Abstract
OL001
Increase in percentage of consultations disclosing domestic abuse (DA) in Integrated Sexual Health (ISH) services during Covid-19 ‘lockdown’ following rapid transition to telemedicine and targeted interventions to improve delivery of routine enquiry
1North Central and East London Foundation School, London, United Kingdom
2Central and North West London NHS Trust, London, United Kingdom
3Central and North West London NHS Foundation Trust, London, United Kingdom
4UCL Public Health Data Science Research Group, Institute of Health Informatics, UCL., London, United Kingdom
Abstract
Introduction
A surge in domestic abuse (DA) has been reported during Covid-19 lockdown measures. BASHH guidance recommends routine enquiry (RE) about DA in Integrated sexual health services (ISH). Following UK lockdown (23/03/2020), reduced clinical capacity required rapid service transformation, with consultations moved to primarily telemedicine appointments. We aimed to describe changes in detection of DA in response to routine enquiry through this period of time.
Methods
Data from our service evaluation were collected from EPR, collated on excel and analysed anonymously using STATA. The percentage of routine enquiry, and disclosures of DA, during consultations were compared for six weeks prior to lockdown (10/02/2020-22/03/2020) and six weeks of lockdown (06/04/2020-17/05/2020). Sensitivity analysis compared disclosures in the first eight weeks of lockdown [including transition to telemedicine], with the eight weeks prior to lockdown.
Results
There was an increase in the percentage of DA disclosures in the six weeks of lockdown compared to the six weeks prior to lockdown, from 0.22% (CI: 0.14%-0.32%) to 0.57% (CI: 0.33%-0.91%) (p = 0.002). The increase in percentage of DA disclosures remained significant [0.24% (CI: 0.17–0.33) to 0.46% (CI: 0.27%-0.73%) p = 0.027] in the sensitivity analysis. There were no disclosures of DA in the first two weeks of lockdown during transition to telemedicine and consultations including routine enquiry dropped to 52% (from baseline average >70%). The proportion of consultations including routine enquiry increased to 63% in the two weeks following targeted intervention. (Fig. 1.). Further data describing the weeks following the lifting of lockdown will be presented.
Conclusion
We report an increase in the percentage of disclosures of DA within an ISH service during ‘lockdown’, despite potential barriers for at risk individuals to access appointments and disclose via telephone consultation. Awareness-raising and targeted telemedicine training were able to improve delivery of effective routine enquiry and safeguarding via telemedicine.
OL002
Determining the prevalence of and risk factors associated with Mycoplasma genitalium macrolide resistance in a clinic-attending population in England
1Public Health England, London, United Kingdom
2Mortimer Market Centre, University College Hospital London, London, United Kingdom
3Archway Centre, University College Hospital London, London, United Kingdom
4Edgware Community Hospital, London, United Kingdom
5The Doctors Laboratory, London, United Kingdom
610 Hammersmith Broadway, Chelsea and Westminster Hospital, London, United Kingdom
756 Dean Street, Chelsea and Westminster Hospital, London, United Kingdom
8Jefferiss Wing Centre for Sexual Health, St Mary’s Hospital, London, United Kingdom
9John Hunter Clinic, Chelsea and Westminster Hospital, London, United Kingdom
10Charing Cross Hospital, London, United Kingdom
11Burrell Street Clinic, Guy’s and St Thomas’ Hospital, London, United Kingdom
12Streatham Hill Sexual Health Clinic, Guy’s and St Thomas’ Hospital, London, United Kingdom
13Walworth Road Sexual Health Clinic, Guy’s and St Thomas’ Hospital, London, United Kingdom
14Guy’s and St Thomas’ Hospital, London, United Kingdom
15Whittall Street Clinic, Queen Elizbeth Hospital Birmingham, Birmingham, United Kingdom
16Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
17Bristol Sexual Health Centre, Bristol Royal Infirmary, Bristol, United Kingdom
18Public Health England Bristol, Severn Pathology, Bristol, United Kingdom
19Leeds Sexual Health, Leeds General Infirmary, Leeds, United Kingdom
20Princess Royal Community Health Centre, Huddersfield, United Kingdom
21Locala Sexual Health, Bradford, United Kingdom
22Leeds General Infirmary, Leeds, United Kingdom
23Cumbria Sexual Health Services, Workington, United Kingdom
24Kentwood Clinic, Cumbria, United Kingdom
25Cumberland Infirmary, Carlisle, United Kingdom
Abstract
Introduction
Mycoplasma genitalium (Mgen) is recognised as a public health concern due to extensive antimicrobial resistance (AMR), but UK data are limited. Using data from a pilot of Mgen AMR surveillance, we determined the prevalence and risk factors of Mgen macrolide resistance among attendees at sexual health clinics (SHCs) in England.
Methods
The Mgen Antimicrobial Resistance Surveillance (MARS) pilot included data from all consecutive Mgen positive specimens collected from 17 SHCs from January-March 2019. Macrolide resistance was inferred from the presence of 23s rRNA Mgen mutations, and history of a previous STI within the past year was used as a proxy measure for high-risk. Logistic regression was used to determine crude and adjusted associations between demographic, clinical and behavioural factors and Mgen resistance.
Results
Of 352 isolates submitted, 249 (70.74%) were successfully sequenced and, of these, 69.48% (173/249; 95% CI: 63.34%-75.14%) were macrolide resistant. Most specimens from women (66.67%), heterosexual men (65.75%) and MSM (85.11%) displayed resistance (p = 0.074). Resistance among people of White, Mixed and Black/Black British ethnicity was 65.69%, 83.33% and 71.83% (p = 0.012), respectively, and was more common among high-risk (84.09%) than low-risk individuals (66.34%; p = 0.020). The adjusted odds ratio (aOR) of resistance in MSM compared to heterosexual men was 3.99 (95% CI: 1.54–10.35; p<0.01). Increased resistance odds were observed in patients of Mixed (aOR: 3.87; 95% CI: 1.01–14.74; p = 0.048) and Black/Black British ethnicity (aOR: 2.06; 95% CI: 0.99–4.27; p = 0.053) compared to those of White ethnicity, and for high-risk people compared to their low-risk counterparts (aOR: 2.73; 95% CI: 1.10–6.77; p = 0.030).
Discussion
Macrolide resistance was widespread, with MSM, people of Mixed or Black/Black British ethnicity, and high-risk patients most likely to have resistant infections. The ubiquity of resistance-associated mutations in an era of rising multi-drug resistance stresses the importance of resistance-guided therapy, particularly in groups most at risk of acquiring macrolide resistant Mgen.
OL003
Development and testing of auditable quality standards for the safeguarding of young people aged 16–17 seeking online STI testing
SH:24, London, United Kingdom
Abstract
Introduction
Safeguarding young people is a potential challenge for online services. The Joint BASHH/FSRH Standards for Online and Remote Providers of Sexual and Reproductive Health Services make recommendations for safeguarding online but provide no auditable standards to benchmark quality. We systematically developed and tested auditable standards for this purpose.
Methods
We mapped the user journey for a 16 year old ordering STI testing from an online sexual health service, from the point of seeking information until the point of receiving the testing kit. We broke down the BASHH/FSRH standards for remote testing into auditable components for each stage of the user journey. We tested the feasibility of evaluating these standards in online services, using a mystery shopper approach.
Results
We developed 26 auditable standard components that are relevant to young people’s safeguarding during online testing (examples in Table 1), derived from the BASHH/FSRH standards. We then tested 21/26 of these components on 15 services. 5 components were excluded from testing, because this would place an unnecessary burden on the service. The mystery shopper exercise revealed significant variation between the 15 services tested (Table 2). E.g. 6 services did not ask any safeguarding questions from 16–17 year old users and 3 services did not attempt contact within 72 hours, when the user indicated safeguarding concerns.
Discussion
Clear, specific, realistic and auditable standards enable services to ensure they are providing high quality and safe care, and will reduce variation in how guidance is interpreted, for example related to safeguarding. Standards should align with those of face-to-face services, whilst being tailored to the needs and constraints of digital services and the reality of various online user journeys. We recommend revision and review of the BASHH/FSRH standards on online service provision to include auditable outcomes that can be used to monitor service quality
OL004
What do senior Genitourinary Medicine doctors think about the future of the specialty?
1Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
2Manchester University NHS Foundation Trust, Manchester, United Kingdom
3M&F Health, London, United Kingdom
4Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, United Kingdom
Abstract
Introduction
Genitourinary Medicine (GUM) is a specialty experiencing significant challenge and change with fragmented commissioning, reduced budgets, changes in service models and leadership plus an evolving clinical role impacting services and recruitment across the country. We conducted a national survey to understand the experiences of GUM consultants and explore views on the future direction of the specialty.
Methods
Questions were developed to evaluate changes in working patterns and complexity, the impact of commissioning in England, positive and negative aspects of the role and how we identify as a specialty. The survey was disseminated via BASHH to doctors on the GMC specialist register from 13/12/2019 - 14/01/2020.
Results
There were 272 respondents; approximately 68% of those eligible. They reported 61% of their clinical workload as ‘complex’ with 73.3% indicating this had increased recently. This was attributed to service model changes, complex STI management, an ageing HIV population and multi-agency safeguarding. Local authority (LA) commissioning was viewed negatively by 82.8% and 78.1% preferred the NHS model. Overall, 80.1% favoured re-naming the specialty with 86.9% supporting ‘Sexual Health and HIV Medicine’.
Discussion
The survey‘s excellent response rate means the findings are representative of UK GUM consultants. The 2013 commissioning changes and budget cuts were viewed as overwhelmingly negative due to service fragmentation, closures and pressures, poor commissioner relationships and low morale all resulting in poor staff recruitment and retention. Wider concerns include the future of our specialty, poor trainee recruitment and maintaining relevance in a rapidly changing clinical and financial climate. Many felt changing specialty name would help reflect our role and remit. Despite the numerous challenges, physicians cite patient care, positive colleague interactions and an innovative, progressive specialty as the best parts of working in GUM. This survey presents a clear view on the future of the specialty from GUM consultants.
OL005
Feasibility and acceptability of an online genital diagnosis and treatment service
1SH:24, London, United Kingdom
2King’s College London, London, United Kingdom
Abstract
Introduction
Diagnosis and management of genital herpes and warts requires an intimate examination and sometimes multiple clinic attendances, with inconvenience and embarrassment for users and significant costs to the health system. Since October 2018, a specialist online sexual health service, has undertaken an unadvertised pilot to evaluate free photodiagnosis and postal treatment for genital herpes and warts.
Method
Routinely collected anonymised data from orders received during 2019 were analysed to describe user characteristics and clinical outcomes. A purposive sample of 15 face-to-face or telephone semi-structured interviews explored users’ perceptions and experience of the service. Inductive thematic analysis was conducted.
Results
In 2019 there were 237 service users (Table 1). 40.5% of orders were diagnosed as either genital warts or herpes (figure 1). 89.6% of those diagnosed were treated through the service. Qualitative data identified that this group were highly satisfied with their experience, valuing the convenience with less time off work and less travel, faster access to care and a more discreet, less stigmatizing service. Among those diagnosed as normal/not needing treatment (17.7% of users) some felt reassured and were pleased not to have “wasted time” at clinic while others wanted the increased information and support associated with face-to-face care. Of the 41.8% of orders signposted to clinic, 13.7% of these were due to poor quality photographs. Users expressed disappointment and annoyance related to difficulties of uploading photos without the benefits of a remote diagnosis. Some acknowledged the difficulty of diagnosing remotely and still valued the service.
Discussion
Findings suggest that online photodiagnosis was feasible and acceptable. However, effective and acceptable management of those who require referral needs careful remote communication. Moving to a remote model of care for diagnosing warts has the potential to reduce pressure in clinics.
Table 1. Characteristics of users of photodiagnosis orders
OL006
Heterosexual and heterogeneous: characterising changing trends of syphilis in England using surveillance data (2016–2019)
1Public Health England, London, United Kingdom
2UCL Institute for Global Health, London, United Kingdom
3UCL, London, United Kingdom
Abstract
Introduction
Although syphilis in England is concentrated among men who have sex with men (MSM) in large urban centres, cases of heterosexually-acquired syphilis have risen significantly from 2013. Addressing syphilis among heterosexuals is included in PHE’s Syphilis Action Plan, including preventing vertical transmission. However, this requires a better understanding of the current picture.
Methods
We extracted data from GUMCAD to describe trends in heterosexual syphilis from January 2016 until September 2019. Primary, secondary, and early latent syphilis diagnoses among adult (≥16 years) heterosexual men and women were examined. We compared diagnoses between 2016 and 2019 using data from January to September only. We applied univariate and bivariate statistics to describe and compare the number of diagnoses by reproductive age (15–45 years), ethnicity (white, non-white), and country of birth (UK born, other). We used a Χ2 test to compare the number of syphilis diagnoses among heterosexuals and MSM according to geographic areas (London, non-London).
Results
Between 2016 and 2019 there was a 62.9% (426 vs. 694) and a 110.6% (216 vs. 455) increase in the number of syphilis cases reported among heterosexual men and women, respectively. Of all syphilis diagnoses made among heterosexual women, 81.0% (n = 3154) were made among those of reproductive age. Men with syphilis were on average older than women diagnosed (mean = 38.9 vs. 31.6, p≤0.001). Most cases were white (n = 3229, 71.2%) and UK born (n = 3068, 67.7%). Among heterosexuals, diagnoses appeared to be less concentrated in London than among MSM (27.5% vs 55.9%, p≤0.001).
Conclusion
Syphilis diagnoses among heterosexuals appear to be increasing, importantly among women of reproductive age. In England, this epidemic appears to be geographically different than the one described among MSM. Further research is required to inform tailored prevention strategies, with a focus on understanding behaviours, local contexts and sexual networks.
OL007
Changes in trends of Lymphogranuloma venereum among men who have sex with men in England suggest changes in HIV prevention
Public Health England, London, United Kingdom
Abstract
Introduction
Lymphogranuloma venereum (LGV) is an invasive form of Chlamydia trachomatis concentrated among gay, bisexual and other men who have sex with men (MSM). HIV-positivity has been associated with an increased risk of LGV; however, increases among HIV-negative MSM have been reported across Europe since 2017. We describe the recent epidemiology of LGV among MSM in England.
Methods
We extracted quarterly records of diagnoses made between January 2013 and September 2019 from two independent surveillance datasets, clinical data (GUMCAD) and laboratory data. We described the relative increase in diagnoses between January to September 2019 compared to the same period in 2018. We used clinical data to stratify by HIV status and plotted epidemiological curves. We calculated diagnosis rates per 1,000 attendances and rate ratios to compare the risk of LGV by HIV status, and across two periods: from January 2013 to June 2017 (Period 1), and July 2017 to September 2019 (Period 2).
Results
Between 2018 and 2019, we found increases in both clinical and laboratory reporting, of 45% and 30% respectively. From 2013 and 2019, the overall risk of LGV was greater among MSM with HIV compared to those without (rate ratio (RR) = 2.58), however, when comparing Period 2 to Period 1, we found a 29% increase in risk among MSM without HIV (RR = 1.29) and a 15% decrease for MSM with HIV (RR = 0.85).
Discussion
Triangulation using independent laboratory and clinical datasets identified surges in LGV diagnoses, suggesting increased transmission. While increases occurred regardless of HIV status, these are higher among MSM without HIV. Although MSM living with HIV are still at increased risk of LGV, the apparent dilution of risk by HIV status suggests mixing of sexual networks and decreased serosorting, potentially linked to changes in the perceived risk of HIV acquisition due to improvements in prevention.
OL008
Congenital syphilis in the UK- is it on the rise?
1Integrated Screening Outcomes Surveillance Service, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
2Infectious Diseases in Pregnancy Screening Programme, Public Health England, London, United Kingdom
Abstract
Background
Public Health England’s (PHE) Syphilis Action Plan, launched in 2019, addresses the recent increase of infectious syphilis diagnoses including cases of congenital syphilis (CS). Within the Plan’s maternity strand, PHE’s Infectious Diseases in Pregnancy Screening (IDPS) programme’s Integrated Screening Outcomes Surveillance Service (ISOSS) conducts enhanced data collection of all CS cases in the UK (since 2015, when previous surveillance ceased) within its UK population-level surveillance of the screened-for infections in pregnancy.
Methods
Confirmed/suspected CS cases diagnosed ≥2015 are reported. Enhanced data collection (started 2019) is conducted for any UK-born children following established process for HIV vertical transmissions (interviewing all clinicians involved in care of the mother/baby). An annual Expert Review Panel (ERP) establishes circumstances surrounding transmissions and contributing factors. From 2020, data on all pregnancies in women screening positive for syphilis and their infants will also be reported to ISOSS.
Results
Twenty-nine CS cases have been reported, with enhanced data collection ongoing. Year of birth ranged from 2015–2020, with cases reported from London (6), North (10), South (7), Midlands (3), Wales & Scotland (2). Most infants were born to white, UK-born women; median age at delivery was 25 years (IQR:22-28). Early findings show that >third of mothers screened negative in pregnancy, seroconverting before delivery; other factors identified included late booking and inadequate screening/referral and/or treatment during pregnancy or after delivery.
Discussion
ISOSS provides the only population-level data collection on CS in the UK. Findings to date, including a number of seroconversions, demonstrate the importance of ongoing CS monitoring and surveillance. The ERP will identify learning points to inform national guidelines and policy on screening and wider infection control for PHE and BASHH. The upcoming maternity syphilis surveillance will provide additional insights and contexts, including a national vertical transmission rate, for the wider strategy for the Syphilis Action Plan.
OL009
Spontaneous clearance of genital and extra-genital Neisseria gonorrhoeae: data from the GToG trial
Department of Sexual Health and HIV, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
Abstract
Introduction
Neisseria gonorrhoeae (GC) infection can resolve without antibiotic treatment; however, the literature describing how often and how soon this occurs, at which sites, and other potentially predictive factors, is limited. In this analysis based on a UK cohort, we describe the overall rate of spontaneous clearance of GC and explore associated factors.
Methods
Utilising data collated in the Gentamicin compared with Ceftriaxone for the Treatment of Gonorrhoea (GToG) trial, we assessed rates of spontaneous clearance in 720 patients with GC. Upon enrolment, repeat NAAT and culture testing was undertaken (genital, rectal, pharyngeal site for MSM and female patients and genital site for heterosexual male patients). Those who cleared GC without antibiotic treatment between their initial presentation and subsequent entry into the trial were deemed to have spontaneously cleared. Sociodemographic characteristics, sexual history, and sites of infection for those who spontaneously cleared were compared with that of those who did not.
Results
The rate of spontaneous clearance was 20.5% (83/405) over a median of 10 days (IQR 7–15) and occurred at all sites. There were no differences in terms of age, gender, sexuality, HIV status, or history of previous GC infection between the spontaneous clearance group and the no spontaneous clearance group. A significant difference was observed in patient reported dysuria and concurrent chlamydia infection, both more frequent in the no spontaneous clearance group (Dysuria: 4/83 [4.8%] cf. 42/322 [13.0%]), (p = 0.035), (Chlamydia: 9/83 [11.1%] cf. 69/322 [22.0%]), (p = 0.029).
Discussion
We present high rates of spontaneous clearance in the absence of antibiotic therapy. This is consistent with previous limited published data. Further work to assess the importance of bacterial load, genotype and host immune response on spontaneous clearance of infection is required. If this is indicative of cure, it suggests that point of care testing prior to treatment could reduce unnecessary exposure to antimicrobials.
OL010
Disseminated gonococcal infection case series: clinical presentations, microbiology findings and whole genome sequencing results
1Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
2Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
3Big Data Institute, University of Oxford, Oxford, United Kingdom
Abstract
Introduction
Disseminated gonococcal infection (DGI) is a rare complication of gonorrhoea (GC) arising from gonococcal bacteraemia. It classically manifests as one or more of acute arthritis, tenosynovitis and dermatitis, more commonly in females. Anecdotally, DGIs are increasing. We describe eight cases of DGI; seven presented within 13 months.
Methods
• All cases presented, or were referred, to GUM/ID at a large teaching hospital, in England and diagnosed with proven/probable DGI.
• Demographic, clinical and microbiological data were prospectively collected.
• Whole genome sequencing (WGS) of positive cultures was undertaken
Results
Three proven (synovial fluid/skin GC culture-positive) and five probable cases were identified, all males (7/8 MSM), and most (7/8) with no genital symptoms. Hip and wrist were the most commonly affected joints. Dermatitis featured in 5/8. All were GC NAAT-positive at an extra-genital site (pharynx or rectum); only 3/8 were urine NAAT-positive. Five cultured isolates from five patients underwent WGS: 2/5 had no linkage to other DGI or database isolates, 3/5 were 8–20 single nucleotide polymorphisms apart and from ST-7822, one of commonly circulating lineages in England. 6/8 presented initially to non-GUM specialties and experienced a delay in diagnosis and initiation of appropriate antibiotic therapy (mean 10.7 versus 4 days). Five required hospital admission (mean stay 14.4 days).
Discussion
This is the first study of WGS in DGI. Cases of DGI were not all associated with a single clone or outbreak, but several were from the same lineage, consistent with ST-7822 possibly causing more invasive infection. Our series supports an increased rate of DGI (our department saw <1 case/year historically). This may be related to host factors combined with increased GC prevalence in MSM worldwide. The cases demonstrate the lack of genital symptoms, which may contribute to delay in management and highlights the importance of extra-genital NAAT testing and awareness outside of GUM.
ON001
Looking at factors which put MSM at higher risk of Hepatitis C acquisition
BSUH, Brighton, United Kingdom
Abstract
Introduction
From 2018–2019 we noted a significant increase in the number of new acute Hepatitis C (HCV) diagnoses amongst men who have sex with men (MSM) attending our clinic. We wanted to investigate what factors facilitating this outbreak.
Methods
A retrospective case review triggered by a spike of diagnoses in 2019 identified common factors in MSM in the acute phase of HCV infection. Test results, patient history recorded at diagnosis and Health Adviser (HA) database were used to collate data from May 2018 to present.
Results
A cluster of new HCV cases all named the same index patient, causing concern over reckless transmission, and prompted a look-back by HAs, the Health Protection Team and local partner organisations were involved in multidisciplinary approach towards supporting this patient through HCV treatment avoiding legally enforced treatment (a Health Protection Part 2a order). 37% of the cases were deemed attributable to this Index patient. 58% were known to be HIV positive. 53% of new HCV diagnoses had an additional rectal sexually transmitted infection. 63% of patients disclosed they were currently or had recently engaged in Chemsex, 58% were intravenous drug users (IVDU).
Discussion
This case highlights the importance of stringent PN. In addition, the prevalence of Chemsex amongst MSM is a significant factor in the acquisition and onward transmission of HCV. There is limited service provision for people who engage in Chemsex to support effective long-term recovery. This group are challenging due to the high incidences of condom-less sex and high numbers of anonymous contacts, chaotic lifestyle and mental health issues associated with IVDU. Reducing transmission amongst this group requires dialogue around risk reduction, careful attention paid to partner notification and support around mental health needs.
ON003
Introduction of online resources as an alternative to pre-insertion counselling for intrauterine contraception (IUC): A service evaluation
Chelsea & Westminster Hospital NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
As part of a quality improvement project to address increased demand for intrauterine contraception (IUC), an information video and leaflet were introduced in July 2018, as an alternative to pre-insertion counselling appointments. The resources were sent via text message at booking. Clinic schedules were reviewed, and IUC training expanded.
Methods
A retrospective case note review of IUC clinics was carried out between February–April 2018 and February–April 2019. Emergency IUC were excluded. We identified the number of pre-insertion appointments (any appointment <12 weeks prior, where the woman was only attending to discuss IUC), non-attendances and non-insertions.
Results
There was a 54% increase in IUC appointments, as result of doubling IUC trained staff. Resources were texted to 92% of patients and there was a 40% reduction in pre-insertion appointments. Non-attendance rates remained similar between both groups. Overall non-insertion rates were 5% lower and the proportion of women not having an IUC due to pregnancy risk was more than halved, although the failure to insert rate increased by a quarter. See Table 1.
Discussion
Following the implementation of texting online resources, there was a significant reduction in the number of women attending pre-IUC insertion, meaning 57 appointments were freed for other patients. By providing consistent online information, pregnancy risks pre-insertion were markedly reduced, thereby saving approximately £966 in specialist appointments. Failure to insert rates increased temporarily which may have been due to less experienced staff, but quickly reduced to <2% by the end of 2019. Non-insertions for other reasons were similar, but again lower in the intervention group. This will hopefully reduce further following additional IUC replacement information introduced in 2020. In times of austerity and limited access for patients, coupled with high demand for long-acting contraception, we recommend this cost-effective initiative, which not only increases capacity but facilitates a one-stop-shop for women requesting IUC.
ON004 Withdrawn
ON005
An analysis of sexual assault presentations, reporting and engagement in follow-up care in a specialist level-3 service
56 Dean Street, London, United Kingdom
Abstract
Introduction
This service evaluation aims to improve understanding of sexual assault presentations in specialist level-3 services and to identify and address concerns from patients around reporting and attending follow-up, including responses from communities underrepresented in sexual offences data; men who have sex with men, trans and gender non-conforming people, and commercial sex workers.
Methods
103 patients were identified over a six month period using GUMCAD data and sexual assault SHHAPT codes from 2019. A retrospective case note review was undertaken, looking at patient demographics, details of the alleged perpetrator and the nature of the assault. Data was collected concerning intentions to report to the police and whether the patient accessed follow-up through sexual assault services, specialist reporting services or in clinic. Comparative analysis was informed by the Office of National Statistics and through discussion with LGBT reporting services.
Results
56% of patients were from the LGBT community. 10% reported they were commercial sex workers. 25% from BAME communities. Most commonly, sexual assault occurred either through removal of condom or whilst the patient was unconscious. 62% did not know the perpetrator.
62% did not intend to report to police. 33% who did, were not able to follow through. Reasons for this have been noted and analysed where given. No instances of removal of condom were reported.
22% accessed Sexual Assault Referral Centres. 66% returned to clinic for follow up. 63% of these were with a Health Advisor.
Discussion
Results contradict ONS data that suggests most survivors know the perpetrator.
Findings indicate low levels of reporting at first attendance and low levels of access to specialist sexual assault services. Return to clinical services is acceptable in most patients.
Insights into reasons for not reporting including patients not being ready or desiring to confront the perpetrator has wider implications for sexual health clinics’ role in supporting survivors.
Results of retrospective case note review
ON006
Infections diagnosed in female sex workers attending an inner city sexual health clinic
Central and North West London NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
National and regional data in England on the sexual health (SH) needs of female sex workers (FSW) is often limited and out of date. To gain a better understanding of these needs we conducted an audit on the number of infections diagnosed in FSW attending an inner city nurse led SH clinic in England.
Methods
We retrospectively extracted all GUMCAD diagnosis codes recorded in the electronic patient record between 01/09/2018-01/09/2019. Data was anonymised and analysed using excel.
Results
There were 367 FSW who attended the clinic and 85 sexually transmitted infections (STI) were diagnosed in 52 (14%) of the women. Chlamydia was the most common STI diagnosed and bacterial vaginosis was the most common non-STI found. There were 5 contacts of infection of which 3 tested positive. 10 women who had pharyngeal and/or rectal chlamydia or gonorrhoea did not have it vaginally. There was 1 new HIV diagnosis however, data on the number of new hepatitis cases was unavailable due to coding issues. All STI infections were treated according to BASHH guidelines.
Discussion
The high prevalence of STI infections highlights the need for accessible SH services for FSW. Ten infections would have been missed if only the vagina had been screened and supports continuation of triple site screening in this group. Condom use for oral, rectal and vaginal sex should be reinforced at each visit. The high number of bacterial vaginosis infections indicates an ongoing need to discuss vaginal hygiene. Continued research and regular publishing of UK based data of infection rates is required to best understand and meet the ongoing SH needs of FSW in this country, especially as they are a highly transient and vulnerable population. Improved local data collection and a re-audit is planned later this year and will be expanded to included contraception use.
