers were informed to seek consent for referral at the time of testing and acquire the individual's mobile number. The PN service was advertised through email to all providers who undertake testing and in addition, educational sessions and updates were provided.ResultsThe table shows progressive improvement in the uptake of PN over the course of the year (see abstract P32 table 1).Abstract P32 Table 1Partner notification of chlamydia positive patients in 2011MarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberChlamydia positives38394967406863433639% of positives with consent for PN8101634403238475662DiscussionDespite a marked increase in the referral rate for PN, uptake remains suboptimal. Specific GP practices that rarely test for Chlamydia or refer for PN are identified and contacted, reminding them of the importance of PN.
P33 Gonorrhoea in young heterosexuals: outbreak management and safe sex messages
Authors: Foster K , Waldram A , Sankar N , Jeffrey N , Stonebridge J , Bellamy S 
Published: May 2012

BackgroundIncreases in gonorrhoea infection in young heterosexuals have been reported in two distinct areas of the North East of England over the past 6 months. Multi-agency working between GUM, public health, health protection and communication teams has attempted to increase awareness and reduce transmission. From initial case and partner notification information, there appeared to be misunderstandings about the routes and risks of transmission, along with a perception that a negative chlamydia test could be regarded as an STI “all clear”.MethodsFollowing the report of increase in area 1 in September 2011, a number of interventions were put in place, including enhanced surveillance, network mapping of contacts and cases, raising awareness among healthcare professionals, other organisations working with young people and with young people themselves. An increase in cases in area 2 was reported in November 2011. Similar interventions are being introduced and ongoing work to explore any links between the clusters.Results65 cases of gonorrhoea have been reported in area 1 since May 2011 (compared to a usual annual number of 15); in area 2 clustering of cases has occurred at higher rates than previously seen, although overall number of cases has not increased. Partner notification and network mapping has shown multiple casual partners although no large extended sexual networks. Dual-testing of chlamydia screening samples is now being considered to further outbreak control. We report the lessons learnt from managing these two clusters and how they can be applied to future STI clusters.
P36 Evaluation to assess patients' perceptions of receiving the recent infection testing algorithm [RITA] result
Authors: Gilbart V , Anderson E , Garrett N , Perera S , Rayment M , Williams H , Tosswill J H , Delpech V 
Published: May 2012

BackgroundIn the UK the primary objective of RITA has been to measure HIV incidence. The UK is the first country to routinely return results to patients and with over 7000 tests returned to clinicians so far, RITA is now seen as part of baseline HIV clinical care in participating centres.ObjectivesTo evaluate patients' experience of receiving a RITA result, including effects on identifying likely timing of infection, partner notification and relationships.MethodsFive HIV centres in England asked their patients to complete a questionnaire on their experience of receiving a “recently infected” RITA result soon after their HIV diagnosis.ResultsForty patients with newly diagnosed HIV and a “recent” RITA result completed the questionnaire (93% MSM). The majority (30/40, 75%) said that receiving the recent RITA result was helpful; 10 were unsure how helpful it was, and no participants found it unhelpful. 24 patients (60%) reported RITA helped identify partners who may be at risk of HIV and 24 (62%) felt it helped them to better understand how they may have been infected. Most (35, 88%) either felt neutral or “not more upset” when they learnt that they were likely recently infected. Of those in a relationship 33/37 (89%) reported RITA testing had not caused any relationship problems.ConclusionThe majority of patients receiving recent RITA results found this information helpful and no-one found it unhelpful. The result was felt to be useful in increasing an understanding of the likely timing of infection and for identifying “at risk” partners.
P37 Sex, drugs, risk taking and STIs
Authors: Keane F E , Thomas E , Picton A , Palmer J , Haddon L 
Published: May 2012

BackgroundHazardous alcohol consumption (HAC) and recreational drug (RD) use are associated with risky sexual behaviour but there is little hard evidence about actual sexually transmitted infection (STI) acquisition in these cohorts.AimTo investigate the association between HAC, RD use, risky sexual behaviour and STI acquisition.MethodsPatients self-completed the Fast Alcohol Screening Test (FAST), a validated screening tool to identify HAC, and questions on RD use. Markers of sexual risk-taking and STI diagnoses were obtained from patient records. Three cohorts: those with/without HAC (ie FAST positive/ negative respectively), RD use ever/never and recent/no recent RD use were analysed. Statistical significance (p<0.05) was calculated using Pearson's χ2test.ResultsConvenience sampling identified 221 new/re-book patients, 21 were excluded due to administrative errors. Respondents included 70 (35%) men and 130 (65%) women (age range, 15–69 years; median 25. 105 (53.6%) and 91(46.4) identified as FAST positive and FAST negative, 85 (43.6%) and 110 (56.4%) reported RD use ever and never and 33 (16.8%) and 163 (83.2%) reported RD use and no RD use in the last 1/12 respectively. 67/102 FAST positives reported a new sexual partner in the previous 3/12 compared to 29/88 FAST negatives (p<0.001). Recent RD users were also more likely to report partner change (23/32 compared to those with no recent RD (75/159, p=0.011). There was an increase in STI diagnoses in FAST positive compared to FAST negative patients (34/105 and 17/91 p=0.029), no difference was observed in the other cohorts.DiscussionHAC is very common among our patients and appears to be linked to increased STI acquisition. Recent RD use is not uncommon. Our findings support the recommendations of the recent Alcohol and Sexual Health Working Party that identification of hazardous drinkers and brief interventions may improve sexual health outcomes.