ON007
Managing chlamydia contacts: should clinics implement a test and wait process as recommended for gonorrhoea and does patient age make a difference?
Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
Abstract
Introduction
BASHH standards for partner notification recommend epidemiological treatment for all chlamydia contacts during the look back period. Some UK sexual health clinics follow a test and wait process for chlamydia contacts presenting after 14 days of exposure. The aim of this evaluation was to determine the potential impact of implementing such a process for contacts aged ≥25 years at our clinic and in comparison with previously presented data for those aged <25 years.
Method
For this retrospective service evaluation of all chlamydia contacts presenting to a UK level 3 sexual health service between 01/12/17-30/11/18, patients were identified using the GUMCAD code PNC. Demographic and clinical characteristics data were collected from the electronic patient records.
Results
For 548 chlamydia contacts seen in the 1 year evaluation period, chlamydia prevalence was 46.3% (254/548). Those aged <25 years were more likely to have chlamydia than those ≥25 years (52.0%, 143/275 and 40.7%, 111/273 respectively, p = .008). There was no difference in chlamydia prevalence by time since exposure: 48.2% (147/305) within 14 days and 43.1% (72/167) after 14 days (p = .29), but prevalence varied by sexual risk: women 51.3% (81/160), heterosexual men 46.7% (149/319) and men who have sex with men 33.3% (23/69, p = .04). There were no age related differences with time since exposure or sexual risk. All patients were offered epidemiological treatment which was accepted by 97.5% (537/551) patients. A change in policy would result in increased clinic costs of £7193.30 per annum or £13.13 for each chlamydia contact.
Discussion
Chlamydia prevalence in contacts is high, especially in those aged <25 years. Not giving empirical treatment to contacts presenting after 14 days of exposure would result in 13.1% of the cohort needing to return for treatment. Antibiotic stewardship benefits in avoiding unnecessary antibiotics must be balanced against potential risks for transmission, complications, loss to follow up, and cost.
OU001
HIV risks in the transgender Hijra community of the Indian subcontinent (specifically India and Pakistan), and potential prevention methods
Cardiff University School of Medicine, Cardiff, United Kingdom
Abstract
Introduction
HIV prevalence in South Asia is especially concentrated among high risk groups such sex workers and injecting drug users at ‘epidemic’ levels. This Literature review aims to identify risk factors that link ‘Hijras’ to HIV transmission, as well as suggest some potential interventions. ‘Hijra’ is a Hindi-Urdu umbrella term given to a self-identifying group of eunuchs, transgender and intersex people in South Asia. This marginalised & unique community is identified as bearing a disproportionately high HIV burden.
Methods
10 pieces of original research, 6 studies from Pakistan & 4 from India, were selected via Medline & Pubmed. Their self-identified weaknesses and methods were compared and contrasted. Data was extracted and tabulated on key issues that influence HIV transmission.
Results
While there was regional variation, the literature highlighted elevated levels of disease transmission as a result of a lack of HIV awareness & education, low contraception use & sex work. Substance abuse and a wide sex network were also major contributing factors. Disturbingly, 40% of respondents in one study claimed they had non-consensual/forced sex. Hijras were more likely to prostitute due to poverty & lack of job opportunities, at 78.6% vs 0.15% (Heterosexual men) and 2.2% (MSM).
Discussion
It is important to note a discrepancy on an official level. While India’s National AIDS Control Organization includes Hijras in the MSM category, the government assigns them as female for administrative purposes, thereby hindering community specific interventions. STI education & medical care must be improved. 25.5 % thought sharing a meal could spread HIV. It was found that about half of Hijras visited a physician after STI symptoms, but less than 5% of those were in government facilities. Also, only 0.6% of condoms were government sourced. It is evident that social stigma & discrimination (i.e. 69% rejected by family by age 21), renders this population vulnerable to risk taking behaviours and ’disease blame’.
OU003
Facilitators and barriers to Pre-Exposure Prophylaxis (PrEP) acceptability among ethnic minority men-who-have-sex-with-men (EMMSM): a systematic review
University of Warwick, Coventry, United Kingdom
Abstract
Introduction
Ethnic Minority Men-who-have-Sex-with-Men (EMMSM) are at disproportionately high risk of HIV infection; in 2017, MSM accounted for 70% of new HIV diagnoses in the USA, 72% of whom were among ethnic minorities. Ethnic disparities also exist in the use of Pre-Exposure Prophylaxis (PrEP), an intervention consistently demonstrated to be effective at reducing the risk of HIV acquisition. This systematic review sought to identify the facilitators and barriers to PrEP acceptability among EMMSM and provide recommendations to improve its uptake in this highly vulnerable population.
Methods
A systematic search of nine databases was conducted to identify primary research published in English after 2000 exploring the acceptability of PrEP among EMMSM in high-income countries. Retrieved studies were screened independently by two review authors, data was extracted using standardised forms and methodological quality was appraised using STROBE and CASP checklists. Facilitators and barriers to PrEP acceptability were categorised using a socio-ecological model and narratively synthesised.
Results
Of 1547 studies retrieved from the initial search, 54 studies were included for review. Facilitators and barriers to PrEP use were mapped to the individual, interpersonal, community, institutional and structural level (Figure 1). The most frequently reported facilitators included its perceived benefit to serodiscordant relationships, the psychological reassurance it offers, and a self-perceived high risk of HIV infection. The most frequently reported barriers to PrEP use were associated with social stigma, fear of side-effects and poor relationships with healthcare providers.
Discussion
This comprehensive review found a broad consensus in the existing literature, with well-established facilitators and barriers to PrEP use in EMMSM. Efforts to improve uptake of PrEP in this population should focus on improving cultural competency in healthcare providers, and developing multi-level strategies to improve PrEP awareness, education, and outreach to EMMSM communities.
OU004
Sexually transmitted infection (STI) research priority setting – working with patients, the public, clinicians and stakeholders to identify STI research priorities for the North West of England
1University of Liverpool, Liverpool, United Kingdom
2Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
3Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Abstract
Introduction
Patient and public involvement in research is contributing to a shift in research agenda setting. Despite STIs posing a critical public health problem in the UK, the patient and public voice is typically neglected from STI research. This study aimed to identify the top ten STI research priorities for the North West of England by working with patients, the public, clinicians and stakeholders.
Methods
This descriptive study took place between May and August 2019 in the North West of England. Main outcome measures included potential STI research priority themes identified through qualitative surveys (n = 373) circulated among patients, the public, clinicians and stakeholders. The final outcome was the top ten STI research priorities of patients and the public, clinicians and stakeholders respectively determined by an interactive research priority setting exercise conducted using semi-structured telephone interviews (n = 11) and focus group discussions (n = 2) to rank survey themes.
Results
Four out of ten STI research priorities were the same for both patients and the public, and clinicians and stakeholders including STI health promotion and Sex and Relationship Education, targeted STI services for high risk groups, STI antibiotic resistance, and counselling and emotional support for those with STIs in the North West. The importance of further research into remote STI services, rapid diagnostics and point of care tests, and risk-taking behaviours, sexual behaviours and wider health determinants was also evident throughout the data.
Discussion
This study is the first time the patient and public voice has informed a user and provider led STI research agenda in the UK. It provides an example of how PPI can be successfully implemented within the field of sexual health and will ensure that STI and sexual health services within the region are responsive to the needs of those who use and deliver our services to ultimately improve STI care.
OU005
How long does it take to make an appointment at a sexual health clinic in the UK?
1University of Southampton, Southampton, United Kingdom
2Solent NHS Trust, Southampton, United Kingdom
Abstract
Introduction
A unique feature of sexual health services (SHS) is that patients can book a clinic appointment themselves. With the loss of the mandated 48-hour access target, demand being at an all-time high, and funding simultaneously being cut, access is thought to have suffered as services have been reconfigured. The aim of this study was to assess how long it takes and the barriers that exist when making an appointment at a SHS in the UK.
Methods
Between October and November 2019 mystery shoppers telephoned 241 clinics identified by the BASHH website on 3 separate occasions during clinic opening times. They recorded the number of attempts needed to make a successful contact, how the call was dealt with, and the time taken for the call to be initially answered and then completed.
Results
73% of the 678 telephone contacts were answered on the first attempt (range: 1–4). The median length of the total call was two minutes 16 seconds (range: 24 seconds to 60 minutes) and 75% of the calls lasted less than 4 minutes. 15% of the calls were put on hold for over 5 minutes, and on 5.70% of occasions the callers were advised to book online. There was variation across the different BASHH groups.
Discussion
Care should be taken to ensure that the first point of contact with a clinic is favourable as it reflects on how an entire service may be perceived.
OU006
Access to sexual health clinics in the UK; a mystery shopping telephone service evaluation
1University of Southampton, Southampton, United Kingdom
2Royal South Hants Hospital, Southampton, United Kingdom
Abstract
Background
Free, confidential and rapid access to care is an essential cornerstone of sexual health services (SHS) with the NICE guideline recommending that 98% of patients contacting a clinic should be offered an appointment within 48 hours. With the increasing demands on services combined with service reconfiguration and cuts to funding there is concern that clinics are struggling. The aim of this service evaluation was to establish whether the NICE access recommendation is being met1.
Methods
During October and November 2019 all SHS clinics in the UK open for more than 2 days a week were telephoned by researchers asking to be seen. Two researchers posed as a symptomatic female patient with symptoms suggestive of genital herpes and one as an asymptomatic contact of chlamydia infection. Collected data was analyzed using SPSS v24.
Results
In total, 242 clinics were contacted on 3 separate occasions totalling 719 contacts. Symptomatic ‘patients’ were offered to be seen within 48 hours in 92% of cases, of which 57% were advised to attend the walk-in service. The asymptomatic ‘patient’ was offered to be seen within 48 hours in 89% of cases, of which 55% were in the walk-in service. There was a significant variation in access between BASHH branches ranging from 50% to 100%, (X2 = 32.180, df = 17, P<0.014). 50% of symptomatic ‘patients’ not accommodated within 48 hours would have waited > 1/52 to be seen and 9% were referred to a clinic elsewhere more than half of which were more than 10 miles away.
Conclusion
This service evaluation demonstrates that in up in 10% of telephone contacts, access to SHS services falls below the 48-hour NICE recommendation. When researchers telephoned clinics, they were most likely to be directed to a walk-in service rather than be offered a fixed appointment.
P001
Gonorrhoea culture in a hub and spoke service
Solent NHS Trust, Portsmouth, United Kingdom
Abstract
Introduction
Gonorrhoea is fastidious making culturing it particularly difficult; with increasing antibiotic resistance culture has become even more pertinent. BASHH guidance recommends 100% of those diagnosed with gonorrhoea should have culture from positive site and these 85–95% should be positive.
Method
We audited all positive gonorrhoea results in a 6 month period across our service. We recorded if culture had been undertaken, type of culture (plate or charcoal) and culture result. Due to lower rate of positive cultures we undertook departmental promotion of correct technique and trialled one hub plating and incubating and one using charcoal and refrigerating over 1 month, spoke clinics continued charcoal without refrigeration.
Results
In the first cycle there were 536 positive gonorrhoea results, 87.9%(473) of which were cultured, 40.8%(193) of these cultures were positive. 312 cultures were taken by swab of which 38.8%(121) were positive and 161 cultures were plated of which 44.7%(72) were positive. In our hubs there was a 43.3%(165/377) positive culture rate whereas in spokes which have longer transit time there was a 30.2%(29/96) positive culture rate. In the second cycle 81% of patients seen in hubs were cultured and 64% in spoke clinics. The plating and incubation had a positive rate of 33.3%(8/27), charcoal and refrigeration 22.2%(2/9) and charcoal without refrigeration 41.7%(10/24).
Discussion
Our service missed the BASHH recommendations for both cultures taken and positive cultures. This may be due to culture technique and transit time as our clinics are not in the same site as our laboratories. Numbers were smaller for direct plating as opposed to charcoal swabs, this could be a limiting factor in drawing conclusions from the second cycle audit. It is difficult to draw conclusions as to best culture method for gonorrhoea, further research is required to assess culture and transit time.
P002
A critical review of NICE guideline’s recommendation to provide empirical antibiotic therapy for those suspected to have chlamydia trachomatis and their partners
Lancaster Medical School, Lancaster, United Kingdom. Lancaster University, Lancaster, United Kingdom
Abstract
Introduction
NICE guidelines currently state that if the risk of chlamydia infection is high then treatment should be started empirically without test results. NICE guidelines also currently state ‘ensure that the person’s current partner is treated for chlamydia irrespective of their screening result’. Although early treatment shortens an individual’s infectious period and limits transmission, it also eliminates antigen impingement which impairs the development of protective immune responses, known as the arrested immunity hypothesis.
Methods
This paper reviewed the evidence behind antibiotic resistance in chlamydia and whether we should be providing empirical therapy to patients and their partners, considering the ability of the infection to clear spontaneously.
Results
Many studies have shown that administering antibiotics can actually weaken the immune memory, leaving a recovered host fully susceptible to re-infection by the same pathogen. Re-infection is common after therapy and occurs in around 10–20% of patients within 12 months. This review has recognised that current studies are limited as longer intervals between testing would be ideal in order to maximise time available for the infection to resolve spontaneously. Although the increase in chlamydia screening and treatment appear to be decreasing the incidence of chlamydia complications, this could be leading to more chlamydia re-infections due to attenuated immunity.
Discussion
Whilst appreciating the challenges posed by not treating straight away, the evidence from this paper suggests to wait where possible and to not become routine in empirically prescribing antibiotics to patients and their partners. For now, we await further evidence behind chlamydia and it’s immune mechanisms, potentially holding the key to a vaccine in the future. Until then, we should continue to use our judgement and treat chlamydia where necessary in order to minimise risk of complications, as it would be unethical to our patients not to do so.
P003
Lymphogranuloma venereum in a heterosexual male
1Central and North West London NHS Trust, London, United Kingdom
2UCL Centre for Clinical Research in Infection and Sexual Health, London, United Kingdom
Abstract
Introduction
Lymphogranuloma venereum (LGV) is endemic among men who have sex with men (MSM) since 2003 in Europe. Confirmed LGV among heterosexuals is rare with 12 non-MSM reported cases in Europe in 2017.
Case report
A 39-year-old heterosexual UK-born White man reported a lump on the glans penis which eroded to a painful ulcer (present for one month). He denied any constitutional or rectal symptoms. Symptoms had not improved with two seven-day courses of Flucloxacillin 500mg QDS. His last sexual contact was condomless vaginal sex with a one-off White-European female partner five months before presentation. He denied any foreign travel, ever paying for sex or sex with men. On examination: bilateral tender non-fluctuant inguino-femoral lymphadenopathy, no “groove sign” and a 1x1.5cm deep sloughy indurated ulcer and erythema on the left dorsal aspect of his distal penis (see image).
Chlamydia was detected in his urine and from a swab of the ulcer. The in-house realtime LGV PCR assay was positive. A Herpes simplex/Treponema pallidum PCR swab and bacterial wound culture from the ulcer were negative as were investigations for HIV, syphilis and gonorrhoea. His symptoms resolved with Doxycycline 100mg orally twice daily for 21 days. His last reported sexual partner was uncontactable.
Discussion
Confirmed cases of LGV among heterosexual men are uncommon: In 2016, there were 684 LGV diagnoses reported through GUMCAD; 97.4% were men and 91.7% were MSM. Site of infection is not reported in surveillance data although rectal infection with proctitis is the main manifestation in MSM. This man presented with secondary ‘inguinal’ stage LGV although the primary ulcer was still present. Although rare, this case highlights the importance of considering a diagnosis of LGV in heterosexuals and having a low threshold to test when presented with inguino-femoral lymphadenopathy and/or genital ulcers, particularly if Chlamydia is detected from an anogenital site.
P004
Antimicrobial resistance in the management of Mycoplasma genitalium
56 Dean Street, London, United Kingdom
Abstract
Introduction
Mycoplasma genitalium is an important cause of non-gonococcal sexually transmitted infections. High levels of antibiotic resistance poses a persistent challenge in sexual health. The primary objectives of this audit were to identify the level of macrolide resistance and clinic outcomes.
Methods
Retrospective case note review was performed from a central London sexual health clinic for all patients who had a resistance test for M.genitalium between 24/12/2018 and 17/08/2019. Data on moxifloxacin prescription rates, test of cure (TOC) and TOC outcomes, and patient symptoms was collected. The study’s exclusion criteria included duplicate results (N = 3) and incorrect coding (N = 2).
Results
Total number of cases was 87, of which 97.7 % (N = 85) were male. Sexual orientation was MSM 70% (N = 61); heterosexual 25% (N = 22); bisexual 4% (N = 4); unknown 1% (N = 1). Macrolide resistance was identified in 70% of tests (N = 61). 74% of these patients received treatment with moxifloxacin. 61% of the total cases received moxifloxacin including 8 cases where no resistance was identified. A TOC was performed in 49% of cases with a higher rate of uptake in the macrolide resistant cases. 15 cases reported ongoing symptoms despite antibiotic treatment. Of these, 11 had macrolide resistance detected. 4 of these 11 cases had a correlating positive result on TOC.
Discussion
This study adds to the growing evidence that there is a high level of macrolide resistance leading to a greater rate of moxifloxacin prescribing. Other important study findings include the low TOC uptake rate. Whilst limited due to the relatively small sample size the findings of this study suggest that further research, and data for other treatments is needed.
P005
Keeping an eye on syphilis
1The Northern Contraception, Sexual Health and HIV Service, Manchester, United Kingdom
2Manchester Royal Eye Hospital, Manchester, United Kingdom
Abstract
Introduction
The incidence of infectious syphilis in the UK has remained high since the late 1990s, mainly in cities and commonly among men who have sex with men (MSM). Ocular involvement has been reported to be about 1% in those with early syphilis.
Method
A retrospective review of records of patients diagnosed with ophthalmic syphilis between October 2016 and October 2019 at a teaching hospital in northern England.
Results
11 patients (9 male) were diagnosed with ocular syphilis and 19 eyes were included in the series. 8/9 were MSM. The median age was 53 years (range 27–68). 4 (36.4%) were HIV positive with 2 newly diagnosed. 5 had systemic symptoms attributed to syphilis. All patients complained of reduced vision. At presentation visual acuity was <6/36 in 10/19 eyes; 9/11 had retinal lesions (most frequently placoid retinitis) and 6/11 had optic nerve swelling. All patients were treated with procaine penicillin and probenecid plus steroids. 9/11 patients attended for at least one post treatment serology follow up and all showed adequate drop in RPR (≥ 4 fold). Visual acuity improved significantly in the majority of patients with 13/19 eyes achieving >6/12 acuity. 2 patients had permanent visual impairment from retinal detachment. There appears to be no difference in visual outcomes between HIV positive and negative patients. Different visual presentations, diagnoses and pathologies will be discussed in details at the meeting.
Discussion
Patients with syphilis can present with diverse range of ocular symptoms and diseases. Most achieve excellent visual acuity after appropriate treatment. Clinicians in all areas must have a high index of suspicion and low threshold for syphilis testing in patients with ophthalmic symptoms. Syphilis is a mandatory investigation in all forms of uveitis. We also recognise the need to carefully assess for ophthalmic symptoms in patients diagnosed with syphilis.
P006
Could the introduction of a test and wait policy for the management of chlamydia contacts result in significant treatment delays and clinical complications for patients?
1University of Liverpool, Liverpool, United Kingdom
2Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
Abstract
Introduction
BASHH standards for partner notification recommend epidemiological treatment for all chlamydia contacts during the look back period. Some UK sexual health clinics follow a test and wait process for contacts presenting after 14 days of exposure. The aim of this evaluation was to model potential clinical impacts on patients subsequently found to have chlamydia.
Method
This retrospective service evaluation of 588 patients with chlamydia presenting to a UK level 3 sexual health service over a 5 month period in 2018, used GUMCAD codes to identify patients. Demographic and clinical characteristics data were collected from the electronic patient records for 12 months following diagnosis.
Results
54.1% of patients were male (318/588), 67.7% (398/588) aged 20–34 years, and 81.0% (476/588) white British. 12.8% (75/588) presented as chlamydia contacts. 45.9% (270/588) patients were treated for chlamydia at initial attendance, with 52.6% (309/588) treated at follow-up. 1.5% (9/588) patients were lost to follow-up prior to treatment. Of symptomatic patients not presenting as contacts, males were more likely to be treated at initial presentation than females (76.3%, 87/144 and 20.9%, 19/91 respectively, p < 0.001). There was a mean of 7.5 days between presentation and treatment for those not treated initially, and of 1.9 days between results notification and attending for treatment. 2.2 attempts were required to contact patients to return for treatment. In the subsequent 12 months, 2 patients represented with epididymo-orchitis (both treated at initial presentation), and 4 patients represented with pelvic inflammatory disease (2 treated at initial presentation).
Discussion
Patients found to have chlamydia return promptly once informed of results, reducing treatment delays. Potential complications in the 12 months after treatment were too small to determine any clinical impact of the 7.5 days treatment delay. Antibiotic stewardship benefits in avoiding unnecessary antibiotics must be balanced against potential risks for transmission, complications, loss to follow up, and cost.
P007
Mycoplasma genitalium testing for patients with persistent non-gonococcal urethritis and pelvic inflammatory disease- an evaluation of treatment outcomes
Solent NHS Trust, Southampton, United Kingdom
Abstract
Introduction
BASHH guidelines (2018) recommend Mycoplasma genitalium (MG) testing in all cases of Non-gonococcal urethritis (NGU), pelvic inflammatory disease (PID) and contacts. Our service restricted testing to persistent NGU/PID cases due to costs. We aimed to evaluate the outcomes of this approach.
Methods
EPR records of MG positive patients attending an urban sexual health service between 01/01/2019-31/12/2019 were reviewed for demographic, clinical, treatment and test of cure (TOC) data.
Results
39/109 patients tested (males = 27, females = 12) had MG (36%). Mean age was 26.5 years (range 16–48). Heterosexual = 35/39; MSM = 4/39. White British = 28, White European = 2, Black African = 5, Asian = 2, mixed = 2. 18/39 patients did not have concurrent resistance testing (RT). 3/18 received moxifloxacin as 1st line (TOC negative). 15/18 received Doxycycline followed by extended Azithromycin (D-EA) as 1st line; 7/15 needed Moxifloxacin as 2nd line either due to persistent symptoms (n = 5, all had negative TOC) or sex with untreated partner (n = 1, defaulted TOC) or a positive TOC (n = 1 who awaits result of a 2nd TOC without further treatment); the remaining 8 cleared symptoms with D-EA alone (TOC negative = 6, defaulted = 2). Macrolide resistance (MR) was seen in 12/21 patients (57%). 1 patient who had additional quinolone resistance was cured with Moxifloxacin. All 12 patients with MR had received D-EA as 1st line. 10/12 were subsequently treated with Moxifloxacin with negative TOC, 2/11 defaulted re-treatment. Of those without MR (9/21), 6 were treated with D-EA (TOC negative in 4). 2 were treated with 5 day Azithromycin and 1 received moxifloxacin, all had negative TOC. TOC was negative in 74% (29 /39) of patients.
Discussion
54% needed Moxifloxacin either as 1st line or 2nd line therapy to achieve microbiological cure. This combined with the high rate of MR (57%) suggests that the follow up and TOC of those treated with D-EA is critical.
P008
Analysis of chlamydia and gonorrhoea co-infection in those with presumptive gonorrhoea diagnosed via same-day microscopy. A retrospective case note review
Lewisham and Greenwich NHS Trust, London, United Kingdom
Abstract
Introduction
In January 2019, the national Gonorrhoea treatment guidelines were updated to switch from dual therapy with Azithromycin 1g and Ceftriaxone 500mg (BASHH 2011), to mono therapy with Ceftriaxone 1g (BASHH 2019). As part of an internal audit, we looked at the number who had GC diagnosed via microscopy, and those who receive a subsequent CT result via lab based NAAT testing. Due to the nature of microscopy accuracy, the focus was on penile urethral samples.
Methods
Retrospective case note review, all patients coded as gonorrhoea, and microscopy taken within in a 12 month time period. Results then also cross matched against internal paper records for microscopy results. Notes were then reviewed, and data collated by age, gender, sexuality, ethnicity, reported recent partners, and culture sensitivity (if available). For those with co-infection, the treatment given at visit, reason if not mono therapy, delay in CT treatment, and follow up status was also recorded for attendances from March to December 2019.
Results
Total number of microscopically diagnosed urethral gonorrhoea = 145. Total number with both CT and GC on NAAT testing: 47. Table 1 shows the break down by sexuality, ethnicity, age, and reported partners. Table 2 shows the treatment given, and delay in treatment, and those who are untreated for chlamydia.
Discussion
32.4% (P = 0.025) of patients with urethral gonorrhoea had a co-infection with CT diagnosed on lab based NAAT testing. Do we need to consider a different treatment regime in those with symptomatic GC with no CT result available, such as cefixime 400mg with 2g Azithromycin, or sticking to monotherapy for the GC, and combining with 100mg BD Doxycycline?
Table 1:
Table 2:
P009
12 years of continuous audit of neisseria gonorrhoeae (GC): comparing management at an Integrated Sexual Health Service (ISHS) to national guidelines
Coventry and Warwickshire Partnership Trust, Coventry, United Kingdom
Abstract
Introduction
The British Association of Sexual Health and HIV (BASHH) released updated guidelines on GC in January 2019. These detail 7 auditable outcomes, at a performance standard of 97%.
Methods
This is a retrospective study of all cases of GC diagnosed between January and June 2019 at ISHS. Management was compared to the BASHH auditable outcomes and to similar data analysed annually from January to June at the same clinic since 2007.
Results
198 patients were diagnosed with GC in the first half of 2019. 94.1% were offered Test of Cure (TOC), 69.1% had TOC. 92.9% were offered a full Sexually Transmitted Infections (STI) screen, 89.0% of these accepted screening. 87.9% undertook Partner Notification. 77.2% were given written or digital information. 92.0% received first line treatment, or reasons why first line treatment was not given was documented. 90.6% had cultures taken prior to treatment. There were no cases of treatment failure.
Discussion
The only domain with improvement was TOC. It is difficult to compare screening to previous years, due to the nature of HIV/Syphilis testing. The clinic performed worse than in previous years in the 3 other criteria and none of the outcomes reached the BASHH performance standard. We recommend continued staff and patient education around GC.
P010
Neisseria gonorrhoeae (GC) – a worrying trend in antibiotic resistance from 2007 to 2019
Coventry and Warwickshire Partnership Trust, Coventry, United Kingdom
Abstract
Background
The British Association of Sexual Health and HIV (BASHH) 2019 guidelines on GC recommend patients diagnosed by NAAT should have cultures taken prior to treatment. BASHH also recommends having a Test of Cure (TOC) at an appropriate time.
Methods
This is an analysis of GC cases between January and June 2019 at an Integrated Sexual Health Service. Antibiotic sensitivities and days to TOC were collected and compared to similar data from January to June since 2007.
Results
In the first 6 months of 2019, there were 198 cases of GC diagnosed at this clinic. Cultures were taken from 174 (87.9%) patients and for 126 (63.6%) sensitivities were found.
TOC was offered to 175 (88.4%) and taken in 126 (63.6%) patients. Days to TOC ranged from 7 to 92 and the mean, median and mode were 19.8, 15 and 14 respectively.
Discussion
Over 50% of cases showed reduced susceptibility to at least one antibiotic and worryingly, over 1 in 4 cases showed reduced susceptibility to 3 or more antibiotics. All cases of reduced susceptibility to cefuroxime were sensitive to ceftriaxone. We support BASHH guidance of TOC in 2 weeks.
P011 Withdrawn
P012
Impact of ceftriaxone monotherapy for gonorrhoea diagnosed at point-of-care: missed opportunity to treat concomitant chlamydia?
Croydon University Hospital Sexual Health Clinic, London, United Kingdom
Abstract
Introduction
The 2019 BASHH guideline for management of Neisseria gonorrhoea (NG) recommends ceftriaxone monotherapy. Azithromycin, previously recommended as an adjuvant, was thought to improve treatment outcomes for NG and provided empirical treatment for Chlamydia trachomatis (CT). Some clinicians, concerned that patients could suffer delay in CT treatment if given ceftriaxone alone, act outside of guidelines, giving CT therapy based on risk factors they perceive to predict NG-CT co-infection.
Aims
To measure the proportion of NG-CT co-infection amongst patients diagnosed with NG at point-of-care in our service. To determine which risk factors, in those diagnosed with NG at point-of-care, were associated with NG-CT co-infection.
Methods
A retrospective case-note-review was performed for patients diagnosed with NG at our metropolitan Level-3 sexual health clinic between February and July 2019. Clinical, behavioural and demographic data was collected, with CT and NG (NAAT and/or microscopy) positivity. Multivariate analysis (logistical regression) was performed to determine association between risk factors and NG-CT co-infection.
Results
Seventy-six patients were diagnosed with NG at point-of-care. All were male, 63 heterosexual and 13 were men who have sex with men. 15 (19.7%) had CT. There was a borderline association between the 15–24 age group and NG-CT co-infection (p = 0.05). The odds of CT were 5 times lower in those aged 25–44 than in those aged 15–24 (matching public health data for CT infection overall). No clinical or behavioural risk factors were significantly associated with NG-CT co-infection.
Discussion
Our study showed c.20% of patients with NG diagnosed at point-of-care had CT: a significant minority, but not enough to recommend routine CT treatment for all diagnosed with NG at point-of-care. No risk factor was statistically predictive of dual infection to support targeted CT therapy. Despite statistical methods employed, subgroups were small which could conceal small differences between risk factors. An extension study with larger numbers is planned.
P013
The predictive value of symptoms and investigations in the diagnosis of neurosyphilis
1Imperial College Healthcare NHS Trust, London, United Kingdom
2Imperial College, London, United Kingdom
Abstract
Introduction
An accurate diagnosis of neurosyphilis (NS) is challenging due to variable symptoms at presentation and non-specific cerebrospinal fluid (CSF) diagnostic parameters. We assessed the symptomatology and diagnostic value of CSF protein (Pr) and white cell count (WCC) in all individuals with clinical suspicion of NS undergoing a lumbar puncture (LP).
Methods
Data on 63 individuals having a LP examination for suspected NS between January 2017 and February 2020, were assessed. Parameters included presenting symptoms and CSF Pr and WBC. Clinical NS was defined as individuals with a positive syphilis serology, with a neurological symptom who had a positive CSF Rapid Plasma Reagin (RPR), positive CSF Treponema Pallidum Particle Agglutination (TPPA, titre >1:320 where performed) along with high index of clinical suspicion. Sensitivity, specificity and positive predictive value (PPV) in diagnosis of clinical NS of presenting symptoms and CSF parameters were calculated using SPSS V24.
Results
The majority were male (58/63, 92%), MSM (45/63, 71%), HIV-positive (38/63, 60%) and symptomatic (57/63, 90%). The most frequent symptom was headache (20/63, 32%). Among 18 cases of clinical NS (29%), tinnitus had the highest PPV. Having >1 symptom did not improve PPV. CSF WCC had the highest PPV among CSF diagnostic parameters. (Table 1)
Discussion
In our cohort, the most common presenting neurological symptom was headache. However, headache was associated with the least PPV for clinical NS. A CSF WCC>5 c/mL had a high specificity and PPV and a CSF Pr>0.45 g/dL had a high sensitivity for diagnosis of clinical NS. CSF WCC and Pr results are usually available within few hours, while CSF TPPA and RPR results may take up to two days to be reported. Therefore, CSF WCC and Pr could be useful in determining optimal initial management of an individual with suspected NS.
P014
Mycoplasma genitalium - correlating guidelines with clinical care
Nottingham University Hospitals, Nottingham, United Kingdom
Abstract
Introduction
In 2019, British Association for Sexual Health and HIV published its first guideline on the management of Mycoplasma genitalium infection (M.gen) in patients who are 16 years and older. The following was recommended. 1. Testing for M.gen in patients with non-gonococcal urethritis, pelvic inflammatory disease, mucopurulent cervicitis, epididymo-orchitis, sexually acquired proctitis and current sexual partners of persons infected with M.gen. 2. Treatment for M.gen guided by macrolide resistance-mediating mutation tests. 3. Test of Cure (TOC) at least 5 weeks after the start of treatment. This project aimed to develop an understanding of the cohort we are offering M.gen testing to, what treatments are being used and time to TOC.
Methods
Patients offered M.gen testing between 1 January 2019 and 1 January 2020 were selected. Data collection and analysis was performed using Excel.
Results
All patients who tested positive for M.gen were treated with Moxifloxacin 400mg daily, orally for 10 days. 7/9 patients attended for TOC. Average time to TOC was 40 days, Range 14–63 days.
All TOC were negative.
Discussion
Patients with persistent symptoms and regular partners of individuals with M.gen infection are being tested for M.gen. This is likely due to cost implications. The majority infections are macrolide resistant and fluoroquinolone sensitive and respond adequately to moxifloxacin. Implications for treatment for dual resistance to macrolides and fluoroquinolones remains unclear as a patient in this cohort, with confirmed dual resistance achieved microbiological and clinical resolution with moxifloxacin. More research is required. 3/9 patients attended for TOC earlier than 5 weeks and showed evidence of microbiological and clinical cure and this raises the question whether time to TOC could be reduced? More research with a larger cohort is required to establish this
P015
Neisseria gonorrhoeae: efficacy of empirical treatment and review of local trends in antibiotic susceptibility - what’s occurring?
St Helens and Knowsley Teaching Hospitals NHS Trust, Knowsley, Merseyside, United Kingdom
Abstract
Introduction
Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The recently identified extensively drug-resistant isolates in 2018 highlight the real threat to effective treatment options. This collaborative study between Sexual Health Clinic and the Microbiology Department at our Trust investigated the following for patients treated by our Sexual Health Clinic: 1. Empirical treatment given to patients against the isolates’ antibiogram. 2. Test of cure attendance rates and results. 3. Trend in antibiotic resistance isolates of Neisseria gonorrhoeae.
Methods
All data was extracted from the laboratory information system (Telepath) and Sexual Health Clinics’ electronic records. We compared our empirical treatment data to the standards set by the British Association for Sexual Health and HIV (BASHH).
Results
A total of 132 gonorrhoea culture positive patients were identified between October 2018 and November 2019. Of these patients 96% (127/132) received the recommended empirical treatment of ceftriaxone or ceftriaxone plus azithromycin, only 4% (5/132) patients did not with documented reasons. Test of cure (TOC) attendance rates revealed only 73% (96 /132) of patients returned. TOC results showed 95% (91/132) patients tested negative. There were no observed treatment failures. Trends in antibiotic resistance were reviewed between January 2013 and November 2019. An increase in resistance was observed against all antibiotics, except ceftriaxone were no resistant isolates were seen and penicillin where a decrease in resistance of 9% was seen (table 1 below).
Conclusion
BASHH guidance was adhered to; empirical treatment was active against the isolate in all cases and there were no treatment failures in those followed up. However, there is scope for improvement in TOC follow up rates. Whilst there was no increase in ceftriaxone resistance, rising resistance to other agents (in keeping with national trend) is a concern.
P016
Management of gonorrhoea and resistance patterns in a large integrated sexual health service
Barts Health NHS Trust, London, United Kingdom
Abstract
Introduction
Since 2009, there has been a 249% increase in cases of gonorrhoea, with 3 cases identified as extensively drug-resistant in 2018. The aim of this audit was to assess adherence to newly updated BASHH guidelines in 2019 regarding the management of gonorrhoea in a large sexual health service.
Methods
A retrospective analysis was conducted for the first 100 patients attending clinic from 1st April 2019 and were coded as gonorrhoea.
Results
100 cases were returned with a median age of 30 years (IQR: 24 to 37 years), 80% male and 53% heterosexual. 59% (57/97) of those with a positive NAAT were symptomatic at presentation, with microscopy detecting gonorrhoea in 85% (34/40) of symptomatic males. 92% were treated with first-line antibiotics (1g ceftriaxone IM) and the remainder treated with azithromycin, mainly due to penicillin allergy. 87% had cultures taken prior to treatment; of those, 60% (52/87) returned culture results with only 1/52 having azithromycin resistance. The rest were fully sensitive to ceftriaxone, with 40% (21/52) showing ciprofloxacin resistance. 97% of patients had full sexual health screening, with 27/97 (28%) chlamydia positive, 2 syphilis, 1 Mycoplasma genitalium, 1 had both chlamydia and syphilis, and 1 had both chlamydia and newly diagnosed HIV.
Discussion
High levels of adherence to updated BASHH guidelines were seen for the treatment of gonorrhoea, with 92% receiving first-line treatment. Microscopy detection rates of 85% in symptomatic males is similar to accepted detection rates of 90–95%. For those not given first-line treatment, none returned for a test of cure. Ciprofloxacin resistance in this study (25%) was comparable to the 2017 national average (36%); hence ciprofloxacin should only be used with appropriate sensitivity results. One sample was azithromycin-resistant, but treated effectively with ceftriaxone. Active follow-up of patients given non-first-line treatment to attend for test of cure onsite is imperative.
P017
Lack of clinical value in pre-treatment determination of the presence of parC mutations in Mycoplasma genitalium
SpeeDx Pty Ltd, Sydney, Australia
Abstract
Introduction
Extended spectrum fluoroquinolones, typically moxifloxacin, are used as second-line therapy for macrolide-resistant infections with Mycoplasma genitalium. Several mutations in the quinolone resistance determining region (QRDR) of the topoisomerase IV gene (parC) of Mgen have been associated with moxifloxacin-failure in multiple studies. We sought to assess what evidence had been reported from these studies to support performing pre-treatment detection of parC mutations to enable resistance guided therapy of macrolide-resistant Mgen.
Methods
Peer-reviewed studies published prior between 2013 and 2020 that met the following criteria were included in the analysis; (a) Outcome-based study of moxifloxacin efficacy in treating macrolide-resistant Mgen, (b) Presence and identity of parC QRDR mutations determined prior to initiation of treatment, (c) Clinical and microbiological test of cure performed on study participants, (d) Number of subjects with parC QRDR mutants reported irrespective of clinical outcome.
Results
Only 5 studies met the criteria outlined above, with a total of 45 subjects having parC mutation-positive Mgen infection. Twenty-five (55.6%) of these study participants were reported as having failed moxifloxacin therapy whilst 20 (44.4%) were successfully treated with the drug. This observed difference was not statistically significant (p = 0.29).
Discussion
Only limited data is currently available concerning the predictive value of pre-treatment determination of parC mutations in M. genitalium. There is no indication, however, that identification of these mutants is a clinically useful predictor of therapeutic failure. The availability of simple assays for pre-treatment screening for parC mutations could facilitate investigations into microbiologic and clinical factors influencing fluoroquinolone success in treating macrolide-resistant infections.
P018
A review of syphilis diagnoses in a semirural setting
St Helens and Knowsley NHS Trusts, St Helens, United Kingdom
Abstract
Introduction
In England, syphilis diagnoses have increase by 148% since 2008. Data from the local sexual health clinic highlighted a 500% increase in syphilis diagnoses from 2014 - 2019 prompting a retrospective service evaluation.
Methods
Data was collected on syphilis diagnoses from 1st April 2018 to 31st March 2019 using GUMCAD coding. Once patients were identified, information was extracted from clinical proformas to determine demographics and sexual history.
Results
Overall, a total of 48 patients received a syphilis diagnosis in clinic. Males accounted for 77% (37/48) of diagnoses, majority MSM and bisexual men, 69% (33/48). Diagnoses in heterosexual were 31% (15/48) patients, majority female, 73% (11/15). Most diagnoses were early syphilis 88% (42/48). Of the 48 patients, 60% (29/48) had previously been diagnosed with another STI, 31% (9/29) chlamydia or gonorrhoea, 10% (3/29) HIV and 10% (3/29) genital warts. Documented partner traceability was 65% (31/48). Amongst heterosexual patients, prevalence was highest in the 20–29 age group 53% (8/15) while amongst MSM patients, prevalence was highest in 30–39 age group, 42% (14/33). Only 13% (2/15) of heterosexual patients attended with symptoms; other reasons included referral from another department, 27% (4/15) and partner notification, 20% (3/15).
Discussion
Our local data shows a majority of cases affecting MSM in line with national data however a higher number of heterosexual cases ( 31%) as compared to national data (25% in 2018 - PHE data) particularly affecting women. As a result, targeted community outreach has been established to engage with vulnerable women that may be at risk of syphilis and not routinely attending for testing. Due to the number of referrals from other departments pathways have been reviewed. As an example syphilis serology has been added as a routine test by the oral department for mouth ulcers. Documentation of partner traceability needs to be improved.
P019
Clinical evaluation of the SpeeDx CT-LGV (Beta): a new multiplex real-time PCR for simultaneous detection of Chlamydia trachomatis and invasive serovars causing lymphogranuloma venereum (LGV)
1Imperial College NHS Trust, London, United Kingdom
2SpeeDx Pty Ltd, Sydney, Australia
Abstract
Introduction
Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection worldwide. The invasive serovars L1, L2 and L3 of CT are known to cause Lymphogranuloma venereum (LGV) and is often associated with men who have sex with men (MSM). Detection of LGV variants in patients presenting with a rectal CT infection is important, as a longer course of treatment is required compared to infections caused by other variants. BASHH guidelines therefore recommend testing CT-positive specimens from patients who are suspected of LGV infection1. The CT-LGV (Beta) test (SpeeDx, Australia) is a single well, multiplex qPCR utilising novel PlexZyme® probe chemistry. The test simultaneously detects CT and the invasive serovars (L1, L2 and L3) that cause LGV. Here we evaluated the clinical performance of the SpeeDx CT-LGV (Beta) test in comparison to an in-house qPCR assay supplied by Public Health England (Colindale, UK).
Methods
A retrospective study was performed in November 2019 on 200 stored DNA extracts from rectal swab specimens. Specimens consisted of 148 CT positive, which includes 90 LGV positive and 58 LGV negative samples as well as 52 CT negative samples. The study compared the results of the CT-LGV (Beta) assay for concordance with the in-house multiplex PCR.
Results
In comparison to the in-house assay, the CT-LGV (Beta) assay had a sensitivity of 96% and specificity of 100% for CT detection. From the CT positives identified, the test had a sensitivity of 96.6% and specificity of 100% for detection of LGV variants.
Discussion
The CT-LGV (Beta) assay demonstrated high clinical sensitivity and specificity compared to the in-house assay.
1 White et al. Int J STD AIDS. 2013 Aug;24(8):593-601.
P020
The truth lies in the eye of the beholder: Neisseria gonorrhoeae
Leeds Teaching Hospitals Trust, Leeds, United Kingdom
Abstract
Introduction
Gonococcal keratoconjunctivitis is a potentially devastating infection. Neisseria gonorrhoeae can cause a rapid, severe, vision threatening ulcerative keratitis. We report a case of severe gonococcal keratoconjunctivitis, its management complicated by antimicrobial resistance.
Discussion
Although rare, the possibility of Neisseria gonorrhoeae should always be considered in young adults with a unilateral purulent ocular discharge and severe corneal involvement. Our case highlights that the management of this condition is complicated by necessity for prompt diagnosis, effective parenteral therapy, and antibiotic resistance.
P021
Clinical evaluation of the ResistancePlus® MG FleXible test on the GeneXpert Infinity-48s instrument for simultaneous detection of Mycoplasma genitalium and macrolide resistance
1Microbiology Department, Vall d´Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
2SpeeDx Pty Ltd, Sydney, Australia
3Microbiology Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
Abstract
Introduction
Mycoplasma genitalium (MG) has a disturbing capacity to develop antibiotic resistance and may soon become untreatable. The resistance-guided treatment strategy has demonstrated excellent efficacy against MG1,2 and is now recommended in the recent BASHH guideline3. The aim of this study was to evaluate the clinical performance of the novel molecular
Methods
Between March 2019 and April 2019, a total of 146 samples (95 MG positive and 51 MG negative), were collected at the Vall d´Hebron University Hospital in Barcelona, Spain. Specimens consisted of 18 vaginal swabs, 32 endocervical swabs, 15 urethral swabs, 38 first-void urines and 43 rectal swabs. Results were compared to the Allplex™ STI Essential assay (Seegene, SK) for MG detection, with Sanger sequencing of the 23S rRNA gene used for confirmation of MRMMs.
Results
Results are displayed in Table 1. 84/90 (93.3%) of
Discussion
The
P022
Ocular symptoms as atypical presentation of re-emerging pathogen
Pilgrim Hospital, Boston, United Kingdom
Abstract
Introduction
We present an unusual case of patient presenting with blurry vision, and rapid visual loss in left eye over two days. Ophthalmology examination showed significantly reduced visual acuity in left eye (1.06 logMAR), and features consistent with uveitis. Clinical examination demonstrated a generalised maculopapular rash over trunk and limbs, which the patient had previously dismissed. A broad differential diagnosis was considered, including infective aetiology.
Discussion
Syphilis is caused by the spirochete treponema pallidum, which is transmitted sexually, and mother to child. It has the ability to affect any body system, which explains why it can present itself in a multitude of ways. There are infrequent case reports in the literature of syphilis presenting with ocular symptoms. The incidence of syphilis is at its highest since WW2. With rising number of cases, medical clinicians need to be vigilant of this infection, and the variations in the way it can present. It is notoriously difficult to diagnose, but importantly, highly curable. This case highlights the importance of a sexual history as part of a systemic enquiry, as it can help form a differential diagnosis.
P023
The association of chemsex with the diagnoses of syphilis, gonorrhoea, and chlamydia among men who have sex with men in the UK
1University of Bristol, Bristol, United Kingdom
2London School of Hygiene and Tropical Medicine, London, United Kingdom
Abstract
Introduction
In the last decade diagnoses of most sexually transmitted infections (STIs) have risen among men-who-have-sex-with-men (MSM). Although a significant proportion of this is likely due to increased STI screening, understanding the role of behavioural drivers remains critical. We measure associations between stimulant use to enhance and prolong sexual experiences (chemsex) and bacterial STI diagnoses in UK MSM, individually considering HIV-diagnosed MSM, PrEP users and other MSM.
Methods
We used UK 2017–18 European MSM Internet Survey data (n = 10,525). We constructed causal inference models using multivariate logistic regression, calculating adjusted odds ratios (aORs) and 95% confidence intervals (95%CI) of associations between participation in recent (12 months): exclusively dyadic or multi-partner chemsex versus no chemsex; with recent self-reported diagnoses of syphilis, gonorrhoea, and chlamydia.
Results
Among MSM with an HIV-diagnosis 25% of users indicated recent multi-partner chemsex, versus 28% of PrEP users and 5% of other MSM. Adjusting for age; ethnicity; UK-birth; cis-trans status; sexual identity; education; settlement size; and relationship status; participation in recent multi-partner chemsex versus no chemsex was associated with greater odds of recent syphilis, gonorrhoea and chlamydia diagnosis. aORs for recent syphilis, gonorrhoea and chlamydia diagnoses were; 2.8 (95%CI;1.8–4.3), 3.8 (95%CI;2.6–5.6), and 2.8 (95%CI;1.9–4.2) respectively in HIV-diagnosed MSM; 2.0 (95%CI;1.2–3.4), 2.9 (95%CI;2.0–4.2), and 1.9 (95%CI;1.3–2.8) respectively in PrEP users; and 4.1 (95%CI;2.4–6.9), 2.7 (95%CI;1.9–3.8) and 2.5 (95%CI;1.7–3.6) respectively in other MSM. Conversely, exclusively dyadic chemsex had no significant associations with bacterial STI diagnoses among HIV-diagnosed MSM, only gonorrhoea [aOR 2.3 (95%CI;1.2–4.6)] among PrEP users and syphilis [aOR 2.7 (95%CI;1.4–5.3)] and gonorrhoea [aOR 1.6 (95%CI;1.0–2.5)] among other MSM.
Discussion
Multi-partner chemsex drives the association between chemsex and bacterial STI diagnoses and thus should be the focus of future tailored chemsex interventions. Additionally, PrEP acceptability among MSM, and particularly chemsex participants has generated an emergent group suitable for such interventions.
P024
Evolving trends in sexual behaviours, clinic attendance patterns and diagnoses of sexually transmitted infections from 2016–2019: a perspective from Bristol
1University of Bristol, Bristol, United Kingdom
2Unity Sexual Health Centre, Bristol, United Kingdom
3North Bristol NHS Trust, Bristol, United Kingdom
4Cardiff Vale Health Board, Cardiff, United Kingdom
5University of Brighton, Brighton, United Kingdom
6Public Health England, Bristol, United Kingdom
Abstract
Background
Due to rising STI diagnosis rates, we explored trends in STI testing frequency and diagnoses, alongside sexual decision-making and attitudes concerning condom use and HIV pre-exposure prophylaxis (PrEP).
Methods
We examined 66,528 electronic patient records (EPR) covering 40,321 attendees between 2016–2019; 3,977 of whom were men or transpersons-who-have-sex-with-men (MSM/TPSM). We also explored responses from MSM/TPSM attendees sent an electronic questionnaire between November 2018–2019 (n = 1,975) examining behaviours/attitudes towards PrEP. We measured trends in STI diagnoses and sexual behaviours including condomless anal intercourse (CAI), utilising linear and logistic regression analyses.
Results
Tests resulting in gonorrhoea, chlamydia or syphilis diagnoses increased among MSM/TPSM from 13.5%-18.5% between 2016–2019 (p < 0.001). The average MSM/TPSM STI testing frequency increased from 1.5/person/year to 2.1/person/year (p = 0.017). Gay MSM/TPSM had the highest proportions of attendances resulting in diagnoses, increasing from 15.1%-19.6% between 2016–2019 (p < 0.001) compared to bisexual/other MSM/TPSM rates which increased from 6.9%-14.5% (p < 0.001); alongside smaller but significant increases in non-MSM/TPSM from 5.9–7.7% (p < 0.001). The proportion of MSM/TPSM clinic attendees reporting CAI in the previous 3 months prior to at least one appointment in a given year increased significantly from 40.6%-45.5% between 2016–2019 (p < 0.0001) and average number of partners from 3.8–4.5 (p = 0.002). Of 617 eligible questionnaire responses, 339/578 (58.7%) HIV-negative and 29/39 (74.4%) HIV-positive MSM/TPSM indicated they would be more likely to have CAI with someone on PrEP versus not on PrEP. 358/578 (61.9%) HIV-negative respondents said that PrEP use would make them more likely to have CAI with HIV-negative partners.
Conclusion
Rising STI diagnosis rates amongst MSM/TPSM are not attributable to increased testing alone. Increased CAI and number of partners may be attributable to evolving sexual decision-making among PrEP users and their partners. Proportionally, bisexual/other MSM/TPSM have the highest rate of increasing STI diagnoses.
P025
Examining ethnic differences in the incidence and predictors of STI diagnoses; findings from a longitudinal study of sexual health clinic (SHC) attendees in England
1Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, London, United Kingdom
2Centre for Population Research in Sexual Health and HIV, University College London, London, United Kingdom
3Public Health England, London, United Kingdom
Abstract
Introduction
In England, black Caribbean and other black non-Caribbean/non-African (BCO) people are disproportionately burdened by bacterial STIs. To inform prevention efforts, we explored whether we could identify specific risk factors that predicted incident STI diagnoses in this population.
Methods
Between May-September 2016, attendees at 16 SHCs (with a high proportion BCO) completed a survey with detailed sociodemographic, behavioural, and partnership questions on STI risk. Survey data were linked to the GUMCAD STI Surveillance System for longitudinal data on bacterial/protozoal STI diagnoses. Multivariable Cox regression estimated the incidence of diagnosis in 18-months following the survey and associated risk factors, stratified by BCO and White British/Irish (WBI).
Results
In total, 2940 heterosexual participants were included. WBI was the largest ethnic group (36%) and one-fifth (18%) were BCO. In the 18-month follow-up period, 240 participants (8%) had an STI diagnosis. The overall incidence rate was 5.7 per 100 person-years (95% CI 5.1–6.5) but this varied by ethnic group (BCO: 12.1, 9.8–15.0; WBI: 3.2, 2.4–4.2, Figure 1). After adjusting for significant covariates, BCO had over double the incidence rate compared to WBI (aHR 2.66, p < 0.001). The strongest predictor of risk for both groups was previous STI diagnosis/es and number of recent partners (both in past year; Table 1). Effect modification was observed between ethnicity and area of residence; living in deprived areas increased risk for WBI, but decreased risk for BCO. Aside from age, there were no unique predictors for BCO. For WBI only, age-mixing conferred increased risk and degree-level education reduced risk.
Discussion
This large, bio-behavioural study of SHC attendees presents novel insights into ethnic differences in STI diagnosis incidence. BCO maintained the highest risk despite accounting for confounding demographic, behavioural and clinical factors. Intensified and tailored prevention and public health messaging is needed to address sexual health inequalities in this greatly underserved population.
P026
Safely expanding online chlamydia treatment during the COVID-19 pandemic
SH:24, London, United Kingdom
Abstract
Introduction
COVID-19 caused widespread clinic closures and necessitated new ways of working, with testing and treatment redirected online. Chlamydia can be safely treated remotely but traditionally was not offered to 16–17 year olds, or people with rectal chlamydia or symptoms. This created inequities for those unable to access clinics. As a digital sexual health provider, SH:24 was approached to consider how to safely expand the number of uncomplicated chlamydia cases that could be treated remotely.
Methods
Uptake of expanded online chlamydia treatment and its contribution to the COVID-19 response was assessed. Treatment for uncomplicated symptomatic and rectal chlamydia commenced 26/03/2020. Clinical criteria developed excluded online treatment for conditions requiring urgent care (risk of pregnancy, PID, testicular torsion, likely gonorrhoea). The protocol for rectal chlamydia treatment included clinic referral if symptoms persists seven days post-treatment, and test of cure. Treatment for 16–17 year olds commenced on 16/04/2020. Users were screened for safeguarding concerns, with positive responses prompting a telephone call before prescribing.
Results
There were 2,817 chlamydia prescriptions issued 26/03/20-26/06/20. This is an increase of 44% compared to pre COVID-19. The proportion of prescriptions issued for symptomatic users more than doubled during COVID-19 period studied (23% vs 11%).
179 prescriptions were issued for rectal chlamydia; 99% were male and in the 26–35 age group.
79 prescriptions were issued to users aged 16–17. 81% were female. Fifteen reported safeguarding flags.
Discussion
COVID-19 stimulated clinical changes that require further evaluation. Expanding online provision is feasible, keeping a total of 863 people out of clinic during lockdown. Concerns about safeguarding, LGV and complicated chlamydia previously restricted remote chlamydia treatment for rectal chlamydia, young people and those with symptoms. Work is required to understand the clinical consequences of these changes. Expanding online treatment has enabled clinics to prioritise urgent care and could be key in the COVID-19 recovery phase and beyond.
P027
Explorative data analysis of new cases of Syphilis in a rural population over a 6 year period
NHS Fife, Kirkcaldy, United Kingdom
Abstract
Introduction
There has been a significant increase in new infectious syphilis diagnosis across the UK in recent years. Primarily this increase is seen in MSM (men who have sex with men) but there has also been a considerable increase in heterosexual individuals. This data analysis looks at new syphilis diagnoses in a rural population between 2014 and 2019 and aims to identify trends in order to implement local prevention and control strategies.
Methods
Every new case of syphilis was identified between 2014 and 2019 by laboratory data and sexual health clinic data in the region and then patient demographic information was extrapolated from each case. Data was analysed to reveal trends.
Results
Incidence has increased from 2014 to 2019 with a steep increase seen from 2018 to 2019. MSM accounted for the greatest number of new cases every year (exception of 2014, MSM equal with heterosexual). The largest number of new cases in MSM, heterosexual and bisexual individuals was seen in 2019. The majority of cases were detected at primary stage. Numbers of patients who had a new diagnosis of syphilis whilst on pre-exposure prophylaxis (PrEP) were too small to extrapolate any significant data regarding impact of PrEP in syphilis rates in this population.
Discussion
Syphilis remains a substantial public health issue which needs addressed at both local and national levels. MSM continue to be the highest at-risk group for contracting syphilis, however, data suggests recent increases in heterosexual individuals also. It is encouraging that the majority of cases were detected at primary stage as this has better treatment outcomes and long-term implications. PrEP became available via the NHS in Scotland in July 2017 and there will need to be ongoing research into the impact of this on STI rates.
P028
Are online pharmacies who provide chlamydia treatment meeting BASHH standards, including the provision of accurate and relevant health advice and risk reduction strategies?
Devon Sexual Health, Exeter, United Kingdom
Abstract
Introduction
Access to chlamydia treatment via online pharmacies is well established. To date there has been no published assessment against BASHH standards of the quality of care delivered by these providers. We assessed chlamydia treatment via mystery shopper journeys through the most commonly utilised online pharmacies.
Methods
The most prevalent UK search terms for chlamydia, and its treatment, were identified using Google Trends. Nine pharmacies were identified which appeared in the top 30 results on >1 term. Mystery shopping journeys utilising service-written case histories were undertaken: 1. MSM with no recent testing with rectal symptoms, 2. Asymptomatic heterosexual female with a positive chlamydia test. Clinical triage provision, available treatments, and health advice were assessed via a service-designed audit tool extrapolated from BASHH chlamydia and PN standards.
Results
All providers offered doxycycline at the recommended dose and duration. Azithromycin was an alternative treatment option from 5/9 providers. One provider blocked treatment provision if GP communication was declined.
No online provider supplied treatment for case history 1, with 8/9 re-directing to sexual health services for further investigation. For case history 2, only 3/9 providers recommended engagement with sexual health services. Specific safeguarding questions were asked by 1/9 providers.
Table 1: Provision of key chlamydia health advice topics by providers
Discussion
Reassuringly clinical triage often deflected symptoms consistent with LGV to sexual health services. For asymptomatic patients with positive results treatment is easily available. The patient experience is highly variable. Information is unintuitive and dense, and often easily skipped over. Advice was focussed on the aetiology of chlamydia and management of partners, with less information signposting to services, and little risk reduction or structured partner notification attempted. These results are to be shared with regulators and providers to encourage constructive dialogue. We would encourage similar projects assessing the patient experience for other sexual health treatments available online.
P029
Is there an association between intensive STI screening and gonococcal AMR in MSM? An analysis of national surveillance data in England, 2015–2018
Public Health England, London, United Kingdom
Abstract
Introduction
Quarterly STI screening is recommended for high-risk MSM in the UK, but there are concerns that the consequent increased frequency of antimicrobial therapy may have contributed to the emergence of Neisseria gonorrhoeae antimicrobial resistance (AMR). We determined the association between the frequency of gonorrhoea treatment and reduced susceptibility (RS) to current and previous first-line antibiotics.
Methods
We used data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) and the GUMCAD STI surveillance system from 2015–2018 to determine the number of gonorrhoea diagnoses individuals with an isolate in GRASP had in the previous 3 years. We assumed individuals coded with a gonorrhoea diagnosis were treated according to national guidelines. The associations between the number of gonorrhoea diagnoses and RS to azithromycin (minimum inhibitory concentration (MIC)>0.25 mg/L), ceftriaxone (MIC≥0.03 mg/L) and cefixime (MIC ≥0.06 mg/L) were determined using logistic regression, using one model per antibiotic, stratified by gender/sexual orientation, adjusting for demographic, behavioural and clinical factors, including HIV status and year.
Results
We identified 3,973 MSM diagnosed in GRASP between 2015–2018; 2,577 (65%) had one gonorrhoea diagnosis, 1,283 (33%) had 2–5 diagnoses, and 113 (3%) had >5 diagnoses. The proportion of isolates with RS to azithromycin, ceftriaxone and cefixime was 48%, 16% and 18%, respectively. After adjustment for potential confounders, the odds of RS among those with >5 diagnoses (vs.1 diagnosis) was 0.55 (95%CI:0.36–0.86 p = 0.01) for azithromycin, 1.41 (95%CI:0.77–2.57 p = 0.26) for ceftriaxone and 1.35 (95%CI:0.74–2.48 p = 0.32) for cefixime.
Discussion
We found no evidence of an association between prior gonorrhoea treatment and RS to current/previous first-line antibiotics. Limitations of this analysis include the assumption that individuals attended the same clinic over the study period and that GRASP only includes sentinel data. The reasons behind increased gonococcal AMR among MSM are likely multi-factorial, and not only due to intensive screening.
P030
An opportunistic review of TV NAAT testing in men
Locala, Bradford, United Kingdom
Abstract
Introduction
BASHH Trichomonas (TV) guidelines state that testing in men is recommended for TV contacts, and should be considered in those with persistent urethritis. NAATs offer the highest sensitivity for the detection of TV but in house PCRs require validation and have not been widely available. TV NAAT testing became available to our service in 2018. We were advised that the test was validated for vulvovaginal samples only and that a neighbouring sexual health service, contracted to the same lab, tested male urine samples only on consultant recommendation. We implemented the same but became aware of more widespread testing and sought to review practice.
Method
TV urine NAAT test requests from males requested between 5.9.18 and 8.1.20 were identified. Patient records were reviewed for demographics, indications for testing and TV NAAT result.
Results
285 tests for TV NAAT were made across our sexual health service with 33 positive results. Of those 33, 29 were in asymptomatic individuals, only 7 (21%) were of White British ethnicity and all identified as heterosexual. 29 were known contacts of TV, all of whom were treated with metronidazole on the same day as testing. Of the 4 who were not contacts, 3 had symptoms of urethral discharge and/or dysuria.
Discussion
We confirmed more widespread testing for TV in men than initially recommended and have shown a high rate of positivity (11%). This group are likely to have been at increased risk of infection, either as known contacts or due to symptoms of persistent urethritis. There may be some advantage in being able to confirm the presence of an infection in an individual, treat based on test results and identify further contacts. This must be balanced against the additional cost of the test and the fact that most were treated prior to results anyway.
P031
‘Rolling’ audit of the management of gonorrhoea across a multi-hub sexual health service
1Devon Sexual Health, Northern Devon Healthcare Trust, Exeter, United Kingdom
2Devon Sexual Health, Torbay and South Devon NHS Foundation Trust, Torbay, United Kingdom
3Devon Sexual Health, Northern Devon Healthcare Trust, Barnstaple, United Kingdom
Abstract
Introduction
Following re-tendering of services in a rural county, three sexual health services were brought under a unified management umbrella. As per specification requirements, service-wide guidelines were produced, and in an effort to interrogate alignment of practice, a rolling (updated month-to-month) audit of the management of gonorrhoea (GC) was undertaken.
Methods
Each hub (North, East, South) collated data at the end of the month. Information regarding demographics, treatment, chlamydia co-infection, culture sampling/positivity, timing/results of test-of-cure was collected. Findings were discussed at hub monthly governance meetings.
Results
206 GC cases presenting between July and December 2019 were analysed (North 23, East 111, South 72). Demographic differences across the three hubs were noted, with a younger population in East (both heterosexuals (het) and gay and bisexuals (GBM)) contrasting with an older GBM population in South. The chlamydia co-infection rate was <20% but proportionally greater in heterosexuals. GC culture positivity rates were markedly different across the three hubs – urethral samples being the best correlate with 88% urine nucleic acid amplification tests (NAATs) confirmed on culture service-wide, but correlation was poor for rectal (37%) and pharyngeal (28%) samples. It is worth noting that each service uses a different lab. Sampling practices varied despite unified service guidelines, so that 45–61% had incomplete or no culture sampling at time of treatment. 16 culture positive samples were negative/not processed on NAAT sampling. 64–75% had a test-of-cure (TOC) with most done at 2 weeks. There were 6 TOC failures – all negative on subsequent re-testing (with or without re-treatment).
Discussion
This semi-contemporaneous or ‘rolling’ audit strategy allowed a more timely response to substandard management than usual audit. By reviewing cases each month, each hub was able to follow-up on problems rapidly (for example around culturing practice/lab processes/TOCs). Interesting comparisons could be made across a service serving differing populations.
P032
The economic burden of gonorrhoea in England: testing, treatment and sequelae
University of Bristol, Bristol, United Kingdom
Abstract
Introduction
Neisseria gonorrhoeae is a sexually transmitted bacterial infection which, if untreated, can manifest into subsequent complications including pelvic inflammatory disease and epididymitis. In England, the incidence of gonorrhoea is rising with Public Health England reporting an increase of 26% seen between 2017–2018. This change is likely due to both, better STI detection and a reflection of the sociological changes in sexual relationship behaviours. However, despite the growing threat of gonorrhoea strains which are antimicrobial resistant (AMR) the burden of gonorrhoea in England remains unclear and an economic evaluation is highly warranted to support future health policy decisions.
Methods
A rapid literature review of 611 papers sourced from Cochrane Library, PubMed and Embase was conducted identifying 150 papers for qualitative and quantitative discussion. Additional grey literature sources were obtained using generalised search terms to compliment academic research. Data regarding the direct costs of gonorrhoea infection was extracted, converted to GBP and inflated to current prices. A decision tree model of gonorrhoea sequelae was formed to support cost-of-illness estimates.
Results
Data was available for a variety of gonorrhoea infection costs including prices of consumables, clinician appointments, administrative and partner notification fees, treatment drugs and sequelae for which reported values ranged from £0.40 to £5,400. Sources which provided varied cost estimates for the same resource were assessed for content using the CHEERS checklist helping to distinguish possible explanations for the price differences.
Discussion
With AMR gonorrhoea strains on the rise healthcare pathways must adapt to overcome the increased economic burden caused by the reliance on alternative testing methods, more expensive medicines and an increased incidence of gonorrhoea sequelae resulting from untreatable infections. Pharmaceutical co-development of a meningococcal B and gonorrhoea vaccine could help prevent the increasing societal burden of gonorrhoea infection in England and this research will support the development of informed healthcare and vaccine policy.
P033
Environmental contamination by Chlamydia trachomatis and Neisseria gonorrhoeae: is it time to change our cleaning regimes?
1The Hub, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
2Unity Sexual Health, University Hospital Bristol and Weston NHS Trust, Bristol, United Kingdom
3University of Bristol, Bristol, United Kingdom
4Clinical Microbiology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
5Infection Prevention and Control, Royal Cornwall Hospital NHS Trust, Truro, United Kingdom
6Northern Devon Healthcare NHS Trust, Exeter, United Kingdom
7PHE South West Regional Laboratory, National Infection Service, Public Health England, Bristol, United Kingdom
8National Institute for Health and Research, Health Protection Research Unit in Behavioural Science and Evaluation in Partnership with Public Health England, University of Bristol, Bristol, United Kingdom
9Population Health Sciences, University of Bristol, Bristol, United Kingdom
Abstract
Introduction
Nucleic acid amplification tests (NAATs) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are highly sensitive. Previous studies have demonstrated varying levels of contamination with CT/NG DNA/RNA on surfaces and toilets in sexual health clinics (SHCs). CT/NG RNA/DNA on these surfaces could potentially contaminate clinical samples, resulting in false positive tests and negatively impacting patients’ lives and relationships. Previous studies have failed to show improvements in surface contamination through staff training alone. We investigated levels of environmental contamination in SHCs in a UK region.
Methods
Questionnaires were sent to all ten sexual health clinics (SHCs) in the region. Five clinics with differing characteristics were selected from seven respondents. Clinics followed standardised instructions to sample predetermined surfaces within clinic rooms and patient toilets which were tested using a CT/NG NAAT at their local laboratory. Clinic staffs were not pre-warned about sampling times.
Results
Table 1 shows the range of clinic characteristics and level of surface contamination at each clinic (range 0–58%). In clinics 1, 2, 3 and 4 contamination was found within the consultation and examination rooms as well as the patient toilets.
Discussion
Environmental contamination remains of concern in SHCs. Clinic 5 had strikingly lower numbers of positive swabs 0/32 (0%). Clinic 5 alone was using a chlorine-based cleaning product. Chlorine has the property of denaturing DNA/RNA, setting it apart from other commonly used cleaning products. In addition, clinic 5 was unique in this survey in conducting twice yearly, clinic specific infection control training. We suggest that all clinics routinely audit levels of contamination. Clinics could switch to chlorine-based cleaners as an inexpensive intervention for reducing contamination. We report separately an evaluation of a complex intervention using a chlorine-based cleaner with and without regular staff education which was conducted in two of the contaminated SHCs.
P034
Clinical environmental contamination with Chlamydia trachomatis and Neisseria gonorrhoeae: is chlorine the only “solution”?
1Unity Sexual Health, University Hospital Bristol and Weston NHS Trust, Bristol, United Kingdom
2University of Bristol, Bristol, United Kingdom
3The Hub, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
4PHE South West Regional Laboratory, National Infection Service, Public Health England, Bristol, United Kingdom
5National Institute for Health Research, Health Protection Research Unit in Behavioural Science and Evaluation in Partnership with Public Health England, University of Bristol, Bristol, United Kingdom
6Clinical Microbiology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
7Infection Prevention and Control, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
8Population Health Sciences, Bristol, United Kingdom
Abstract
Introduction
We recently demonstrated significant clinical surface contamination with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) RNA/DNA in four sexual health clinics (SHC) not using chlorine-based cleaners. Surface contamination poses a risk of false-positive tests. Unlike other cleaning products, chlorine denatures DNA/RNA. There are currently no national recommendations for minimising environmental DNA/RNA contamination in SHCs. We introduced a three-armed intervention to reduce surface contamination at one urban clinic. In order to determine the individual impact of each arm of this intervention, we subsequently conducted a staged, two-armed intervention at another urban clinic.
Methods
The three-armed intervention at Clinic 1 included 1) Daily cleaning with chlorine-based solution Actichlor©. 2)Staff education programme, including a seminar and video tutorial, based on local glove hygiene audit. 3)Modifying male urine sample preparation to reduce splash contamination in toilets. At Clinic 2, intervention 1 was introduced, followed by intervention 2. Pre and post-intervention samples were taken from the same surfaces and tested using a CT/NG NAAT. Staff were not informed when and which surfaces were to be sampled.
Results
The three-armed intervention at Clinic 1 reduced contamination of surfaces sampled from 54% (30/56) to 0% (0/56) (p < 0.0001). The introduction of intervention 1 at Clinic 2 reduced contamination from 58% (30/52) to 27% (14/52) (p = 0.003). This reduced further to 8% (4/52) with the addition of intervention 2 (p < 0.0001) (see table).
Discussion
The staged intervention at Clinic 2 has demonstrated that whilst once daily cleaning with a chlorine-based solution is effective, it is not sufficient to reduce contamination to acceptable levels. The introduction of staff education appears to reduce levels further. However, results from the three-armed intervention suggest that maximum contamination reduction requires a detailed review of local clinic sampling procedures with targeted modifications. We believe these recommendations should be included in national STI testing guidance.
P035
An audit reviewing antibiotic prescribing for contacts of Gonorrhoea in a community clinic
North West London University Teaching Hospital, Harrow, United Kingdom
Abstract
Introduction
Resistance to antimicrobials is complex and increasing. Combined with a lack of new antimicrobial medicines, there is a growing risk that infections may not be treatable in the future. British Association for Sexual Health and HIV (BASHH) recommend all partners of Gonorrhoea (GC) be treated within the preceding two weeks or three months dependent on timing and presentation. Epidemiological treatment is not needed for all sexual contacts.
Methods
A retrospective review of the electronic patient records (EPR) was conducted and all patients with the code PNG (contact of GC) were selected. Forty patients were found during the 1 month audited period from 1/2/20-29/2/20. The following were recorded: demographics, sexuality, time since exposure, verified contact slip, exposure site, relationship type, symptoms, positivity and culture prior to treatment.
Results
Of the forty patient audited, 12/40(30%) were female, 17/40(43%) heterosexual male and 11/40(27%) MSM. The majority of contacts were white British 9/40(23%), white other 7/40(17%) followed by black African 5/40(12%) and 6/40 (15%) black Caribbean and 6/40(15%) Asian. The others were from non-white backgrounds reflecting the diverse population. 7/40(17%) attended with contact slips and 4(57%)) had positive results. 23/40 (58%) contacts presented <2/52 following exposure, 15/40 (37%) >2/52 and no documentation in 2/40 (5%). 39/40 (98%) were treated, however, only 12/40(30%) were found to be GC positive. 30/40(75%) were asymptomatic. Over half 23/40 (58%) regular contacts, 10/40 (25%) casual and 7/40(17%) unknown. Only (1)10% of the casual contacted tested positive yet they were all treated. All the casual contacts were asymptomatic and presented >2 weeks. 6/40(15%) had culture done prior to treatment.
Conclusion
In a time of increasing anti-microbial resistance, treatment of contacts must be cautiously assessed to avoid inappropriate use. This audit clearly highlights the need for heightened awareness amongst clinicians.
P036
Are we achieving the standards for providing emergency contraception - findings from an integrated sexual health clinic?
Walsall Healthcare NHS Trust, Walsall, United Kingdom
Abstract
Introduction
Emergency Contraception (EC) can be understood as the use of any drug or device used after unprotected sexual intercourse to reduce the risk of conception of an unintended pregnancy. In the UK, specific standards have been set by the Faculty of Sexual and Reproductive Health. This review assessed the provision of EC in an integrated sexual health clinic, in accordance to national guidelines, to establish strengths and weaknesses in order to inform future service development.
Method
Retrospective case note review was performed on the electronic database on 100 consecutive patients selected from those requesting emergency contraception between April 2018 and February 2019. The following standards were assessed: 1. Percentage of women presenting for emergency contraception (EC), are advised that a copper intrauterine device (Cu-IUD) is the most effective method 2. Percentage of women prescribed oral EC who are advised and given information on starting a reliable method of contraception. 3. Percentage of women resuming or quick starting a hormonal method of contraception after taking hormonal EC who are advised to do a pregnancy test no sooner than 3 weeks after the most recent episode of unprotected sexual intercourse (UPSI). 4. Percentage of women presenting for EC who have a sexual health risk assessment and are offered screening if indicated. Target for all four was set at 97%.
Results
Cu-IUD was offered to 91% with an acceptance rate of 6%. Advise and information about starting a reliable method of contraception was given to 98%. Only 87% were advised to do a pregnancy test. Sexual health screening was offered to 98%.
Discussion
Our review has shown that not all were offered Cu-IUD with a poor uptake, 13% were not advised to do a pregnancy test, but met the targets for the remainder. This was presented to clinic staff to address areas of improvement and will be re-audited. Additional demographic data will be presented.
P037
Opportunistic cervical screening in post-partum women
1Sandyford Sexual Health, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
2School of Medicine, University of Glasgow, Glasgow, United Kingdom
Abstract
Introduction
Uptake of cervical screening has been declining nationally, particularly among those from deprived areas. A recent programme in our health board provided funding for post-partum intra-uterine contraception (PPIUC) at caesarean section in an effort to reduce abortion and short-interval pregnancies. Women were invited to attend 6-weeks following insertion for a speculum examination to assess intra-uterine contraception threads. The project aimed to assess cervical screening status, whether screening was offered during the appointment, and the outcome.
Methods
A prospective case note review was performed on all women who had PPIUC at caesarean section from 1/1/19-31/12/19. Women were identified through a robust referral process into SRH services, which was cross checked with hospital systems to ensure complete data. Data was collected from the National Sexual Health system, Clinical Portal and SCCRS, which was subsequently collated and analysed on Microsoft Excel.
Results
146 women had PPIUC fitted within this time. Of these 70 were due a cervical screening test. Of these 46 attended the appointment, with 24 not attending. The majority of women were from SIMD 1 and 2 (n = 50; 71%). The mean overdue time was 23.3 months (range 0–147). Of those who attended, 24 had screening performed. 2 were unsatisfactory.
Discussion
Women who were overdue smears at their first appointment were overwhelmingly from deprived areas. When screening was performed it did not appear to cause a high unsatisfactory rate. Due to record-keeping it was not possible to assess if women declined screening or were not offered it. This programme offers a novel way of reaching those who are least likely to engage with cervical screening.
P038
Reproductive and sexual health in a mental health setting
1South West London & St George’s Mental Health NHS Trust, London, United Kingdom
2Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
Abstract
Introduction
Serious mental illness (SMI) is a risk factor for sexually transmitted infections (STI), unplanned pregnancy and rapid repeat pregnancy. Unplanned pregnancy in this population is associated with increased rate of termination of pregnancy, pregnancy complications and mental health relapse. Patients with SMI often have more contact and better engagement with Mental Health Services than with their GP or Sexual Health Clinic.
Methods
From 20th January to 28th February, patients attending outpatient appointments with an Adult Mental Health Team in South West London were asked to complete an anonymous, co-produced questionnaire giving details about their use of contraceptives, previous STIs, previous unplanned pregnancy, awareness of the location of the local Sexual Health Clinics and openness to discussing sexual health with a mental health clinician.
Results
20 patients completed this survey, with female-to-male ratio of 3:1. The rate of barrier contraceptive use was 5% (n = 1), with 40% (n = 6) of female respondents using non-barrier methods of contraception e.g. oral contraceptives. The awareness of the risks of unplanned pregnancy and sexually transmitted infections without use of barrier contraceptives was 90% (n = 18) and 100% (n = 20) respectively, with 35% (n = 7) having previously been diagnosed with an STI. Of the female respondents, 47% (n = 7) had a previous unplanned pregnancy. The rate of awareness of the location of the local Sexual Health Clinic was 65% (n = 13). Of all respondents, 90% (n = 18) would be willing to discuss their sexual health with a mental health clinician.
Discussion
This study demonstrates that few individuals with SMI use barrier contraceptives, despite an awareness of the risks of unplanned pregnancy and STIs. Mental Health Services already promote physical health improvement in patients with SMI; they have a unique opportunity to promote the use of barrier contraceptives and thereby reduce the risk of STIs, unplanned pregnancy and rapid repeat pregnancy in this population.
P039
Sex education among young adults to reduce sexually transmitted infections and unwanted pregnancy
MCPHS university, Boston, USA
Abstract
Introduction
• Despite greater effectiveness of contraceptive methods, sexually transmitted infections (STIs) still on rise in young adult population
• 2.8% increase in chlamydia, 5.1% increase in gonorrhea, 15.1% increase in primary and secondary syphilis (Fehring et al., 2017).
• Fewer than 30% of pediatricians distribute condoms or provide instruction on proper condom use (Schneider et al., 2019).
Methods
• Systematic search of the literature using PubMed, Health Source Nursing/Academic Edition, and Google Scholar
• Search terms: “+”sex education”, +”sex education intervention” +teen, and +”sex education intervention” + young.
• Search limited to past five years, scholarly articles, full articles, clinical trials, randomized controlled trials, and meta-analysis or systematic reviews.
Results
• Primary themes identified:
• Eliciting support for sex education programs
• Effective program delivery
• Specific sex education approaches
• Effect of sex education program on young adults
Findings
• Sex education programs have positive impact on young people attending them (de Castro et al., 2018; Moton & Tawk, 2016).
• Must be well-designed and relevant to population (Chu et al., 2015; Cofre et al., 2018; Eleftheriou et al., 2017).
• Other socio-cultural and external influences must be taken into consideration (Rashid & Mwale, 2016).
• Broad-based coalition formation and support contributes to successful creation and delivery of such programs (Borawski et al., 2015; Saul Butler et al., 2018).
Discussion
• Well-designed sexual education programs can be effective in young adult population
• Design that meets needs and demonstrates relevance most effective
• Broad community support essential for such programs
P040
Problem bleeding in sub-dermal implant (SDI) users: an audit and management pathway
Dorset County Hospital NHS Foundation Trust, Dorchester, United Kingdom
Abstract
Introduction
Women requiring contraception should be offered a choice of all methods including long- acting reversible contraception (LARC). LARC methods are more cost effective than non-LARC even if only used for 1 year. Side effects may lead to early removal. The FSRH has published guidelines for the management of problem bleeding in hormonal contraception, which focuses on excluding other causes of bleeding and adding the COCP in SDI users. Our sexual health service provides an integrated service for under 25s. An audit was undertaken to assess the premature removal rate of SDIs, reasons for removal and management of side effects prior to removal.
Method
All women who had a SDI inserted or removed from 01/02/19 – 01/08/19 were included in the audit. Data was collected retrospectively from patient records.
Discussion
The premature removal rate was worse than the standard, with problem bleeding being the main reason. This may relate to the young age of those attending. Due to lack of evidence other than adding the COCP, practical guidance in managing problem bleeding associated with a SDI is limited. Not all patients were offered the COCP and management was not consistent. As a result of this audit, a pathway was developed for the management of problem bleeding with the SDI. Following the exclusion of other causes, this offers a stepped and pro-active approach, starting as soon as a patient presents with problem bleeding. This will be presented and a re-audit will be undertaken to assess if this has improved the consistency of management and premature removal rate.
P041
Re audit comparing the use of intrauterine contraception (IUC) in an integrated sexual health service (ISHS) against the Faculty of Sexual and Reproductive Health (FSRH) guidelines
Coventry and Warwickshire Partnership Trust, Coventry, United Kingdom
Abstract
Introduction
The Faculty of Sexual and Reproductive Health (FRSH) guidelines state that patients attending for Intrauterine Contraception (IUC) fitting should be offered screening, a chaperone and a pelvic assessment. An audit was performed at an integrated sexual health service (ISHS) in 2018, which highlighted shortfalls in both offer and uptake of Sexually Transmitted Infection (STI) screening in patients attending for IUC. This is troubling as it is well-known that IUC insertion can increase the risk of Pelvic Inflammatory Disease, caused by STIs. We aim to see whether practice has changed after the original data was presented.
Methods
We performed a re-audit at the same ISHS. Data was analysed retrospectively, from June to November 2019, and compared to that from June to November 2018 and the FSRH standards of 97%.
Results
217 IUCs were fitted in the time period analysed. The age of patients ranged from 14 to 53, with a mean of 30. 148 (68%) of patients received a copper IUC and 69 (32%) received the Intrauterine System. National targets were met in pelvic assessment (98.6%) and presence of a trained assistant (98.2%) but not in STI Screening (93.1%). The service improved in 2 out of the 3 outcomes.
Table 1:
There was also improvement in uptake of nucleic acid amplification tests (NAAT) and blood tests (81.1% and 14.3% respectively). There is no national standard to compare these results against.
Table 2:
Discussion
National targets were reached in offering an assistant and performing a pelvic assessment. The clinic improved in offering and uptake of STI screening, but did not meet the standards set by FSRH for the former. Further improvement is needed regarding uptake of STI screening, particularly with regards to HIV and Syphilis testing. Addition of uptake of STI screening to auditable outcomes might increase screening and could lead to improved patient care.
P042
An Audit of the child sexual exploitation risk questionnaire (CSERQ15) in Wales
1The University of Sheffield, Sheffield, United Kingdom
2Betsi Cadwaladr University Health Board, Betsi Cadwaladr, United Kingdom
Abstract
Introduction
The Childhood Sexual Exploitation Risk Questionnaire (CSERQ15) is a screening tool used to identify any under-18 who is at risk of Child Sexual Exploitation (CSE) in Wales. An audit of CSERQ15 form inclusion, completion and appropriate referral was undertaken to identify interventions which could be made to improve the service.
Methods
The notes of all Under-18-year-olds who had accessed Sexual Health Services between the 1st July 2017 and 31st December 2017 were evaluated. Data was collated by the Health Board’s Clinical Audit Department.
Results
402 patients met the inclusion criteria. 385 sets of notes were audited (17 could not be found), thus 96% of patients who fulfilled the audit criteria were analysed.
i) Form Completion:
– 92.1% (N = 351) of notes audited contained a CSERQ15;
– 2.3% (N = 9) contained an alternative screening tool;
– 6.5% (N = 25) contained no screening tool.
ii) Patients meeting referral criteria:
– 9.8% (N = 38) of patients met the criteria for referral
– Of these, 34.2% (N = 13) were referred appropriately and 65.8% (N = 25) were not referred.
Discussion
Not every child meeting the criteria for CSERQ15 form completion had a form completed. This means that some children at risk of CSE may not have been identified. Those who met the referral criteria were not all being appropriately referred to support services. This is potentially leaving some children at risk of CSE, despite risk identification through the CSERQ15 form. It is paramount that we continue to strive for 100% form completion and 100% referral, where appropriate, such that no child is at risk of - or subject to - CSE.
To address the findings of this audit, the following measures are recommended:
– Education of staff regarding the CSERQ15 form;
– Mini-audits to ensure CSERQ15 form completion throughout the year;
– Re-audit in a year’s time to identify if the above measures have been successful.
P043
Preventing a COVID-19 BABY BOOM
SH:24, London, United Kingdom
Abstract
Introduction
Lockdown restricted access to contraception across clinics and primary care. Young people, previously ineligible for online provision, were being disproportionately impacted. As a digital sexual health service, SH:24 was asked to help meet this need by rapidly expanding our contraceptive offer. We increased oral and emergency contraception (EC) prescription volumes by expanding geographical availability, and age eligibility to include 16–17 year olds.
Methods
Combined oral contraceptives (COC) and progestogen-only pills (POP) are offered online, according to national guidelines. Ages are verified through NHS Spine and users are screened for safeguarding concerns. EC was available across new regions from 30/03/2020. Ulipristal acetate is offered to maximise the effective window, and all are offered POP as bridging contraception. We used routine data to describe the results of expanding access to online contraception.
Results
Until 28/06/2020: 845 individuals received 1010 EC prescriptions. 81(9.6%) received 2 prescriptions; 24 (2.8%) received 3+. 41 (4.7%) EC prescriptions were for 16–17 year olds; <5 raised safeguarding flags. The majority were for 18–25 (57.0%) & 26–35 (31.2%) age groups. 28.1% were from ethnic minorities. 232 were prescribed both POP and EC during this period. Monthly oral contraceptive prescriptions increased over six-fold between February and June. Since expansion to 16–17 year olds, 92 POP and 77 COC prescriptions were made for this group; 17% were from ethnic minorities; 9 raised safeguarding flags.
Discussion
Rapid scale-up of the digital offer has led to 1179 additional prescriptions during lockdown. This expansion has implications for future provision; safety, user acceptability, equity and appropriateness of these new approaches must be evaluated. For example, the potential impact of postal delays on EC timing and effectiveness. Data on repeat orders are routinely captured by digital services, which provide important opportunities for discussing ongoing contraception and bridging to other oral contraceptives can be easily achieved.
P044
Staff wellbeing – implementation of a contraception service for staff during Covid-19 pandemic
John Hunter Clinic, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
Abstract
Introduction
During the initial months of COVID-19 Pandemic there were immediate changes across UK in access to sexual and contraception health services and supply. It became clear it would be a challenging time for staff across the Trust to access contraception while negotiating the stresses of working during a pandemic, some living temporarily away from home. We were also mindful of the benefit contraception has on managing menstrual disorders which could become more challenging working in full PPE if women ran out of their contraceptive method. With this in mind we wanted to find a novel way to provide staff support during this time and proposed the idea of offering staff working within our Trust access to contraception.
Method
The Trust gave permission for a Contraception Service as part of our Health and Wellbeing for Staff services. A small group of contraception trained nurse prescribers able to offer support in addition to their current roles were identified. An NHS.net email account was set up and consultation was non face-to-face using self-completed medical health questionnaire and telephone consultation. Supplies could be either posted or collected from a negotiated area. Our service was advertised to staff via Intranet Communication Bulletins, ITU Staff Newsletter, Occupational Health, Twitter and word of mouth. Email and note review April-May (2 months)
Results
Number of staff emailing for advice during this period = 54
Total number of contraception’s issued = 24 (Combined Pill = 15, Progestogen Only Pill = 7
Depo Provera injection = 1, Vaginal Ring = 1)
Discussion
Numbers were smaller than expected but easy to manage alongside what we were already doing. Staff expressed thanks and appreciation of being able to access contraception easily during this time period. It felt positive to be able to respond to staff wellbeing and support during this time.
P045
Staff feedback following implementation of a telephone clinic for clinical assessment and method counselling prior to Intrauterine contraception fitting
Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
An adapted operational pathway was necessary, following the COVID-19 pandemic, to maintain availability to long acting reversible contraception (LARC). Following requests for intrauterine contraception (IUC) patients were allocated a telephone appointment for clinical assessment and full method counselling before being offered fitting appointment.
Methods
156 IUC insertions were undertaken in an eight week period following implementation on May 18th. In July SRH Staff were invited to provide feedback regarding the new model of working via an anonymous survey monkey questionnaire.
Results
Twelve (86%) of 14 staff completed the questionnaire: 10 (83%) would definitely support LARC-phone service post COVID-19, the remainder probably would; 9 (75%) strongly agreed that LARC-phone should replace face-to-face triage, 3/12 (25%) agreed. In some instances, staff reported phone communication was more difficult than face-to-face; four (33%) reported hard of hearing/ deafness, seven (58%) mental health illness, seven (58%) safeguarding issues and three (25%) when talking with those under 18. One had concerns with implementing telephone appointments for all except those meeting locally-defined criteria, other feedback included; talking to patients with a language barrier, ensuring it is safe at home to talk to the patient, restriction of service access for vulnerable groups, loss of opportunistic offer LARC-offer and consistent clear documentation especially when the triage and fit aspect of care were delivered by separate individuals.
Discussion
Staff supported this innovation at a time when there were clear benefits for change. Feedback suggests telephone appointments enabled prompt access for many, for those who have difficulty we suggest exploring the utility of video consultation. In current pandemic working where first contact with the service is via phone vulnerable groups should be supported to access face-to-face triage and staff should ensure that all those making contact with sexual health services for any need who are eligible for LARC are offered this method.
P046
Staff views on telephone counselling prior to intrauterine contraception (IUC) fitting during COVID
Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
Remote consultations were implemented to meet health needs and minimise COVID infection risk to patients and staff. Patients requesting IUC were offered a telephonic consultation appointment for a clinical assessment and full counselling about their chosen IUC method. Eligible patients were scheduled a fitting and sent SMS links to IUC videos and postal home-sampling service for STI screening.
Methods
156 IUC insertions were undertaken in an eight week period. Following implementation on May18th. In July SRH Staff were invited to provide feedback regarding the new model of working via an anonymous survey monkey questionnaire.
Results
Twelve (86%) of 14 staff completed the questionnaire; 8/9 (89%) felt the “did not attend” and “turn-away” (fit not appropriate) rate was less. 8/9 (89%) felt patients were always/usually properly counselled for the chosen device and procedure. 7/8 (88%) stated device fitted always the same as what the patient was counselled about, 1/8 reported fitting at least one alternative IUC device. 6/8 (75%) felt they could complete the procedure in less time due to counselling already completed and 7/8 felt 25–30 minutes a suitable length of time for fitting as opposed to the previous time of 40 minutes. All fits were offered within seven days. Suggestions included ensuring clear and consistent documentation of counselling and links sent. Staff felt remote consultations could help the COVID response by reducing travel, support providers to meet locality demand and lastly allow work from home.
Discussion
The new model has shown a high level of acceptability amongst staff with the vast majority reporting beneficial advantages such as; patients were adequately counselled, a shortening of appointment length and reduction in the DNA / turnaway rate amongst fitting clinics. Further data is required to quantify the impact of the new pathway on structural, process and outcome measures.
P047
Compliance with the Faculty of Sexual and Reproductive Healthcare (FSRH) standards for the insertion of intrauterine contraception (IUC) focusing on an integrated approach
Croydon University Hospital, Croydon, United Kingdom
Abstract
Introduction
The practice of IUC insertion was compared to FSRH standards, and provision of integrated sexual healthcare was evaluated.
Methods
A sample of 150 patients attending for IUC insertion between 01/01/2020 – 31/03/2020 were retrospectively reviewed for the presence of a trained assistant, bimanual/USS at insertion, STI screening offer. Additional outcomes were documentation of a sexual history, STI test in the last 6 months, uptake of STI screening, re-presentation of symptomatic patients within three months, and STI detection rate.
Results
We did not meet the three auditable standards. In addition, 56% of patients had only attended contraception services, not genitourinary medicine, and only 19% had a sexual history documented. Despite 91% of patients offered STI screening, uptake was only 53%. Only 24% of those not tested had an STI screen in the last 6 months. The rate of STI detection at IUC insertion was 1%. Of those not tested, 5% returned within 3 months with symptoms.
Discussion
Poor compliance with the presence of an assistant and bimanual/USS examination is likely due to poor documentation. The low uptake of testing may be due to patient/staff barriers including time constraints, perception of risk, and how tests are offered. The majority of women had never attended our genitourinary service, highlighting the need for opportunistic STI screening. Our inner city clinic is in an area of extremely high HIV prevalence so HIV tests should be offered to all patients as per NICE guidance. Adjustments have been made to the computer template to ensure accurate documentation and sexual histories to allow STI risk assessment. We plan further education of nursing staff in sexual history taking as well as the introduction of local guidelines to improve compliance in the re-audit in December 2020.
P048
Assessment of contraception related telephone consultations during COVID-19 pandemic
1Barts Health NHS Trust, London, United Kingdom
2Barts health NHS Trust, London, United Kingdom
Abstract
Introduction
Faculty of Sexual and Reproductive Health (FSRH) published guidance to maintain essential contraception services during COVID-19 pandemic. This audit aims to analyse contraception related telephone consultations to assess compliance with the FSRH guidance.
Methods
Data of 97 random electronic records of Contraception related telephone consultations were collected and analysed using excel.
Results
There were 480 contraception related telephone consultations during the month of April 2020. Ninety-seven electronic notes were randomly selected for analysis. Eight notes were removed from analysis as they were not pertaining to contraceptive consultations. There were 69 established and 20 new contraceptive users.
Out of 4 new COC requests 3 received POP. There was one request each for DMPA and IUC, accepted POP and one who requested subdermal implant declined POP. 7/11 new users had medical history documented, Body mass Index and Blood Pressure were recorded in three. All three patients who received COC were assessed correctly.
*One could have been eligible for Emergency IUD
** Double dose was given as weight was not known
Discussion
Our result clearly shows that we missed out on young and vulnerable population during this period. New users were far less than established users. Opportunity to discuss and encourage patients to use emergency intra-uterine devise and ongoing contraception were missed. Posting and collecting contraception from service were acceptable to all women. This result may support future use of such services. However, small sample size may have influenced our result.
P049
Inserting Levosert devices: Has switching from the Mirena intrauterine system to the Levosert intrauterine system as the first line option for women under 45 proved cost effective in our centre?
1,2,3NHS Borders, Edinburgh, United Kingdom
Abstract
Introduction
In April 2019 the Levosert intrauterine system (IUS) became first-line choice for women under 45 requesting an IUS in our centre. Previously the Mirena IUS was first-line, but the lower price of Levosert represented potential cost-saving. Unlike Mirena, Levosert insertion requires a two-handed technique, and has a wider introducer. (4.8mm,4.4mm). Our aim was to review all IUS insertions since April and analyse if these differences led to an increased rate of failed procedures and wasted devices negating any cost-benefit of the device.
Methods
Data was extracted from our national database for all IUS procedures between April 2019-January 2020. Electronic records were examined for procedural success/failure and reasons for not using Levosert in women <45.
Results
153 IUS devices were inserted in women<45. 102 had a Levosert inserted successfully. In 24 an alternative device was requested. In 5 it’s unclear why Levosert wasn’t used. In 7 following examination the clinician opted for an alternative. In the 15 patients whom Levosert insertion failed, 13 had documentation of a tight cervical os, 1 had a raised BMI making two-handed technique difficult and 1 the insertor bent. In all, an alternative device was subsequently inserted.
Conclusions
The success rate of Levosert insertions was 87.2%. Although lower than the Mirena, (96.2% in our centre) using 2019 prices it still proved the most cost-effective option. Success rate and reduction in “wasted” devices may increase with clinician experience. Further analysis is required to comment on additional time requirements for insertion and patient and clinician experience of the device.
P050
The acceptability of e-prescribing services for contraceptive pills and chlamydia treatment
1University of Westminster, London, United Kingdom
2Solent NHS Trust, Southampton, United Kingdom
3Hampshire County Council, Winchester, United Kingdom
4University of Southampton, Southampton, United Kingdom
Abstract
Introduction
The digitalisation of sexual and reproductive health (SRH) services offers valuable opportunities to deliver contraceptive pills and chlamydia treatment remotely, by post. The study aimed to examine the acceptability of ‘medication-by-post’ services in SRH.
Methods
A survey measuring the attitudes towards ‘medication by post’ delivery methods was distributed in Hampshire (UK) between May and August 2018. Data were collected through a pencil-and-paper survey at three clinics, alongside home-based STI testing kits and online. Logistic regressions were performed to identify potential correlates.
Results
There were 1281 participants (97% White, 86% heterosexual, 74% female and 49% were <25 years old). 8% reported receiving medication by post in the past, and 83% were willing to receive chlamydia treatment and/or contraceptive pills using this delivery method. Lower acceptability was observed in: >45 years old OR = 0.43 [95%CI:0.23–0.81], those screened for STIs less often than once per year OR = 0.63 [0.42–0.93], concerned about confidentiality OR = 0.21 [0.90–0.50], concerned about absence during postal delivery OR = 0.09 [0.02–0.32], and those not willing to provide blood pressure reading during registration OR = 0.22 [0.04–0.97]. Higher acceptability was observed in: those who previously received medication by post OR = 4.63 [1.44–14.8], preferred a ‘home delivery’ method over medication collection at the clinic OR = 24.1 [11.1–51.9], preferred home STI self-sampling over in-clinic screening OR = 10.3 [6.16–17.4], were able to remotely communicate with health advisor OR = 4.01 [1.03–15.6], were willing to register their real name OR = 3.09 [1.43–10.6], were willing to complete an online health questionnaire OR = 3.09 [1.43–10.6], and to use generic medication OR = 2.88 [1.21–6.83].
Discussion
E-prescribing is an acceptable method for remote SRH services and could be considered alongside the medication collection at the pharmacy. Medication-by-post could potentially be useful for patients facing multiple barriers to accessing in-clinic SRH services. The cost-effectiveness and implementation of remote methods of service delivery need to be further investigated.
P051
STI treatment from online pharmacies - are the offers still standing?
1St Helens Sexual Health, St Helens, United Kingdom
2Bolton Centre for Sexual Health, Bolton, United Kingdom
3The Northern Contraception, Sexual Health and HIV service, Manchester, United Kingdom
Abstract
Introduction
At BASHH 2017 we presented the first study of its kind to investigate the online availability of antimicrobials for sexually transmitted infections (STIs). Given the introduction of new BASHH guidelines, a re-audit was now warranted.
Methods
We modified our Google™ criteria to capture a wider selection of pharmacies. Websites selling Mycoplasma genitalium and Non-gonococcal urethritis (NGU) treatments were also included.
Results
32 pharmacies were identified (6 new). 5 websites were excluded (1 required payment prior to assessment, 1 required photo identification and 3 ceased trading).
Gonorrhoea - of the 5 pharmacies providing treatment in 2017, 2 had withdrawn this service, 1 required a paper prescription, 2 sold oral options in line with BASHH. 2 new providers also prescribed in line with BASHH. All websites provided written information.
Chlamydia - 24/27 (89%) pharmacies offered Chlamydia treatment. 17/24 (71%) enquired about rectal symptoms (0% in original study). 23/24 (96%) offered Doxycycline. 16/24 (67%) offered Azithromycin as alternative treatment. 2/24 (92%) had written information (up 8% from 2017). Repeat testing for under 25s was only recommended on 6/24 (25%) websites.
Mycoplasma genitalium - 4/27 (15%) provided treatment. Only 2 providers sold antibiotics in line with BASHH recommendations. 1 service recommended test of cure. 3/4 (75%) advised abstinence for the appropriate time interval during treatment. Written information was available on all websites.
NGU - 3/27 (11%) pharmacies sold treatment. 1 website had to be excluded. Of the 2 remaining, only 1 provided treatment in line with BASHH. Both clinics advised abstinence for 14 days from the beginning of treatment. Partner notification/written information was available on all websites
Discussion
Our re-audit has demonstrated a significant improvement in online prescribing compared to our 2017 data. At the time of writing, three pharmacies have responded to feedback and one has invited us to provide training at their head office.
P052
HIV conspiracy theories & PrEP acceptability in gay men
1Northumbria University, Newcastle, United Kingdom
2Nottingham Trent University, Nottingham, United Kingdom
Abstract
Introduction
Irrational beliefs and cognitive biases, such as conspiracy theorising, can inhibit engagement with healthcare. As a stigmatised minority group, gay men may be more prone to conspiracy theorising than the general population. They are also at risk of poorer health outcomes – especially in relation to HIV infection. This study set out to examine the impact of conspiracy theorising on the acceptability of pre-exposure prophylaxis (PrEP) among gay men in the UK.
Methods
244 White British gay men completed an online survey that included demographic questions, an item on whether they had attended a sexual health screening, and measures of homophobic discrimination, experiences during a sexual health screen (if they had attended), belief in HIV conspiracy theories, and attitudes towards PrEP.
Results
Homophobic discrimination was positively correlated with HIV conspiracy beliefs and negatively correlated with PrEP acceptance. Mediation analyses demonstrated that the relationship between discrimination and attitudes towards PrEP was explained by HIV conspiracy theorising. We also found that gay men who indicated they had attended a sexual health screen (vs. never attended) reported higher belief in HIV conspiracy theories. Focusing on gay men who had attended a sexual health screen, we conducted a further mediation analysis. We found that reported poor contact with a healthcare professional was associated with an increased belief in HIV conspiracy theories, which resulted in negative attitudes towards PrEP.
Conclusions
HIV conspiracy theorising is an important variable in understanding attitudes towards PrEP among gay men. Its roots are in adverse social experiences (e.g. discrimination, poor contact with a healthcare professional) and its consequences may be the rejection of PrEP which can prevent HIV. HIV prevention and PrEP campaigns must focus on prejudice reduction and the challenging of conspiracy beliefs. Clinicians should be cognisant of the impact of conspiracy theorising on PrEP acceptability.
P053
An audit of practice – “improving the assessment, coding and care of patients at risk of HIV at Homerton Sexual Health Services”
Homerton University Hospital, London, United Kingdom
Abstract
Introduction
This was a retrospective audit of notes from the 3-month period beginning August 1st 2018, assessing whether patients at higher risk of contracting HIV were appropriately assessed, coded and cared for, at Homerton University Sexual Health Service, with the overarching aim of reducing HIV transmission.
Methods
Records were obtained for 3 separate ‘high risk’ cohorts of patients; (a) men who have sex with men (MSM) who had unprotected anal intercourse (UPAI) in the last 3 months and who are likely to have UPAI in next 3 months (b) MSM patients diagnosed with a rectal STI or syphilis (c) patients requesting post exposure prophylaxis (PEP) (male, female and trans patients). Six standards were agreed and a target of 100% was set for all but one of the standards, as per the IMPACT study criteria or local guidelines. Preview was used to analyse patient records. Patients were excluded according to the exclusion criteria or if insufficient information was available.
Results
260 patient notes were screened. 17 were included from MSM cohort (a), 13 were included from the rectal STI cohort (b) and 13 were included from the PEP cohort (c). 217 patients were excluded. See results table.
Discussion
This audit highlighted missed opportunities in our consultations, whilst assessing high risk patients, with regards to HIV. Most importantly, we must be better at identifying patients at risk of HIV and to have, and document, conversations around PrEP and where to get it. We are best at having these conversations when patients present requesting PEP and health advisors were particularly good at discussing PrEP. We recommended that the proforma should be changed to help prompt these discussions, to help us identify high risk patients who may be eligible for the IMPACT study. An MDT teaching session was delivered and we will re-audit the data in 12–18 months’ time.
P054
Do stigmatising misconceptions about HIV exist In 2020?
Croydon University Hospital Sexual Health Clinic, London, United Kingdom
Abstract
Introduction
As part of the UNAIDs Fast-Track Commitments, a goal was set to eliminate HIV-related discrimination. Stigma can not only negatively impact people living with HIV (PLWH), but can influence one’s perceived risk of HIV acquisition and deter them from testing. Education is of major importance in preventing new HIV infections; vital in ending the HIV epidemic. The aim of this study was to determine the extent to which stigmatising misconceptions exist in our local population and amongst doctors in our trust.
Methods
A 5-part true/false questionnaire was used to assess knowledge about HIV. Each question centered on a different misconception related to HIV. Themes included route of transmission, latency of HIV infection, undetectable = untransmittable, risk of vertical transmission and life expectancy. The following participants were approached:
• Members of the public (MoP) in the concourse of Croydon University Hospital and the waiting room of Croydon Sexual Health Clinic.
• Doctors (not GUM-HIV) on wards or at Grand Rounds.
Participants were given feedback so that their responses could be used to educate them.
Results
Of 129 respondents there were: 26 doctors and 103 MoP. The least understood theme amongst MoP was the risk of vertical transmission and amongst doctors was U = U. In both groups the best understood theme was route of transmission. Doctors scored considerably higher than MoP with 35% getting all 5 questions correct. The average scores were 4/5 and 3/5 for doctors and MoP respectively.
Discussion
Poor knowledge still exists amongst MoP and doctors. We found that knowledge of U = U is limited, with less than half per group correctly answering the U = U question. Further research is planned to expand the participant groups e.g. to primary health care professions. This study has identified areas of poor knowledge, which will allow targeted education strategies aimed at re-addressing misconceptions.
P055
The online PrEP clinic: improving access to pre-exposure HIV prophylaxis and follow-up
1Manchester NHS Foundation Trust, Manchester, United Kingdom
2The Northern Contraception, Sexual Health and HIV Service, Manchester, United Kingdom
Abstract
Introduction
Some patients have reported difficulty accessing integrated sexual health (ISH) services for PrEP and have subsequently run out of medication. This work outlines a new model of service provision aimed at improving access to PrEP medication and follow-up, whilst reducing the demand of PrEP-related attendances on ISH clinics.
Methods
Our integrated sexual health service launched the online PrEP clinic in February, 2020. The clinic utilises an online self-assessment form that is then reviewed by a doctor. If the patient is suitable for the clinic, they are invited to a follow-up appointment with a trained clinical support worker (CSW) and receive a comprehensive sexual health screen and renal function tests. If the patient sources their medication through our service, the doctor will also prescribe and dispense PrEP ready for collection. Patients sourcing PrEP independently are also invited to use the service to ensure they are taking PrEP safely and effectively. A retrospective case study was conducted to review uptake of the online PrEP clinic and assess whether the service was a viable alternative to standard ISH appointments for PrEP follow-up. Data was collected for PrEP-related attendances in February 2020 and included patient demographics, methods of sourcing PrEP and the type of follow-up appointment required.
Results
In February, there were 33 submissions for the online PrEP clinic, of which 28 (84.8%) were appropriate. Of the 28 appropriate submissions, 22 (78.6%) received follow-up by CSW appointment, 4 (14.3%) required follow-up by a doctor in the ISH clinic, and 2 (7.1%) patients attended the ISH clinic before follow-up could be arranged.
Discussion
The majority of patients using the online PrEP clinic were suitable for CSW follow-up appointments. By moving such patients away from ISH clinic appointments, the service increases its capacity to manage patients established on PrEP, whilst improving access to ISH appointments for symptomatic patients.
P056 Withdrawn
P057
PrEP use, access and perception of risk in a UK sexual health clinic outside London: findings from the challenges and opportunities of PreP (CHOP) study
1University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
2University of Bristol, Bristol, United Kingdom
3NIHR Health Protection Research Unit, Bristol, United Kingdom
4NIHR ARC West, Bristol, United Kingdom
5Cardiff Royal Infirmary, Cardiff, United Kingdom
Abstract
Introduction
We examined knowledge and attitudes towards HIV pre-exposure prophylaxis (PrEP) among an urban sexual health clinic’s attendee, during the IMPACT trial to ascertain if PrEP impacted on sexual decision-making or perception of risk.
Methods
All clinic attendees (November 2018 for 12 months) self-identifying as men/trans-persons-who-have-sex-with-men (MSM/TPSM) were sent an electronic questionnaire. Eligibility required completed questions concerning HIV-status; sexual decision-making; PrEP use (partners/ self); consent to participate; and MSM/TPSM self-identification. Interviews were conducted with 24 respondents at risk of HIV acquisition and analysed thematically utilising an inductive approach.
Results
There were 617/2818 eligible respondents. 202/578 (35.0%) HIV-negative respondents had used PrEP of whom 86.1% (174/202) were current PrEP-users. Interviewees reported widespread awareness and enthusiasm for PrEP, which was described as ‘life-changing’. Among respondents who had never used PrEP, 145/376 (38.6%) were unaware how to access PrEP and 101/376 (26.9%) could not access the Impact trial, of whom 78/101 (77.2%) were eligible. Interviewees identified expense and difficulty sourcing PrEP were the main barriers. 379/578 (65.6%) HIV-negative respondents indicated they would be more likely to have condomless sex if taking PrEP, while 472/578 (81.7%) believed taking PrEP would reduce their anxiety about acquiring HIV. 31/39 (79.5%) HIV-positive respondents believed PrEP would reduce anxiety about HIV transmission to their partners. Despite interviewees’ awareness of STI antimicrobial resistance, optimism around STI’s as ’curable’ was common, although many saw this as ‘stupid thinking’
Discussion
PrEP awareness was high. However, access was limited by lack of trial places and cost of purchase. Reduced fear of HIV transmission and HIV testing was significant and highly valued. Although there was awareness of antimicrobial resistance, STI’s were still seen as ‘curable’ and this did not change perception of risk or influence sexual decision making. Service development and health promotion should take account of individuals’ ability to assess their own risk.
P058
PEP in the city – a new way of delivering post-exposure prophylaxis from the Emergency Department
1The Northern Contraception, Sexual Health and HIV Service, Manchester, United Kingdom
2St Helens Sexual Health, St Helens, United Kingdom
3Emergency Department, Manchester University NHS Foundation Trust, Manchester, United Kingdom
4Manchester University NHS Foundation Trust, Manchester, United Kingdom
Abstract
Introduction
We present our contingency plan for the management of patients presenting to our Emergency Department (ED) requiring HIV (Human Immunodeficiency Virus) Post-Exposure Prophylaxis (PEP) during the COVID-19 pandemic.
Method
The pre-COVID pathway relied on patients who needed PEP being dispensed a 5 day supply of PEP. A generic leaflet was included in each PEP pack. This contained a large amount of medical jargon and no contact details for local services. A handwritten fax referral was sent to Genitourinary Medicine (GUM) who would recall the patient for face to face (F2F) review in order to obtain baseline screening and supply an additional 23 days of medication. F2F follow up testing was arranged at 2 weeks and 8–12 weeks post-PEP.
Results
An electronic PEP referral was introduced and the ED Clinical Decision Support Guideline (CDGS) was redesigned. Pharmacy was able to supply 28 days of PEP meaning that if a patient was required to self-isolate, they would have an adequate supply of treatment at home.
The patient information leaflet was rewritten using simple terminology and details of local GUM services were included. Baseline bloods were taken within ED removing the need for F2F appointments. Upon receipt of the PEP referral, a Health Advisor would call the patient and arrange for confirmatory home testing kits to be sent at the required window period. Patients attending ED who were non-Manchester residents were eligible for the same service thus reducing unnecessary F2F contact at other clinics. 16 patients were successfully referred from ED to GUM between May/June 2020.
Discussion
Our new pathway has helped us to substantially mitigate risk for patients requiring PEP via the ED. Following the success of this collaborative project, we have decided to adopt this pathway permanently as we predict demand for PEP will increase as the UK begins to ease lockdown restrictions.
P059
A dangerous waiting game? Are patients coming to harm whilst awaiting PrEP?
Nottingham City Hospital, Department of Sexual Health, Nottingham, United Kingdom
Abstract
Introduction
HIV pre-exposure prophylaxis (PrEP) is not yet available on the NHS in England, despite proven efficacy (1,2), unless as part of the IMPACT trial (3). Spaces on the IMPACT trial are limited resulting in long waiting lists and, in some centres, patients have acquired HIV whilst awaiting a space (4). PrEP is available online and resources are available to ensure that it is purchased safely. We aimed to establish whether patients are being directed to such resources and whether they were coming to harm whilst awaiting a trial space.
Methods
We retrospectively reviewed electronic records (EPR) of patients added to the list (n = 140) since recruitment places were filled in November 2017, recording details including time on list, number of STIs recorded, whether post-exposure prophylaxis (PEP) was given during this time and whether appropriate information was given to safely source and take PrEP.
Results
Of 140 patients 78% were on the list for more than one day (mean 105 days). Of these, 96% continued to have unprotected anal intercourse and 25.6% acquired at least one STI, a surrogate marker for increased risk. 25.5% self-sourced PreP; of these 76.6% received appropriate monitoring. 45% of patients were given written information regarding how to safely self-source PrEP. 11% required PEP. No-one acquired HIV in the study period.
Discussion
Patients remained at risk of harm whilst on the waiting list for PreP trial places and few had documented evidence of having been given written information on self-sourcing. Moving forwards, we have included PreP self-sourcing leaflet provision on the EPR to function as both a reminder and evidence for re-audit. We also recommend follow-up phone calls to high risk patients. PrEP is due to become available on the NHS in England by October. We will present data on outcomes on the waiting list to October 2020 at the conference.
P060
PEPSE management – Are we meeting the standards?
NHS Lanarkshire, Lanarkshire, United Kingdom
Abstract
Introduction
Post Exposure prophylaxis against HIV (PEPSE) is an important public health tool which can help reduce the number of new HIV infections. We wanted to audit our practice against the current BASHH standards as we know anecdotally that some clinicians don’t feel confident managing these patients due to few requests.
Methods
A PRISM (Patient record information and search module) search was performed to identify patients prescribed PEPSE medication (Tenofovir disoproxil/emtricitabine and Raltegravir) between 1st October 2017- 1st November 2019. A retrospective case note review was then performed using the sexual electronic patient record (EPR).
Results
10 of the 11 patients identified as MSM. Table 1 shows the results against BASHH auditable outcomes. Pre-exposure prophylaxis against HIV (PrEP) was discussed in 5 of the patients and 3 patients subsequently commenced on PrEP.
Discussion
Although only 27% of PEPSE was dispensed within 24 hours of exposure, the majority of patients were actually requesting PEPSE > 24 hours after exposure so more awareness raising is needed. At the time of the audit, our service only gave out 5 day starter packs and further supplies and follow up were often performed by our colleagues in the Infectious Disease department. Therefore, it was difficult to know who was following up the patients and may have been the reason for the low numbers of patients documented as having completed the course of treatment and having subsequent HIV tests. This may have also been the reason why a low number were then commenced on PrEP. Following on from this audit our practice has changed and the 28 day supply of PrEP is now dispensed by sexual health so that all follow up is performed by us. The audit results have been presented to staff and a further audit is planned in 1 year.
P061
Case study: a 13 year old boy’s post exposure prophylaxis was stopped prematurely due to Raltegravir induced thrombocytopenia
Cardiff & Vale University Hospitals NHS Trust, Cardiff, United Kingdom
Abstract
Introduction
Provision of HIV post-exposure prophylaxis after sexual exposure (PEPSE) is routine in sexual health clinics and due to the sexual health and safeguarding issues involved, patients as young as twelve may be seen by non-paediatricians. Depending on weight, standard or modified drug regimens will be required. This case describes the management of a vulnerable 13 year old boy presenting for PEPSE who experienced significant thrombocytopenia with adult doses of raltegravir.
Discussion
This case exemplifies an ‘uncommon’ side effect of raltegravir, occurring in an estimated 1/100 to 1/1000 cases in both paediatric and adult populations, despite appropriate dosing. Staff in the sexual health clinic were relatively inexperienced in managing PEPSE complications in children but much more confident with the safeguarding and sexual health issues involved.
P062
Introduction of the first virtual PrEP Service in Scotland
Sandyford, Glasgow, United Kingdom
Abstract
Introduction
Due to Covid we needed to quickly reduce clinic footfall. Pre lockdown we were about to launch an online STI testing pilot for routine screening. As clinical priorities shifted to those at greatest need we moved the limited resource to PrEP patients and complemented it with postal medications to create a virtual service. Eligible patients had phone consultations, offered online testing and advised on receipt of their results PrEP would be posted.
Methods
Records of patients referred to online testing from the clinic and the online provider were reviewed.
Results
Since 28/4/2020, 106 referred, 101 ordered a kit, 83 returned kit. 60 went through the process without issue. 24 needed to come in, all due to issues with blood testing- 8 haemolysed, 8 insufficient, 5 unable to test, 1 false positive HIV test. 3 cases of gonorrhoea, 5 Chlamydia and 1 syphilis diagnosed.
Discussion
In a short time, we have introduced the first virtual PrEP service in Scotland. Re-focusing online resources has facilitated continuing PrEP during Covid and enabled targeting of the limited face to face services. We saw high acceptance of ordering a test, however only 78% returned kits. It is vital the pathway is quick to ensure patients do not run out of medications. The largest delays were in patients ordering or returning their kits. Added to this there were higher than expected issues with blood testing. For virtual PrEP to be viable work needs to be done to improve the return rates and turnaround time. We are working with the online provider to improve testing and develop communications to support patients in the process
P063
Review of managing HIV infected pregnant women – an audit against BHIVA guidelines
Walsall HealthCare NHS Trust, Walsall, United Kingdom
Abstract
Introduction
In the United Kingdom the vertical transmission rate of HIV infection has declined from 25.6% in 1993 to 0.1% among women taking anti-retroviral therapy with an undetectable HIV viral load in 2000. In 2011 over 97% of pregnant women were screened for HIV. This audit was performed to assess the management practice compared to the BHIVA guidelines, in this hospital.
Method
A retrospective case note analysis was performed on HIV infected pregnant women who had live births from January 2017 till July 2018. Data was collected on the following: age, ethnicity, date of diagnosis of HIV, current anti- retroviral regimen, viral load and CD4 counts at booking and at 36 weeks gestation, mode of delivery, neonatal treatment and subsequent testing of the baby, latter according to the guidelines.
Results
All of the mothers were managed by the multi-disciplinary team. They all had an undetectable HIV viral load at 36 weeks gestation, opposed to 80% in 2005. There were no mother to child HIV transmissions. All babies had received neonatal prophylaxis. All babies except three had been tested at birth, 6 weeks, 12 weeks and at 18 months. The three had transferred to other centres due to relocation of parents. As opposed to all babies born by caesarean section in 2005, 33% delivered vaginally and 40% had elective caesarean sections. None breast fed.
Discussion
This audit has shown significant improvement in outcome measures, compared to the previous audit. It was recommended that information on infants transferring to other centres should be obtained to ensure continued engagement in care. Changes in the updated guidelines have been incorporated in local policy including support for those electing to breastfeed, with adherence to enhanced testing. Additional data will be presented
P064
Should hyperproteinaemia be specifically recommended as an indication for HIV testing, in order to further improve 90–90-90?
Rotherham NHS Foundation Trust, Rotherham, United Kingdom
Abstract
Introduction
The draft 2020 BHIVA/BASHH/BIA Adult HIV Testing Guidelines list a number of indicator conditions which are associated with HIV seroprevalence ≥ 1 per 1000. Although examples of blood dyscrasias, such as thrombocytopaenia, are stated in the draft guidance, hyperproteinaemia is not specifically mentioned. People living with HIV may have hyperproteinaemia due to excess production of gammaglobulins. In the non-specialist setting, hyperproteinaemia might be more likely to result in investigations to exclude other conditions such as myeloma, as HIV may not be considered in the differential.
Method
We conducted a retrospective case note review of all newly diagnosed HIV patients from January 2016 to December 2019. Cases were retrieved via the INFORM electronic database. We assessed the prevalence of hyperproteinaemia around the time of HIV diagnosis.
Results
16 new HIV diagnoses were identified, of which 7 (43%) had a period of hyperproteinaemia spanning greater than 3 months prior to or following HIV diagnosis. The age range of those with hyperproteinaemia was 25–60 years. Of the 7 (43%) with hyperproteinaemia, all had an elevated globulin fraction. Of the 16 patients, the rates of late diagnosis (CD4 count less than 350) were higher in the group with hyperproteinaemia compared to those that did not (50% vs 33% respectively). One patient with hyperproteinaemia had a CD4 count of 19 at the time of diagnosis in 2019, and on review of liver function results available from primary care prior to diagnosis, this patient had demonstrated hyperproteinaemia since 2008.
Discussion
Although limited due to the small sample size, there is undoubtedly a strong association between hyperproteinaemia and HIV, which is well described. Increasing awareness of this association by specifically listing hyperproteinaemia as a recommendation for HIV testing may help to reduce the number of people living with undiagnosed HIV.
P065 Withdrawn
P066 Withdrawn
P067
Evaluating trends in new HIV diagnoses over 9 years in an inner-London HIV clinic
1St George’s University of London, London, United Kingdom
2Courtyard Clinic, St George’s Hospital NHS Trust, London, United Kingdom
Abstract
Introduction
Despite a reduction in UK HIV incidence, 38,600 people were living with HIV in London in 2017 and 35% were diagnosed late. Our aim was to identify demographic trends, late diagnoses and time to initiation of antiretroviral therapy (ART) at an Inner-London HIV clinic.
Methods
Public Health England reports identified new HIV diagnoses 01/01/2009-31/12/2017. Electronic and patients’ notes retrospective data collection identified: diagnosis date, gender, age, ethnicity, route of exposure, CD4 count, HIV symptom status and date of ART Initiation.
Results
628 patients were diagnosed HIV positive. 436/628(69%) male, 192/628(31%) female. Median age 40 years (range 16–93 years). Ethnicity: White (n = 258, 41%), Black (n = 277, 44%), Black Carribean (n = 47, 7%). 258 diagnoses in men who have sex with men, 180 in heterosexual women, 138 in heterosexual men. Diagnoses fell by 65% from 118 in 2009 to 41 in 2017. The median CD4 count increased from 215 to 326 cells/mm3. Late diagnoses were high; 61%(n = 54) 2009, 56%(n = 23) 2017. 346/628(55%) asymptomatic, 134/628(21%) symptomatic, 92/628(15%) AIDS and 35/628(6%) seroconverted. Declines in asymptomatic diagnoses (56% to 41%), AIDS (16% to 4%) and seroconversions (7% to 0%) occurred 2009–2017 with symptomatic diagnoses increasing (20% to 55%). Over this time, the median time between HIV diagnosis and initiation of ART fell from 37 to 29 days.
Discussions
Declining HIV diagnoses and time to starting ART reflects falling HIV incidence in the UK and National guidelines on earlier initiation of ART. Of concern are continued high rates of late diagnoses, which despite falling AIDS diagnoses, are associated with increasing rates of symptomatic HIV at diagnosis. Accordingly, the hospital recently introduced opt-out HIV testing in A&E to improve earlier diagnosis. This will need to be implemented alongside initiatives in primary care and the wider community to achieve a significant reduction in late HIV diagnosis.
P068
Comparison of user characteristics and testing outcomes between a national online service targeting high risk populations and local online services in the same areas
1SH:24, London, United Kingdom
2Public Health England, London, United Kingdom
3Kings College London, London, United Kingdom
Abstract
Introduction
Service 1 is a specialist online sexual health service providing STI testing and contraception in partnership with local sexual health services where commissioned by local authorities. From October 2019 to January 2020, service 2 promoted free HIV and syphilis testing nationally among high risk populations and provided testing as part of national HIV testing week. This study compares the populations who access HIV testing through these two services to understand their impact on access to testing for HIV.
Methods
Individuals who requested an HIV test from 1/10/2019 to 31/01/2020 through either service and were resident in areas where service 1 is commissioned were included in the analysis. Demographics, risk behaviours, previous testing and testing outcomes were compared using chi -squared tests.
Results
In total 35,739 and 3,378 tests were ordered from service 1 and service 2, respectively. Service 2 users were older than service 1 users (Median age 29 vs 26) and more likely to be men who have sex with men (MSM):57.0% compared to 10.5% (P<0.0001), whilst service 1 users were more likely to be female: 61.8% compared to 25.3% of service 2 users (P<0.0001). A higher proportion of service 2 users were of black and minority ethnicity (19.8% compared to 17.2%, P<0.0001). 34.8% of service 1 users had never previously visited an STI clinic. Among service 2 users 38.9% had never previously tested for HIV. Of those with a result, 149 service 1 users (0.86%) and 13 service 2 users (0.84%) had reactive tests, P = 0.956. Of those aged 16–18 years, 11% of service 1 and 29.7% of service 2 users reported a safeguarding issue.
Discussion
The two services are serving different populations reflecting the difference in how the services are promoted. Both services are supporting those who have not previously tested to test for the first time.
P069
Trends in HIV testing and diagnosis in UK general practice from 2005–2016
1University College London, London, United Kingdom
2University of Brighton, Brighton, United Kingdom
Abstract
Introduction
In 2018, 43% of adult HIV diagnoses in the UK were made late, indicating the need for timely HIV testing and diagnosis. This study examined trends in HIV testing and diagnosis in general practice using routinely collected data.
Methods
We conducted a cohort study using The Health Improvement Network (THIN) data for 587 general practices across the UK during 2005–2016. The primary outcomes were the annual incidence of HIV testing and HIV diagnosis per 100,000 person-years among adults aged 15+ years. We present data on all HIV tests and diagnoses, and separately for records indicative of non-routine testing (i.e. tests that did not take place during pregnancy or new patient registration). Poisson regression modelling was used to calculate incidence rate ratios by age group, sex, deprivation and region.
Results
Rates of overall recorded HIV testing increased between 2005 and 2010 (from 335.9 to 393.7 per 100,000 person-years), plateaued until 2015, and dropped thereafter (to 342.6 per 100,000 person-years). Rates of non-routine HIV testing increased steadily over the same period (from 110.5 to 276.2 per 100,000 person-years), and were highest among women (adjusted incidence rate ratio [aIRR] 5.9), those of black ethnicity (aIRR 1.7, 95% CI 1.6–1.7), and in the most deprived areas (aIRR 1.1, 95% CI 1.1–1.1). Rates of HIV diagnosis from non-routine testing remained steady (from 7.4 to 6.3 per 100,000 person-years) and were highest among men (aIRR 1.8, 95% CI 1.6–1.9), and those of black ethnicity (aIRR 11.7, 95% CI 10.5–13.0).
Discussion
Our study shows that non-routine HIV testing has increased over the study period, which may represent symptomatic testing for indicator conditions, while rates of HIV diagnosis have remained stable. Late HIV diagnosis remains common in the UK, but could be mitigated by indicator condition-guided testing for HIV. Future research should focus on further implementation in primary care.
P070
Acceptability of i-reader mobile camera technology in an online HIV self-testing pathway
1University College London, London, United Kingdom
2Glasgow Caledonian University, Glasgow, United Kingdom
Abstract
Introduction
There is growing evidence that HIV self-tests (HIVSTs) may have higher levels of acceptability than self-sampling, and appeal to users because they are convenient and offer immediate results. However, HIVSTs raise new challenges in terms of self-interpretation and linkage to care and prevention for those who are testing at home. We explored the acceptability of using a prototype smartphone camera app (‘i-reader’), which simulates reading and delivering self-test results using the smartphone camera (Fig. 1), within a novel HIVST online clinical pathway.
Methods
Between September and November 2019, we conducted think-aloud interviews (n = 27) with a community convenience sample (Table 1). Using a mock HIVST with pre-determined result, participants were asked to complete selected tasks using i-reader. Participants were asked to think aloud as they completed these tasks. Follow up probes explored usability and acceptability. Transcripts were analysed using thematic analysis.
Results
Participants described i-reader as “easy to use,” “helpful” and “quick.” Trust in i-reader was identified as a key theme. Trust was facilitated by personal attitudes to technology, the routineness of using a smartphone camera to gather and share information, beliefs that technology could mitigate human error under stress, correspondence between i-reader and participants’ self-interpretations of the result, and opportunities for confirmatory testing, either at home or at the clinic. Lack of trust was related to quick processing time from image capture to delivery of results, concerns about human error, image quality, and camera malfunction, and a general distrust of technology.
Discussion
i-reader could help people interpret HIVSTs, as well as providing information, support and linkage to care and prevention. However, trust in i-reader is both a major facilitator and barrier to engagement with the app. Further research is needed to explore digital technologies for supporting HIVST and to test this online HIVST clinical pathway in a real-life setting.
P071
Characteristics of service users diagnosed with HIV infection via a large online sexual health service (SHS)
1Chelsea and Westminster Hospital, London, United Kingdom
2Preventx, Sheffield, United Kingdom
Abstract
Introduction
Approximately 2000 people living in our capital city have undiagnosed HIV, and 43% of new HIV infections in 2018 were diagnosed late. Online SHS (e-SHS) have potential to increase access to STI testing for some high risk/hard to reach groups. We report the characteristics of our e-SHS users, who tested HIV+ between 8.1.18 and 31.12.19.
Method
E-notes review of service users with reactive HIV results, who attended for confirmatory testing at physical SHSs.
Results
Of 223782 e-kits tested, 144 (0.06%) had a reactive HIV result. 64 (44.4%) confirmed HIV positive, of whom 34 (53.1%) were previously undiagnosed. Of the new diagnoses: median age 28 yrs (range 21–50 yrs); 94.1% (32/34) were male and two female; 88.2% (30/34) were bisexual men/MSM and four heterosexual. Previous HIV testing history and HIV risk factors are shown. 3/4 heterosexuals reported no HIV risk factors. 17 (50%) individuals had 24 concurrent STIs (9 chlamydia, 9 gonorrhoea, 4 syphilis, 2 Hep B).
P072
HIV testing outcomes of persons using a large urban online sexual health service (SHS)
1Chelsea and Westminster Hospital, London, United Kingdom
2Preventx, Sheffield, United Kingdom
Abstract
Introduction
Online SHS can increase access to HIV testing although linkage to care for those testing HIV+ can be challenging. Our postal STI/HIV screening service covers a large urban area and integrates with its local physical SHSs. Positive e-screening HIV tests are re-tested (Roche Elecsys Ag/Ab Duo), categorised as reactive or low reactive (depending on a cut-off index: <10 = low-reactive, ≥10 = reactive) and referred to a physical SHS for confirmatory testing (CT). We present the CT outcomes of users that had reactive screening HIV results.
Method
E-notes review of individuals with reactive HIV results via e-service screening.
Results
Between 8.1.18 and 13.12.19, 378714 kits were ordered, and 260880 kits containing blood samples were returned. A HIV test result was provided from 223782 (85.78%) blood kits and 148257 unique users. The result was reactive in 144 (0.10%) and low reactive in 647 (0.44%) cases. CT results of reactive cases included: HIV+ 44.44% (64/144); HIV negative 47.2% (68/144); Unknown 8.33% (12/144) - despite contact attempts seven attended a SHS but neither user or SHS provided the CT outcome, and another five were informed about their result but chose to progress care independently. 46.88% (30/64) of those who confirmed HIV+ had previously been diagnosed but hadn’t declared this. The remaining 34 (53.12%) were new HIV diagnoses and 100% successfully transitioned to HIV outpatient services. CT result was relayed by service user and/or physical SHS (Table)
Discussion
0.10% of unselected e-service users had a reactive HIV screening result, 44% of which confirmed HIV+. All users with reactive results were aware of their result, 92% attended for CT and all new diagnoses transitioned to an HIV service, demonstrating the advantage of integrating e-SHS and physical SHSs across a geographical network.
P073
Feasibility and acceptability of receiving reactive HIV self-test results at home within an online clinical pathway
1University College London, London, United Kingdom
2Glasgow Caledonian University, Glasgow, United Kingdom
Abstract
Introduction
Advantages of HIV self-tests (HIVSTs) include their convenience and immediacy of results, but concerns remain about lack of support. The language for delivering a reactive result following home testing is important for balancing the urgency of seeking confirmatory testing with individuals’ needs to manage their emotions about the result. We explored acceptability of delivering HIVST results within an online clinical pathway (OCP).
Methods
Between September and November 2019, we conducted think-aloud interviews (n = 27) with a community convenience sample (Table 1). Using mock HIVSTs with pre-determined results participants completed tasks, including interpreting the test using manufacturer’s instructions, entering the result into the OCP, and accessing result-specific information/support. Participants were asked to think aloud as they completed these tasks. Follow up questions explored feasibility and acceptability of the OCP. Transcripts were analysed using thematic analysis.
Results
All participants were able to interpret the HIVST result using the manufacturer’s instructions. Many desired guidance on performing and interpreting the HIVST within the OCP and the option to visually confirm their self-interpreted result by selecting an image that resembled the result rather than text (e.g., ‘positive’). Participants felt the OCP provided clear next steps, reinforcing the importance of confirmatory testing. However, they emphasised the need for emotional support comparable to that received in face-to-face clinic-based testing, including peer and out-of-hours support. Trust, identity, privacy and security were key concerns for the acceptability of delivering results of HIVSTs within an OCP.
Discussion
It is acceptable to support people in receiving HIVST reactive results through an OCP, but despite developing the content with a view to meeting their emotional needs, more built-in emotional support is needed. This research has informed the optimisation of the prototype (Figure 1). Further research is needed to explore digital technologies for supporting HIVST and to test this OCP in a real-life setting.
P074
HIV testing in patients diagnosed with community acquired pneumonia (CAP)
1Great Western Hospitals Foundation Trust, Swindon, United Kingdom
2University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
Abstract
Introduction
Late diagnosis of HIV is associated with increased morbidity and mortality. In England (2018), 43% of HIV infections were late diagnoses (CD4 <350) with local rates reaching 53.8%. BHIVA and NICE recommend an HIV test for patients presenting with an indicator condition where prevalence of undiagnosed HIV is >0.1%. CAP is a common indicator condition presenting on the medical take. HIV testing amongst this group is likely to yield a number of otherwise undiagnosed patients allowing initiation of appropriate care to improve health and reduce onward transmission.
Methods
This retrospective study was performed over three cycles (September 2017, March/April 2019 and August/September 2019). Clinical coding identified all patients diagnosed with CAP. 65 patients in each cycle were randomly selected and medical records analysed. Patients without consolidation on radiograph were excluded. In-between each cycle, delivery of medical education to various medical groups, highlighted the importance of HIV testing.
Results
Initial results demonstrated 6.9% (n = 2) of patients diagnosed with CAP had an HIV test performed. This increased to 18% (n = 6) in cycle 2 and remained at 18% (n = 9) in cycle 3. Testing was more common in patients under 65, with 25% (n = 3) in cycle 2 and 45% (n = 9) in cycle 3.
Discussion
Following the teaching sessions, percentage of patients tested for HIV between cycles 1 and 2 improved. However, this remained static in cycle 3, although overall number of patients tested increased. The first teaching programme included sessions to a variety of grades and allied health professionals including a ‘Grand Round’ thus reaching a broader audience. The second session was delivered to foundation trainees alone who may be more reticent to suggest HIV testing. Further recommendations to develop a CAP sticker, to both prompt and provide confidence to clinicians requesting the test are being explored.
P075
Implementation of HIV testing for patients with indicator conditions at a district general hospital
1Riverside Clinic, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
2Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
3University of Bristol, Bristol, United Kingdom
Abstract
Introduction
Diagnosed late, HIV is associated with a tenfold mortality increase in the year following diagnosis and increased onward transmission with 50% of new infections from those unaware of their status. >48% of local HIV diagnoses are late, often with an absence of traditional risk factors. Most have at least one indicator condition, and multiple interactions with doctors in preceding years. Routine HIV testing is cost-effective (NICE) and acceptable to patients. We aimed to provide HIV testing to at least 50% of patients with HIV indicator conditions attending outpatient clinics within 6 months.
Methods
We used QI methodology to trial changes, assess impact, and build upon the learning in a structured way. We reviewed medical records of recent HIV diagnoses locally over the past two years. We evaluated lymphoma, cervical intraepithelial neoplasia (CIN) and diarrhoea/weight loss and collaborated with non-sexual-health teams to promote and facilitate testing in non-routine settings.
Results
59% (13/22) of local HIV diagnoses had at least 1 indicator condition recorded; most commonly diarrhoea/weight loss (32% = 7/22) followed by candidiasis. CIN was found in 3/4 women diagnosed in 2018. Testing in lymphoma patients increased from 13.6% (2013) to 83–86% (2018). We also audited HIV testing in patients with diarrhoea/weight loss and found that 6% were tested (3/50). We implemented routine HIV screening for patients with recurrent high-grade CIN and developed a Standard Operating Procedure, with mandatory HIV testing on the electronic patient records system. We collaborated with the Patient Experience Team to create an information leaflet for patients to read/complete prior to testing. We developed a results/ follow-up management system. We have agreed HIV testing be added to the primary care gastroenterology referrals.
Discussion
Successful implementation requires departmental education to develop clinicians’ testing knowledge, experience and confidence, and local champions to facilitate spread and sustainability in all clinical settings.
P076
Can pre-test discussion for blood-borne virus screening be simplified further?
Solent Sexual Health Service, Southampton, United Kingdom
Abstract
Introduction
Method
A random sample of 50 new patients seen in October 2019 at a large county wide service in the south of England was generated. Electronic patient records were reviewed for BBV risk assessment in the current BBV risk assessment proforma and clinical notes.
Results
Males = 25, females = 25. Mean age 29 (range 17–61). Heterosexual = 47/50; MSM = 3/50. White British = 32, Black British = 3, Asian = 2, White Other = 4, Spanish = 1, British Other = 2, Not recorded = 6. Overall, 60% of records demonstrated documentation of all seven risks audited as per the following table. The risk with the poorest documentation was bisexual partners for female patients (64%) followed by partners from outside the UK (POUK) (72%). Among patients with documented POUK, 12% had high-risk partners.
Discussion
This audit revealed only 60% BBV risk assessments were fully completed. The low rate of completion could be due to the current risk assessment proforma being an exhaustive list of risks which are not relevant to the majority of patients seen in clinics. A condensed risk assessment could result in higher completion rate. This could resemble the concise risk assessment currently used for online STI testing. POUK is one of the major risk factors for HIV acquisition and therefore it is critical to ensure patients are appropriately screened with respect to this risk.
P077
Exploring impact of a social impact bond on a hospital’s ability to engage PLHIV in treatment and care
Elton John AIDS Foundation, London, United Kingdom
Abstract
Introduction
The hospital has substantially expanded their HIV services through funding from a Social Impact Bond (SIB) developed by several public and private stakeholders. Through this SIB, the hospital has established a successful HIV testing programme in ED and has worked substantially on re-engaging patients disconnected from care.
Methods
Three adjoining boroughs have some of the highest incidences of HIV in the UK. Following stakeholder consultation, this SIB partnered with the hospital to offer a one-year outcomes-based payment contract. The funding enabled the hospital to recruit an experienced specialist nurse to join consultants to introduce ED HIV testing on an opt-out basis, including consultation with ED colleagues and training. Following this, work began on tracing PLHIV lost to follow up, and people were called and offered an appointment. This work was supported by the active involvement of the primary care GP HIV Champion.
Results
This approach enabled the hospital over eighteen months to engage 39 PLHIV in new diagnoses and treatment and reengage 24 people who were disengaged from care.
Discussion
Project payments are made on the achievement of two outcomes: identifying new cases of HIV, or reengaging PLHIV back into care after a break. The use of this funding mechanism, rather than grant funding, may be contributing to the success of the project since the focus on achieving outcomes nurtures innovation, particularly when combined with an experienced and passionate team. Outcomes-based payments may also result in additional revenue for the service. The results of this work are part of a larger project that hopes to develop evidence of cost effectiveness to influence the commissioning of both ED HIV testing on an opt out basis, and regular tracing of lost to follow up patients.
P078
Knowledge of U = U: reported impact on HIV stigma and HIV testing in sexual health clinic attendees
Mortimer Market Centre, London, United Kingdom
Abstract
Introduction
U = U has been promoted as a powerful tool in reducing HIV stigma and increasing HIV testing, yet limited research exists demonstrating this impact within sexual health clinic attendees. This study looked at the impact of increased U = U awareness on willingness to test and choices around social and sexual interactions with people living with HIV (PLwHIV).
Methods
Questionnaires were given to all sexual health clinic attendees in London and Surrey over a one week period.
Results
457 questionnaires were returned. Accurate knowledge of U = U was low in both populations, although slightly higher in London (27% vs 18%). Increased knowledge of U = U had positive effect on a range of areas, but particularly on future decisions to test for HIV and willingness to spend time with PLwHIV, with a slightly greater impact in Surrey compared to London. Comments suggested this was partly due to some London respondents already feeling positively towards these issues. See Table 1.
Discussion
Reducing HIV stigma and increasing HIV testing are key components of the 2030 HIV elimination strategy. This study confirms knowledge of U = U is low amongst sexual health clinic attendees, however, increasing awareness can have a positive impact on both decisions to have an HIV test and willingness to spend time with, have sex with, or have relationships with PLwHIV.
Percentage of respondents reporting positive impact of U=U knowledge on:
P079
Lessons learnt from National HIV ‘teaching’ week
Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, United Kingdom
Abstract
Introduction
To assist in reducing rates of undiagnosed and late HIV infections, teaching sessions were delivered to health care professionals during National HIV Testing Week (NHTW) 2019 to promote increased testing opportunities within their clinical practice.
Methods
Two teaching sessions were advertised through the use of promotional posters within the hospital, across social media and on relevant internal communication platforms. Departmental visits were made to promote staff registration and encourage attendance. Certificates were given to all delegates who attended either of the two hour training sessions and submitted a completed evaluation form.
Results
21 delegates registered for the teaching sessions. 13 (62%) attended on the day, 10 (77%) returned their completed evaluation forms. 100% of attendees rated the training as being ‘really relevant’ in developing their knowledge of HIV. 8 (80%) thought that the training had been equally relevant to their clinical practice, with 9 attendees (90%) recommending the training to their colleague. Qualitative feedback identified that attendees attending the training felt much more comfortable and confident in discussing HIV testing with their patients, in addition to recognising sero-conversion indicators and opportunistic infections. Many were unaware prior to attending the session how manageable HIV was and the simplification of treatment now available. For future sessions recommendations were made to include first hand experiences of living with HIV from a patient perspective.
Discussion
Delegates attending the teaching sessions would recommend attendance to their colleagues and felt that the content was both useful and relevant to their clinical practice. Whilst NHTW presented as an ideal opportunity in which to deliver this training, seasonal pressures may have presented as a barrier to those who had registered an interest but were unable to attend. Recommendations for future campaigns would be to develop accessible e-learning to help further improve the knowledge of health care professionals.
P080
Barriers to attending cervical screening amongst ethnic minority women: a qualitative analysis
Haslucks Green Medical Centre, Birmingham, United Kingdom
Abstract
Introduction
In the UK, there are approximately 3000 new diagnosis of cervical cancer per year, most common in those aged 30–34. A smear test detects the virus known to cause abnormal cells in the cervix and cervical cancer and is used as a screening test. Women aged 24.5–64 are invited for cervical screening every 3–5 years. Attendance rates to cervical screening are lowest amongst women from ethnic minorities. This survey aimed to explore the opinions of ethnic minority women behind attending cervical screening.
Method
An anonymous web-based survey was distributed through social media and beauty therapists working predominantly with ethnic minority women in the West Midlands between June and July 2020.
Results
57 women responded. 54/57 were eligible for cervical screening, with 38/54 up to date with their cervical screening (first call or subsequent recall test). 6/54 had attended screening but not their last recall. 10/54 women had never attended cervical screening and were aged 25–36. A common theme why ethnic minority women think attendance at screening is lower amongst them was that smear tests are associated with sex and the cultural belief sex occurs after marriage. Unmarried women perceive they don’t require screening or are hesitant of the implications of attending. One unmarried respondent stated she didn’t want the results posted to her address as her parents would assume she was sexually active so didn’t attend. Other themes included little communication between female relatives, wanting a female clinician, language barriers, previous negative experiences, fear and embarrassment.
Discussion
Pre-marital sex remains stigmatised in some minority ethnic communities. Being sexually inactive or the association of screening with sex may hinder attendance. Interventions are needed surrounding the understanding of cervical cancer and screening as well the emphasis of confidentiality and options of discretion.
P081
Knowledge, practices and misconceptions about vulval skin care across different age groups of women attending a sexual health clinic
1Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
2School of Medicine, University of Liverpool, Liverpool, United Kingdom
3Colorectal Surgery Department, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
Abstract
Introduction
Sexual health clinics present an ideal opportunity to provide opportunistic advice on vulval skin care. However, there are little published data on vulval skin care in those attending clinics. The aim of this service evaluation was to explore vulval skin care among women attending our sexual health clinic.
Methods
An anonymous vulval skin care questionnaire was distributed to female patients attending a UK sexual health walk-in clinic during a 5 week period in 2020. The questionnaire reviewed basic demographics, hygiene practices, confidence regarding vulva skin care, and the desire for more information.
Results
135 women completed questionnaires, of whom 53% (72) were ≤25 years old, and 47% (63) >25 years old. 15% of those ≤25 years and 38% of those >25 years reported being very confident in vulval care. Frequent vulval washing was common, with 28% of ≤25s and 37% of >25s washing their vulval 2–5 times daily. 24% washed with water alone, 5% used a soap substitute, and 70% used soap, wipes or Femfresh. 28% use sanitary products when not menstruating. 70% had previously had candidiasis, bacterial vaginosis, or a genital skin condition. Vulval care knowledge was obtained from health care professionals (30%), parents (31%), friends (18%) and social media (19%), with 20% reporting no knowledge. 50% of those ≤25 years and 38% of those >25 years wished to receive further advice.
Discussion
The majority of women reported a previous genital condition, potentially exacerbated by poor vulval skin care and use of detergent containing products was high. Confidence in vulval skin care was less common in younger women. The majority of patients did not wish to receive further information, although younger women may be more receptive. Our evaluation suggests that women are not aware that they lack knowledge in vulval skin care, and sexual health clinics should consider how to address this.
P082
Evaluation of inpatient Pelvic Inflammatory Disease in a semi- urban county
Worcestershire Health and Care Trust, Redditch, United Kingdom
Abstract
Introduction
Commissioners have noted a higher rate of inpatient Pelvic Inflammatory Disease (PID) and low rates of chlamydia detection in the county compared to national data. Could these two issues be linked?
Methods
100 case notes coded by Gynaecology service using the ICD -10 classification as pelvic inflammatory disease ((N73*), were scrutinised for a) clarification of the diagnosis, b) results of testing performed, and in addition, c) treatment regimens and d) follow up and partner notification.
Results
Of the 100 case notes, only 1
Conclusion
This case note review suggests incorrect ICD-10 coding may be responsible for presenting the county as an outlier for inpatient PID. There were no cases of chlamydia positivity in the cohort of definitive PID although routine testing methods differ from that used in sexual health. I t is planned to present the findings to the gynaecology service with the aim of 1) alerting the service to issues regarding coding, 2) suggesting a uniform approach to testing to include chlamydia /gonorrhoea NAATs and gonorrhoea culture, 3) treating PID in line with BASHH guidelines and formulating pathways to ensure partner notification is completed.
P083
To wait or not to wait? That is the question
Cobridge Sexual Health Centre, Stoke on Trent, United Kingdom
Abstract
Introduction
Funding of local sexual health services has reduced annually in line with the national picture yet demand continues to increase. In October 2019 our walk-in clinic was remodelled to try and improve clinic accessibility despite reduced funding. This study aimed to evaluate changes to clinic access, waiting times and the patient journey as a result of remodelling.
Method
Case notes of all patients attending walk-in clinic, over a 2-week period in September 2019 and a 2-week period in December 2019, pre and post- remodelling were reviewed. Information on demographics, wait times, turn-aways and attendance reasons were reviewed. Data was collected using the IT system ‘Inform’ and analysed via Excel.
Results
853 case notes were reviewed; 401 attending during September and 452 in December. The mean age of patients was 29 (range14-75), 34% were male and 66% were female. 94% were heterosexual. The mean wait time in September was 70 minutes (range 0–222) and in December 43 minutes (range 1–210). 8% of patients in September could not wait due to prolonged waiting times compared to 0% in December. 144 patients were turned away from clinic in September and none were turned away in December. The reason for attendance was similar in September and December. Overall 50% of patients attended for GU reasons alone, 20% for contraception reasons and 30% for both GU and contraception reasons. Of patients attending for GU reasons alone, 55% were symptomatic and 45% asymptomatic. Of asymptomatic patients, 62% underwent no-talk tests (NTT); 27% of these were completed by a support worker.
Discussion
Remodelling of walk-in clinics resulted in a mean reduction of wait times by 33 minutes and reduced turn-aways to zero. This analysis identified areas to further improve clinic efficiency, including directing asymptomatic patients to support workers for NTT and encouraging the use of newly available online testing.
P084
Successful management of persistent vulvovaginal yeast infection using oral voriconazole
1Salisbury NHS Foundation Trust, Salisbury, United Kingdom
2Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
3Solent NHS Trust, Southampton, United Kingdom
4Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
Abstract
Introduction
We describe 10 cases of persistent vulvovaginal yeast infections (PVVYI) treated using oral voriconazole with or without concomitant topical agents.
Methods
Retrospective case-note review of all women prescribed oral voriconazole for treatment of PVVYI in four Level 3 GUM Clinics from Jan 2010-Jan 2020. Demographic details, clinical features, diagnostic results and treatment outcomes were collected.
Results
Ten women with PVVYI were treated with voriconazole. All had experienced vulvovaginal itching, soreness +/- discharge for over 3-months. PVVYI was diagnosed clinically and confirmed on microscopy and culture (including speciation and antifungal sensitivities; table 1). All isolates were fluconazole resistant, 9/10 were either fully or intermediately sensitive to voriconazole. All had received prior fluconazole and clotrimazole and 9/10 had used at least 2-weeks of one or more second-line antifungals with non-clearance of the yeast (table 1). Oral voriconazole 400mg BD day-1, then 200mg BD 13-days was prescribed to all women and 9/10 completed the course. Concomitant topical treatment was used by 6/10. Liver and renal function were monitored at 0, 7, 14 days. 1 woman stopped voriconazole after 5-days due to perioral tingling. Other transient side-effects were nausea, photosensitivity, muscle aches, hair thinning (all n = 1), peripheral visual disturbance (n = 2). 7/10 experienced both a reduction in symptoms and clearance of the yeast on follow-up microscopy/culture. 2 women had an initial partial response, but were successfully treated following a second course of voriconazole, including one with Candida glabrata reported as voriconazole resistant. The woman who only completed 5-days of voriconazole had a partial response.
Discussion
Limited evidence exists to support voriconazole treatment for vulvovaginal yeast infections. We have shown a 2-week course was generally well tolerated and achieved mycological cure in 7/10 women. BNF cost is £176 per 14-day course and it is easy to procure. Voriconazole should be considered for inclusion in BASHH guidelines to treat PVVYI.
P085
Getting to zero – the butterfly effect
Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
Abstract
Introduction
The Butterfly clinic was set up to break barriers for transgender patients accessing services in the North West of England. A one stop shop, for accessing advice, treatment, contraception and education. Improving and empowering holistic decisions for Trans individuals.
Working collaboratively with the Trans community, The Butterfly clinic was developed to suit needs and expectations. Whilst improving education for staff and making a positive impact to the service provided. As well as providing a PrEP service to help combat HIV.
Method
A clinic was created with 30 minute, appointment slots, operating on a Monday evening and is Nurse-Led with Consultant support. Appointments can be made via telephone, online and referral from general clinic using prompt cards which have now become part of the consultation process. The clinic has relied heavily on recommendation and word of mouth through the LGBTQ+ community.
Results
Data collected from the 1/8/19 – 29/2/20 showed 38 attendances, during a 6month period. 4 identified as male, 13 identified as female and 1 identified as non-binary. Every patient had a full STI screen including triple site testing, if indicated and BBV testing. Results showed 4 gonorrhoea positives, 2 chlamydia, 2 syphilis, 1 trichomoniasis vaginalis and 1 case of genital warts. 50% of attendees are commercial sex workers and 50% were able to be enrolled onto the PrEP trial after consultation. To encourage risk reduction and reduce STI transmission, condoms and lubricant administered.
Discussion
Patients attend every 4–12weeks for repeat STI screening, due to building relations and trust within the community. Hepatitis A, B and HPV vaccinations, contraception and cytology are provided. On an average quarterly basis, attendees have 50 sexual partners, enforcing the benefits of the clinic in the battle against the spread of preventable infections and helping the North West to get HIV to Zero.
P086
How is economic evidence conceptualised when evaluating sexual health interventions and the control of sexually transmitted infections (STIs)? – A systematic review
1Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
2Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
Abstract
Introduction
This systematic review investigates economic evaluations of control programmes for STIs such as chlamydia, gonorrohoea, syphilis, and HIV. Local authorities are experiencing budget pressures, and sexual health services must compete for funding with other services, such as social care. It is not clear what approaches are available for commissioners to assess the economic value of sexual health programmes.
Methods
A search strategy was developed for seven databases for studies published between January 1999 and April 2019, with additional hand searching. The studies were categorised in a two-stage process and extracted into a table, which included a critical assessment of study quality. The results were analysed utilising narrative synthesis.
Results
9,530 records were screened and categorised. Of these, 31 were included for data extraction and critical appraisal (see figure 1).
The majority of studies assessed the cost-effectiveness or cost-utility of screening interventions for chlamydia from a provider or societal perspective. No economic evaluation was identified for syphilis. The main outcome measures were major outcomes averted (MOAs) and quality-adjusted life years (QALYs). The study designs were mostly (30) model-based with significant heterogeneity between model designs. There were limitations in assessing uncertainty around the model design. Further, a lack of data was identified in several studies leading to assumptions having to be made and only intermediate outcomes being presented. None of the outcome measures encompassed aspects of equity nor context, which are of high relevance to sexual health decision-makers.
Discussion
The review demonstrated wide heterogeneity in approaches to evaluate costs and outcomes for STI control programmes. Overall, the low quality of available studies highlights a need for high-quality economic evaluations to inform the commissioning of sexual health services.
P087
Offer and uptake of HPV vaccination in men who have sex with men
Sexual Health Dorset, Weymouth, United Kingdom
Abstract
Introduction
MSM are at particularly high risk of HPV-related cancers. A national HPV vaccination programme for MSM was introduced in April 2018. Eligible men should be offered HPV vaccination opportunistically in GUM and HIV specialist clinics. The offer and uptake of HPV vaccination is documented in patient case notes and coded using W codes. This coding data is submitted to PHE in quarterly GUMCAD reports. In 2018 PHE data indicated only 64.2% (61/95) of eligible, unvaccinated MSM were offered HPV vaccination and the uptake was 62.1% (59/95).
Methods
Retrospective audit of MSM age 45 and under attending GUM clinic between 01/07/18 and 31/12/18. For all patients W coding data was analysed and case note review was undertaken where coding had not been recorded to identify the reasons why.
Results
98 MSM aged 45 years and under attended the clinic during the data collection period. 65% (64/98) had a W code recorded. Following note review it was found that 91.7% (66/72) of eligible, unvaccinated men were offered HPV vaccination and the uptake was actually 81.9% (59/72).
Discussion
Although documentation of offer and uptake of HPV vaccination was good W coding data was low and misleading. MSM consultations can often be lengthy and complex and it can be easy for some coding activity to be missed. The majority of patients without a W code had previously completed a course of HPV vaccinations. To avoid inaccurate coding clinicians need to be made aware that all eligible MSM should be given a W5 code at every new attendance regardless of when or where they were previously vaccinated.
P088
Online home testing – a review of service users and outcomes
The Northern Integrated Contraception, Sexual Health and HIV Service, Manchester, United Kingdom
Abstract
Introduction
Sexual health postal testing has many advantages including reducing unnecessary clinic attendances, increasing clinic capacity, and improving access to testing for some key populations who may find it challenging to attend physical services. Our service started home testing in Aug 2017 and the service transitioned from using RU Clear to an ’in house’ postal testing in February 2019.
Methods
A retrospective data analysis was performed between June 2018 and September 2019. In February 2019 the service transition from using RU Clear to our own postal testing service.
Results
From June 2018 to January 2019 16700 kits were ordered and 14845 (88.9%) were returned. 8358 (47.2%) were female, 6356 (30.3%) male, and 89 (0.6%) undisclosed gender. 1155 (7.8%) reactive tests were identified with 657 (4.4%) cases of chlamydia, 276 (1.9%) of gonorrhoea, 3 (0.02%) new HIV diagnoses, 9 (0.06%) hepatitis B virus (HBV) surface antigen, and 9 (0.06%) hepatitis C virus (HCV) antibody. 1334 (9.0%) kits were returned from out of area. From February 2019 to September 2019 15028 kits were ordered and 10751 (71.5%) were returned. 5917 (55%) were female, 3850 (35.8%) male and 984 (9.2%) undisclosed gender. 743 (6.9%) reactive tests were identifies with 516 (4.8%) cases of chlamydia, 175 (1.6%) of gonorrhoea, 1 (0.01%) new HIV diagnosis, 6 (0.06%) HBV surface antigen and 2 (0.02%) HCV antibody. 1048 (10.1%) kits were from out of area.
Discussion
Our data shows a high demand for postal testing and a high acceptance of home BBV testing. However there is a lower prevalence of STIs being diagnosed when compared to national figures. Home testing can increase service capacity. It can also be used in other ways to reduce clinic attendance e.g. test of cure of infections, regular testing in high risk groups. However further studies are needed to show the cost-effectiveness of online testing.
P089
When should women attending General Practice be offered STI screening and sexual health advice? A review of national guidance
1University of Brighton, Brighton & Hove, United Kingdom
2Brighton & Sussex Medical School, Brighton & Hove, United Kingdom
3University College London, London, United Kingdom
4University of Sussex, Brighton & Hove, United Kingdom
Abstract
Introduction
General Practices (GPs) are recommended sites for STI testing and sexual health advice. Guidance outlining when to offer these interventions to women attending GPs should therefore be available. We sought to identify and review guidance on the nature of sexual history that should prompt a healthcare professional to offer STI testing, sexual health advice and/or contraception to women attending GPs.
Methods
Guidance was sought from the websites of the following organisations: British Association for Sexual Health and HIV (BASHH), Family Planning Association (FPA), Brook, National Chlamydia Screening Programme (NCSP), British HIV Association (BHIVA), Faculty of Sexual and Reproductive Health (FSRH), and Royal College of General Practitioners (RCGP). For each organisation all relevant publications were reviewed and guidance extracted concerning primary care or general settings.
Results
Five documents were identified and reviewed in full, spanning BASHH, RCGP, FSRH and FPA. Only one document provided relevant information, indicating that gonorrhoea testing for asymptomatic women should be informed by sexual history and pragmatism. No reviewed documents contained specific and directive information, instead focusing variously on using symptomatic presentation or population descriptors (e.g. young people) to target STI testing or providing detail on the nature of testing and sexual history taking and health advice itself.
Discussion
Sexual health guidance for GPs focuses not on presenting sexual risk, but on symptomatology and whether the woman belongs to a socio-demographically-defined high-risk population. This reflects that opportunistic STI testing is uncommon in primary care, and a reliance on epidemiological notions of risk populations to direct clinical intervention on a person-by-person basis. Further research is planned to support the development of guidance using an evidence-based clinical prediction rule to target STI screening, contraception and sexual health advice to women attending primary care.
P090
Take me home! – an initiative to improve GC TOC in a countywide rural sexual health service
North Cumbria Integrated Care Foundation Trust, Cumbria, United Kingdom
Abstract
Introduction
In 2018 there was a 26% increase in Neisseria gonorrhoeae (GC) diagnoses in England; with 3 drug resistant cases acknowledged. It is paramount that cultures prior to treatment and test of cures (TOC) are performed. In 2018 2 clinics in our service were audited according to BASHH standards for the management of GC. Only 33/45 (73%) of patients had a TOC. A subsequent recommendation to improve TOC was “take home” TOC at the point of treatment to drop in in 2 weeks.
Methods
Retrospective note review for patients who tested GC positive 2.9.2019 – 21.2.2020 across the service, following implementation of the “take home” TOC.
Results
85 cases of GC, with 1 (1%) cetriaxone resistant and 1 (1%) re-infection; 56 (64%) male; median age 26 years (range 15–63); 51 (60%) heterosexual, 34 (40%) MSM. 73 (86%) had TOC; not quite statistically significant (p = 0.0978) when compared to when take home TOCs were unavailable. In 13 cases take home TOC was not appropriate. 32/72 (46%) take home TOC were offered and 29 (91%) accepted. 21/29 (72%) were returned. All 3 (100%) that declined a take home TOC returned for TOC appointment. 45 appointments for TOC were made with 44 returning (98%). 18/23 (78%) who had a text reminder provided a TOC. 1 was telephoned but did not return for TOC. 11/16 (69%) given only advise during consultation provided a TOC.
Discussion
Effective methods to improve TOC are multifactorial and must all be employed for maximal effect.
P091
Impact of clearer SMS text messaging on test to treatment turnaround times (TATs) for Chlamydia Trachomatis (CT)
1Western Sussex Hospitals NHS Foundation Trust, Crawley, United Kingdom
2Western Sussex Hospitals NHS Foundation Trust, Chichester, United Kingdom
3Western Sussex Hospitals NHS Foundation Trust, Worthing, United Kingdom
Abstract
Introduction
SMS use facilitates timely access to treatment and partner notification following diagnosis with sexually transmitted infections (STIs). This is a key element in breaking the chain of onward transmission and reducing risks of complications associated with untreated infection. Revised SMS text messages, naming infections, were implemented as part of a quality improvement project (QI); developed with the aims of reducing TATs among individuals diagnosed with STIs and to better understand factors associated with variation in TATs across three integrated sexual health hubs (ISH).
Methods
Pre and post implementation, retrospective audit of TATs between notification of CT positive result and attendance for treatment, was undertaken across all ISHs.
Results
355 CT diagnoses, 196 in January 2019 and 159 in January 2020, across three ISHs were reviewed. Of these, 163 cases were excluded from analysis having attended as contacts, received treatment alongside testing or having been notified of infection via other communication methods. The below table summarises patient attendance in response to SMS recall before and after introduction of revised SMS texts.
Audit data also highlighted significant variation across ISH, with local amendment of SMS templates and additional telephone consultations between patients and clinics following SMS notification. The ISH recording fewer telephone consultations post SMS notification, resulted in more rapid attendance for treatment.
Discussion
Whilst data shows an overall reduction in the mean time for patients to access treatment following introduction of revised SMS messages, there remains considerable variation between ISHs. SMS messages naming infections, and directing patients to attend services have reduced the need for patients to telephone clinics following notification and appear to reduce TAT. Additional telephone discussion appears to delay attendance, but may result in patients being directed to specific clinics or professionals for care. Ongoing QI is focusing upon staff adoption of change and compliance with revised recall processes.
P092
Health care provider FGM routine enquiry survey
Central Northwest London, London, United Kingdom
Abstract
Introduction
Following the introduction of routine enquiry about FGM to all women attending our Sexual Health (SH) services, we sought to assess the experience and acceptability of routine enquiry amongst our staff.
Methods
An online survey was sent to all staff asking about their experience of routine enquiry of FGM in SH clinic. Data was collated and analysed on survey monkey.
Results
35 responses were received from members of the team including various grade doctors and nurses. 80% (28/35) of respondents reported asking either all of or the majority of new female attendees about FGM. 73% (26/35) of respondents felt confident or very confident in asking about FGM. 55% (19/35) of respondents reported patients giving spontaneous positive feedback about routine enquiry including feeling that it was an important questions and they were glad to be asked. 5/35 (14%) of respondents reported women disclosing FGM at routine enquiry that they had never previously spoken about with any medical professional. No-one (0/35) reported that they had received any negative feedback about routine enquiry. The majority of respondents felt routine enquiry of FGM was acceptable (86%; 30/35) and valuable (89%; 31/35) in the SH clinic. 69% (24/35) reported having observed FGM during an examination
Discussion
Staff experience and confidence in routine enquiry of FGM was generally very positive. Staff reported that routine enquiry was able to identify previously undisclosed survivors of FGM and allowed opportunity to address any complications related to FGM, signpost and to raise awareness. Our survey supports that routine enquiry is acceptable to and felt to be useful amongst staff in a Sexual Health setting.
P093
Referrals to a sexual health clinic – are they appropriate?
iCaSH Suffolk, Bury St Edmunds, United Kingdom
Abstract
Introduction
Our objective was to assess referrals to our sexual health clinic from other clinical settings. Our standard was based on the Clinical Knowledge Summaries for Sexual Health provided by the National Institute for Health and Care Excellence (NICE).
Methods
We undertook a prospective audit of new and rebook patients with genitourinary symptoms attending the clinic between February and March 2020. Patients referred to the local sexual health clinic by general practitioners and hospital teams were identified on the triage form. Further clinical and demographic information was collected from the electronic patient records.
Results
Triage forms were available for 176 patients with symptoms in the audit period, of which 46 (26%) were advised to attend by GPs and local hospitals. Of these, 17 referrals (37%) did not meet NICE guidance. Only 2 patients (4%) presented with referral letters. Referred patients most commonly presented with multiple symptoms, including discharge, dysuria, abdominal and genital pain. In 12 cases (26% of referrals) screening was undertaken but no diagnosis was made or treatment required. The most common diagnoses in referred patients were chlamydia (19.5%), non specific urethritis, and warts (9% each).
Discussion
A significant proportion of referrals fell outside of NICE guidelines, and the purpose of the referral was unclear for some patients due to the lack of referral letters. This audit highlights a need for improved communication between healthcare professionals and the local sexual health clinic. Local patient care pathways should be reviewed to include clearer guidance about screening within primary care and criteria for providing referral information.
P094
Identifying opportunities to improve chlamydia screening pathways in Derby City and Derbyshire
1Public Health England, Nottingham, United Kingdom
2Derbyshire County Council, Derbyshire, United Kingdom
3Derby City Council, Derby, United Kingdom
4Royal Derby Hospital, Derby, United Kingdom
5Public Health England, London, United Kingdom
Abstract
Introduction
Chlamydia remains the most common bacterial sexually transmitted infection in England. Sexually active young adults are at greater risk of acquiring the infection which is often asymptomatic and if left untreated can result in complications. In November 2019 a group of stakeholders from Derby City and Derbyshire attended a workshop to identify how local chlamydia screening pathways can be strengthened.
Methods
Before the workshop attendees completed an audit tool to illustrate their local footfall, offer and uptake of a chlamydia test. This information was combined with data from Public Health England chlamydia surveillance system to create a data pack across the Chlamydia Care Pathway (Figure 1).
Working in groups, attendees reviewed their local data pack. Opportunities to enhance screening and potential barriers were explored using quality improvement methodologies; fishbone and driver diagrams.
Results
Barriers to offering and uptake of chlamydia screening in rural villages, entertainment venues, vulnerable groups and a NHS Termination of Pregnancy (ToP) service were explored. Figure 2 illustrates the barriers identified in the ToP service.
Discussion
The advantage of using local data led to highly focused discussions of how to enhance uptake. Gathering relevant stakeholders encouraged collaborative working and sharing of local pathways to establish a more unified approach across the different settings.
The next steps are to update and develop the local Chlamydia Pathway Action Plan;
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P095
To what extent are community pharmacists "Spotting the Signs" and acting appropriately according to the child sexual exploitation safeguarding training?
1School of Pharmacy, University of Birmingham, Birmingham, United Kingdom
2Umbrella Sexual Health Service, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
Abstract
Introduction
Umbrella sexual health service (SHS) has provided access to limited services through community pharmacists (CP) since 2015. All SHS practitioners should be able to recognise signs of child sexual exploitation (CSE). CP undertake generic children’s safeguarding training which includes identification of signs or risks of CSE, and are expected to have a safeguarding policy. Umbrella provides some additional training and incorporates proformas to screen for CSE into the CP electronic records (Pharmoutcomes®). There has been limited oversight into safeguarding practises within Umbrella community pharmacies and so it was considered essential to review this.
Methods
A retrospective analysis was undertaken using the anonymised routine data, collected from the Pharmoutcomes® CSE proformas for under 18-year-olds, between 1st January 2019 – 30th September 2019. Analysis explored the recording of concerns when risks or vulnerability of CSE were identified and what actions were taken. CSE assessments were stratified using a traffic light system. The data was further analysed for any patterns, including geographical spread and reviewed against local CSE intelligence and 2019 deprivation index scores.
Results
1336 records were analysed. Few (10) concerns were recorded and reported compared to the numbers of risks (569) and vulnerabilities (142) identified through the independent risk stratification. Explanations were not provided as to why concerns were not recorded. Geographical analysis showed that potential CSE risk is widespread across Birmingham. Clusters of heightened CSE risk were evident in the south and north-west of Birmingham, where constituencies were associated with increased deprivation.
Discussion
CP are not recording appropriate levels of concern, action or explanation on Pharmoutcomes® when potential CSE risks are present. CP are well placed across Birmingham to identify CSE risks via the SHS, and contribute to local CSE intelligence. Analysis highlighted key areas of the safeguarding process and training within community pharmacy that can be improved to allow more effective safeguarding.
P096
An evaluation study of the experiences of deaf sign language users who have accessed sexual health services in South England
1London Borough of Croydon, London, United Kingdom
2Brighton and Sussex Medical School, Brighton, United Kingdom
Abstract
Introduction
Research has shown that Deaf sign language users worldwide often receive a different and less than accessible level of care compared to non-Deaf people whilst accessing any health services. There is currently limited research and evaluation into Deaf people and their experiences of accessing sexual health services.
Method
An evaluation study using qualitative interviews to investigate the experiences of Deaf people who have accessed sexual health services. 5 Deaf, British Sign Language users (3 men, 2 women) were recruited from the South of England, interviewed in British Sign Language, either in person or via video telephony. The video recorded conversations were translated into English. The conversations were themed, analysed and 5 main themes developed.
Results
Themes identified were (i) access to sexual health information, (ii) methods of contact with sexual health services, (iii) accessibility of sexual health venues, (iv) experiences of communication with a range of health care professionals, and (v) quality of aftercare. Experiences were varied amongst the Deaf people interviewed with key information on websites not being accessible in British Sign Language users, poor booking processes in terms of providing interpreters as well as lack of interpreting provision and Deaf awareness. Staff were often acknowledged as trying their best, but not having the skills to offer an inclusive service.
Discussion
Transformation of sexual health services in England needs to include improving the accessibility for people who are Deaf, by providing more information in British Sign Language, accessible waiting areas, clear booking processes that allow for seamless booking of qualified interpreters and Deaf awareness to be delivered to staff who deal with service users. These findings are likely to reflect conditions by Deaf sign language users in other health and social care settings and warrants further investigation.
P097
Symptom-based M genitalium testing: a prudent approach?
Cardiff Royal Infirmary, Cardiff, United Kingdom
Abstract
Introduction
There is a paucity of evidence regarding who to test for Mycoplasma genitalium (MG). IUSTI suggest symptomatic based testing, whereas BASHH suggest testing those diagnosed with NGU or PID. To fit into our existing clinic processes, we developed a MG testing algorithm that focused on symptomatic presentation e.g. men with dysuria/discharge, women with pelvic pain. Current partners of individuals diagnosed with MG were also tested.
Methods
We implemented MG testing in February 2019 and audited after 5 months to assess the impact of our testing algorithm.
Results
223 patients were included. 62 (28%) were cis-female and 161(72%) cis-male (no patients were transgender). 137 (85%) of men tested had presented with dysuria/discharge; however, only 75 (55%) of these had a confirmed NGU. 47 (76%) of women tested had presented with pelvic pain; however, only 24 (51%) of these had a diagnosis of PID. 6 (3%) patients were tested as contacts of MG. 41 (18%) patients were tested outside of our local protocol.
The positivity rate for each group is shown below:
Discussion
Although simplifying clinic processes, a testing algorithm based on symptoms alone led to a 61% increase in testing volume, leading to potentially wasted resources. The presence of a confirmed NGU in men with symptoms was a good indicator of the likelihood of having MG. 18% individuals were tested outside of our departmental guidance, suggesting better education was needed. To ensure good antimicrobial stewardship, prudence is required when implementing new diagnostic technologies.
P098
Is it time BASHH considered different auditable outcomes for sexual transmitted infection (STI) treatment: findings from a local audit?
Umbrella, University Hospitals Birmingham, Birmingham, United Kingdom
Abstract
Introduction
The importance of timely treatment of Chlamydia Trachomatis to avoid complications and reduce rates of onward transmission cannot be overemphasised. Remote and online services are increasingly being integrated within sexual health care however it remains essential that treatment is received in line with BASHH guidance, that 85% of patients receive STI treatment within 3 weeks. The audit assesses our practice against this standard looking at treatment received in clinic and partnered pharmacies.
Methods
Retrospective audit of 75 consecutive patients who received a positive Chlamydia result from testing done in clinic and with self-test kits between 28/05/2019-31/05/2019.
Results
66% (n = 73) of patients received treatment within 3 weeks. 7% were treated beyond 3 weeks however for 28% treatment was unable to be verified.
Discussion
Overall our service was not meeting the BASHH standard. However for 28% of patients there was no confirmed treatment. This is because it is not always possible to obtain the data of those treated outside of the service therefore the data obtained is no longer as accurate as it would have been in the past. It may be time to consider other auditable measures and outcomes to reflect the other routes patients use to access treatment, in order to ensure high standards are being met in these settings. Further work is needed on which type of patients are more likely to access which service and why and furthermore what can be done to improve treatment access. Better communication between services is needed to accurately show that patients are being treated. Furthermore education is needed to ensure other issues are addressed such as partner notification.
P099
Implementation of a local pathway for Mycoplasma Genitalium testing
160 Falcon Road Sexual Health Clinic, London, United Kingdom
Abstract
Introduction
Guidelines for Mycoplasma Genitalium (MG) testing were first published by BASHH in 2018. Using a clinic audit we identified a number of patients being tested for MG who did not meet the recommended criteria according to the BASHH MG guidelines. This had the potential to cause unnecessary anxiety for patients, particularly those with resistant MG and was an unnecessary use of clinic resources. We introduced a local pathway for MG testing and treatment with the aim of rationalising testing.
Method
An audit of all MG tests was carried out during April 2019 using data from the laboratory and clinical records of patients, audit data was presented to clinical staff alongside training on BASHH guidelines and a local pathway for MG testing and treatment. Re audit was carried out in November 2019.
Results
Discussion
Implementation of a local clinic pathway and one teaching session for the staff has been extremely successful in reducing unnecessary testing for MG. Demographics of patients across both audit periods were similar.
P100
Evaluation of face to face sexual health consultations during the start of COVID19 lockdown
Barts Health NHS Trust, London, United Kingdom
Abstract
Introduction
The COVID19 pandemic resulted in rapid change to sexual health services, pivoting to primarily virtual consultations. Face to face (F2F) consultations were reserved for specific presentations including suspected gonorrhoea, pelvic inflammatory disease or epidymo-orchitis, positive STIs requiring injections, vulnerable individuals and emergency contraception. We evaluated the F2F consultations in our service to see if they met the local guidance for attendance.
Methods
Electronic patient records were pulled for the first 40 days post lockdown. Demographics such as age, gender, ethnic group were collected. Notes were reviewed of 50% randomly selected patients to ascertain reason for booking F2F appointment, whether use of digital/video technology would have aided the consultation and whether the patient could have been managed entirely remotely.
Results
There were a total of 285 F2F episodes across the service. 43% were female, 57% male, similar to pre-COVID19. Ethnicity was not well documented (missing from 65%) so could not be compared to pre-COVID19. Review of 142 randomly selected notes found 12% could have potentially benefitted from video/digital photo for visualisation of skin lesions to aid diagnosis remotely. 8% could have been managed entirely remotely (with postage of medications). The majority of patients attended for treatment for positive STIs or LARC issues (see graph).
Discussion
The majority of patients were appropriately booked for a F2F consultation. Whilst results suggest a reasonable number could have been managed entirely remotely, there may have been other factors during the telephone consultation that led the clinician to book a F2F, which were not documented. An email photo diagnosis pathway is in development to aid our patients’ options for care. However, there will be situations where a F2F review will be needed, outside the “guidelines” and clinicians must be mindful of the balance of social distancing and ensuring those who are vulnerable get the care they need.
P101
Patient satisfaction following implementation of a telephone clinic prior to intrauterine contraception (IUC) fitting
Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
During the COVID-19 pandemic remote consultations were implemented to meet patients’ sexual & reproductive health needs, and minimise COVID infection risk to patients and staff. Patients requesting IUC were offered a telephonic consultation appointment for a clinical assessment and full counselling about their chosen IUC method. Eligible patients scheduled an IUC fitting and were sent SMS links to IUC video and postal home-sampling service for STI screening.
Methods
Patients receiving an IUC fitting between May and July 2020 were invited by SMS to complete a service evaluation through survey monkey No demographic information was recorded.
Results
30 (19%) of 156 women invited completed the questionnaire 20 (67%) were new attendees to the service; 28 (93%) rated the service as excellent and 2/30 (7% very good; 27 (90%) were very likely to access the phone clinic in the future and 3/30 (10%) likely; 30/30 (100%) stated they would recommend the service to friends or family. 27 (90%) found the online video resources helpful, 25 (83%) stated their consultation started on time, 27 (90%) were very satisfied with the waiting time between telephone appointment & fit. 5 (17%) saw the same staff member at both the telephone and IUC fitting appointments. Of those that didnt25/ 25 did not report dissatisfaction. 30/30 (100%) were satisfied with access to advice & support after the fitting and 23 (77%) were satisfied using a postal home-sampling service for STI screening prior to the fitting, the remainder were neither satisfied or dissatisfied.
Discussion
The COVID-19 pandemic has given us an opportunity to implement creative and remote modalities of SRH delivery. Implementing a telephone counselling clinic prior to IUC fitting showed high levels of acceptability with women and given this feedback will likely continue to be offered post COVID.
P102
Can a Public Health England flowchart for suspected urinary tract infection in primary care be modified and used as a tool to help diagnose and manage uncomplicated lower urinary tract infection in a sexual health clinic?
Kingston Hospital Foundation Trust, Kingston upon Thames, United Kingdom
Abstract
Introduction
Differentiating between urinary tract infection (UTI) and other genitourinary (GU) infections in women is clinically challenging. Currently no national guidelines exist to aid diagnosis and management of UTI in a sexual health setting. We undertook a retrospective observational study in a single sexual health centre to assess whether use of a modified Public Health England Flowchart (mPHEF) for diagnosis of UTI would have improved management of patients with suspected uncomplicated lower UTI, compared with actual practice in that clinic. Outcomes assessed: ability to identify UTI, antibiotic stewardship and use of departmental resources (urine dip and mid-stream urine - MSU).
Methods
Undertook a case review of all women with MSU sent over 6 month period. Patients were categorised to a symptom group: either
Results
For patients with
Discussion
This study lends support to potential patient and resource benefits of our mPHEF, but nevertheless highlights the need for further research. A prospective study assessing applicability of a mPHEF is recommended.
P103
Implementation and evaluation of telemedicine consultations in sexual health during COVID19: service evaluation and prospective patient feedback
Cardiff Royal Infirmary, Cardiff, United Kingdom
Abstract
Introduction
COVID19 has led to closure of traditional walk in sexual health services. Clinicians using telephone consultations may miss non-verbal cues such as changes in body language. NHS Wales procured video consultation (VC) software which was implemented in our clinic. We present service evaluation and patient feedback from this.
Methods
We searched electronic patient records for VC attendance codes. Patients undergoing VC were invited by SMS after consultation to complete an electronic patient satisfaction survey. They rated different elements of the experience using Likert scales and could leave additional feedback.
Results
Between 04/04/2020-17/07/2020, 227 patients had VCs; 105 were new and 115 were follow ups. The median age was 33 ranging from 15–78 years and 102, (45%) were male. Consultations were mostly for GUM 123 (54%) but also SRH (16%), HIV (16%), PREP (6%) and counselling sessions (9%).
62 patients (27%) completed the survey. 44% were aged 25–34. 35% of the survey responders had accessed clinic for SRH purposes only. 85% were ‘very satisfied’ when asked about the overall VC. 89% were ‘very happy’ with the length of time spent with the practitioner and 89% felt ‘very happy’ that their privacy had been respected. 98% said that they would use it again and 98% would recommend it to a friend. In the freehand section, the overall individual feedback was positive including from vulnerable groups in our local population.
Discussion
VC has been used extensively in our integrated service and has allowed the service to manage demand and maintain quality during the COVID19 pandemic. The participating service users match our local patient demographics. The VC experience was highly satisfactory to those who responded to the survey. Although the use of VC will not be possible for all, this service enables us to prioritise those groups who need face to face contact whilst maintaining social distancing.
P104
Maintaining and sustaining open access PREP behind closed doors – development of an online service to minimize COVID19 risk to patients and healthcare workers whilst providing HIV prevention to people at risk
1Cardiff Royal Infirmary, Cardiff, United Kingdom
2Public Health Wales, Cardiff, United Kingdom
Abstract
Introduction
In Wales, PrEP has been freely available for at risk groups such as MSM and trans people since 2016. Despite lockdown measures, casual sex continued for some causing concern about HIV acquisition. Due to a need to reduce face to face visits and provide a service following clinical staff redeployment to COVID wards, the service developed a new model for PrEP provision. Postal kit testing for HIV became available in Wales regardless of age or risk and this provided an opportunity to integrate these services and provide remote PrEP services.
Methods
We examined clinical information, attendance and prescribing data collected from EPR during the COVID19 outbreak and compared with 2019.
Results
Between 01/02/2020-01/04/2020, 186 attended the PrEP service in anticipation of lockdown compared with 111 in 2019. During this period six monthly PrEP was issued with advice to switch to event based dosing where possible. Between 01/04/2020-17/07/2020 93 patients went through the virtual clinic where care was provided by video and telephone consultations and postal kit tests for HIV and renal function compared with 283 in the same period in 2019. 1 used the pharmacy home delivery service whilst all others preferred to pick up PrEP at the clinic pharmacy. 1 patient known to the PrEP service did not access the clinic for further prescriptions during lockdown and seroconverted as lockdown eased.
Discussion
Many people changed sexual behaviours early in the COVID pandemic, yet acute HIV infection was diagnosed in our cohort despite advice to avoid sex with casual partners during the lockdown, highlighting the importance of maintaining provision of HIV biomedical prevention services. PrEP services can be safely delivered outside of the traditional face to face setting via remote or online clinics. These models could also be applied outside of the pandemic to improve access in a format that some patients prefer.
P105
A comparison of safeguarding assessments amongst service users (SU) under 18 accessing an electronic sexual health service (e-SHS) and a Genitourinary Medicine (GUM) face-to-face (F2f) sexual health service (SHS)
Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
Availability and popularity of e-SHS is increasing in a bid to capitalise on more cost-effective options for managing asymptomatic individuals, within a climate of budget cuts in sexual health. Our e-SHS is integrated within a network of F2f-SHS, and offers those aged 16 years or older, free postal STI testing. All <18s complete a self-populated mandatory e-consultation. This includes a safeguarding assessment based on the nationally endorsed Spotting the Signs proforma, also used by our GUM F2f-SHS. We audited safeguarding triggers and outcomes after risk assessment in e-SHS & GUM F2f-SHS and explored how different modalities of care may influence triggers and outcomes.
Methods
Demographic, STI testing and safeguarding data was collected retrospectively from electronic records of 16 & 17 year old e-SHS SUs between 8th January - 18th September 2018 and the first 296 new SUs attending a GUM F2f-SHS after 2nd Jan 2018.
Results
Table 1: Sociodemographic, STI, and safeguarding data
Discussion
Both e-SHS and clinic populations were broadly similar in age, gender and Chlamydia Trachomatis prevalence. This review demonstrated that safeguarding assessments are integral to the e-SHS and largely comparable to work done in GUM F2f-SHS. E-SHS SUs triggered more safeguarding questions compared to F2f-SHS with higher self-reporting of age imbalance, abuse, gifts, money, alcohol, drugs and use of drugs & alcohol for sex, but this compared mandated user-completed responses versus HCP-completed responses. SUs self-disclosing safeguarding risks can be risk assessed telephonically by health advisors in keeping with F2f-SHS processes. Aligning existing e-SHS provision into clinical networks can aid information exchange. We recommend those offering services targeting U18s run in parallel to F2f-SHS with clear referral pathways and development of information sharing protocols to best support the needs of this cohort.
P106
Two-week wait referrals from a busy London sexual health service during the COVID-19 pandemic
1160 Falcon Road, Chelsea & Westminster Hospital NHS Trust, London, United Kingdom
2Central London Community Healthcare NHS Trust Foundation Trust, London, United Kingdom
3St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
The two-week wait referral system exists to allow patients with suspected cancer to be assessed by an appropriate specialist within a two week time frame. The aim of this project was to evaluate the two week wait referral rates in a busy London Sexual Health service and look at whether the nationwide lockdown, during the COVID-19 pandemic affected this.
Methods
The nationwide COVID-19 lockdown started on 23rd March 2020, however for data collection purposes, data was collected for the number of two week wait referrals made during April, May and June 2020 which we defined as “lockdown” and for the same months of the previous year. This was compared to the total number of attendances to the service during both time periods.
Results
No significant fall in the number of two week wait referrals was found during lockdown except for during the month of April 2020 where none were made. This was correlated also with the fewest numbers of attendances in April 2020 to the service.
Discussion
During the COVID-19 peak of April 2020 we found the biggest reduction in attendances to the Sexual Health Service and a reduction in the number of two week referrals made. This recovered from May onward so that overall there was not a significant reduction in two week referrals from the service during lockdown compared to the same months of 2019. This was in contrast to trends seen within the General Practice community and highlights the important role that sexual health plays in identifying potentially sinister pathology in a time of restricted access to services.
P107
Incorrect advice to stop breastfeeding is compounded by omissions in BASHH guidelines
1University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
2University of Bristol, Bristol, United Kingdom
Abstract
Background
Breastfeeding offers health benefits for mother and baby. Rates in the UK are amongst the lowest in Europe, and rapidly fall during the first year. Prescribing during breastfeeding can leave women facing the dilemma of prioritising their health or continuing to feed their child. Incorrect advice may lead women to stop breastfeeding unnecessarily or avoid recommended treatments.
Methods
A retrospective review of all patients attending our service from March 2018-March 2020 was completed to identify all patients documented as breastfeeding. Electronic case-notes were reviewed to identify prescribing advice given regarding safety of breastfeeding. This was compared to BASHH and FSRH guidelines.
Results
In 35 consultations, the patient was documented as currently breastfeeding. The age range was 17–41 (mean = 35) with infants aged 2 weeks-3 years. The primary reason for consultation was contraception in 30/35 (86%) and GUM in 5/35 (14%). 0/16 consultations where infants <6months discussed lactational amenorrhoea method (LAM). A review of relevant BASHH guidelines revealed information lacking on breastfeeding. All medications prescribed were safe in breastfeeding. 3/35 (9%) were given incorrect breastfeeding advice. 2/35 (6%) chose to stop breastfeeding due to information provided.
Discussion
Promoting and managing breastfeeding is an important aspect of holistic sexual healthcare. Low numbers of women were documented as breastfeeding, perhaps reflecting omissions in history taking or documentation. Contraception was provided safely. However, LAM was not discussed, preventing women from making fully informed decisions. Following unnecessary advice to stop breastfeeding results in loss of health benefits, comfort and bonding even when this is no longer the infant’s primary source of nutrition. It is rarely possible or practical to ’pause’ breastfeeding. Use of up-to-date evidence from the Drugs and Lactation Database and the Breastfeeding Network may inform safe prescribing and preserve breastfeeding. This data should be added to all national guidelines to support women on their breastfeeding journey.
P108
Nursing Associates: do they have a place in the sexual health team?
1Western Sussex NHS Trust, Crawley, United Kingdom
2Chelsea and Westminster NHS Trust, London, United Kingdom
3Brighton and Sussex University Hospitals, Brighton, United Kingdom
Abstract
Introduction
Nursing Associates (NAs) are ‘members of the nursing team, who have gained a Foundation Degree...enabling them to perform more complex and significant tasks than a healthcare assistant but not the same scope as a graduate registered nurse.’1 We wanted to assess whether NAs are currently employed within sexual health services, and how this new role is perceived.
Methods
A survey sent to all members of BASHH via the quarterly newsletter. Members were asked to circulate to teams.
Results
All responding services employ band 2/3 Health Care Assistants (HCAs). In most services, HCAs perform venepuncture (57/100%), Microscopy (39/68%), chaperone (57/100%). Some HCAs give vaccinations (13/22%) and perform point of care HIV tests (35/61%). 10% (6) respondents currently had Nursing Associates employed within their team. Only 25 (43%) respondents felt that they fully understood the role. Reasons for not employing NAs included: lack of understanding of the role (23/44%), commissioning arrangements (17/32%), and HCAs/Band 5s are currently fulfilling the role a NA would achieve (35/67%). There was appetite for a national job description (JD) for NAs. Some respondents felt that the lack of a JD was impeding the NAs ability to work to the full extent of their role. Comments included: ‘[NAs] can’t currently work to PGD. [This] would make their role a lot more useful within SHS.’ ‘I am not sure I would feel comfortable with Nursing Associates undertaking care which requires clinical reasoning and decision making’
Discussion
Greater understanding of the NA role is required for them to be fully utilised. A generic job description, and a reassessment of commissioning arrangements would help services integrate them into their staffing structure along with creating links with the RCN, FSRH and BASHH to bring out its full potential.
P109
Implementing a rapid sexual health testing, diagnosis and treatment service: qualitative evaluation
1University of Bristol, Bristol, United Kingdom
2Unity Sexual Health, Bristol, United Kingdom
3Public Health England, Bristol, United Kingdom
Abstract
Introduction
Unity Sexual Health in Bristol re-designed its service to improve access and delivery of care. This includes a Panther (Hologic Inc) system at the point of care to provide rapid STI tests, allowing Nucleic acid amplification testing results for STIs including gonorrhoea and chlamydia to be available within four hours. Previously patients waited over a week for results.
Methods
A qualitative evaluation is running alongside the implementation of the new service, to understand experiences, and inform its iterative development. A total of 21 members of staff and 26 patients were interviewed, and 40 hours of observations conducted of the service in operation, were analysed thematically.
Results
Implementation of the new service required co-ordinated changes in practice across multiple staff teams. Patients also needed to make changes to how they accessed the service. Multiple small ‘pilots’ of process changes were necessary to find workable options. For example, the service was introduced in phases beginning with male patients. This responsive operating mode created challenges for delivering comprehensive training and communication in advance to all staff. However, staff worked together to adjust and improve the new service, and morale was buoyed through observing positive impacts on patient care. Patients indicated that while increased certainty in advance regarding service access was desired, patients valued faster results highly. Patients reported that they were willing to drop off samples and return for a follow-up appointment the same/next day, to receive treatment in accordance with test results.
Discussion
Implementation of service changes to improve access and delivery of care in the context of stretched resources can pose challenges for staff at all levels. Early evaluation of pilots of process change, provide opportunities for prompt feedback enabling adjustment, is valued. Visibility to staff of positive impacts on patient care is important in maintaining morale. The service was acceptable to patients.
P110
RESS-Q: reducing errors in sexual health samples - a quality improvement project showing sustainability
1Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
2Leeds Sexual Health, Leeds, United Kingdom
Abstract
Background
In 2019, Healthcare Assistants (HCAs) reported an increased workload, contacting patients to repeat sexual health samples due to human error. We found that 600 samples were not processed between January to June 2019, affecting 500 patients (2.5% of patients). 70% of non-processed samples required a repeat attendance, and 30% resulted in a missed opportunity to have a full sexual health screen.
Methods
Pareto analysis revealed 80% of non-processed samples were due to mislabelling and leaking:
A Quality Improvement Project (QIP) was developed. Three Plan-Do-Study-Act (PDSA) cycles were tested:
1 HCA-led patient identifier second check and stamp of samples at hub site
2 Data shared and team celebration event following step change
3 Upscale of second check stamp process in 4 spoke sites.
Results
Statistical Process Control (SPC) showing weekly number of non-processed samples:
Baseline weekly mean non-processed sample number improved from 20.9 to 10 (>50% improvement) following 7 successive weeks of improvement from PDSA 1. At 14 weeks the mean improved to 5.1 (75% improvement), and at 26 weeks to 3.2 (85% improvement). 85% sustained improvement since. Special cause highlights seven successive weeks of data points below the mean (statistically significant improvement).
Conclusion
Three PDSA tests of change have led to a sustained improvement of 85% in weekly number of non-processed samples. Six months of 85% improvement has saved an estimated 340 repeat attendances, a third of which patients would not attend. This has created significant capacity in our service and better patient/staff satisfaction. This project demonstrates the effectiveness of QI methodology in improving patient care through use of data, small tests of change and importantly, frontline staff engagement and collaboration.
P111
Healthcare professional experiences of the shift in integrated sexual health (ISH) service delivery as a result of the SARS-CoV-2 pandemic: What can we learn and where do we go from here?
1University College London, London, United Kingdom
2Central and North West London NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
In response to the SARS-CoV-2 pandemic, there has been an unprecedented shift in ISH service delivery. From the 23/03/20, clinics were closed, central services were reduced, telephone assessments became the standard method of service provision and staff were deployed and/or saw their roles change. A service evaluation was conducted using an online survey to capture experiences of this new model of care to work out what is/is not working; what can be improved; and to inform future service delivery.
Methods
Between 20/05/20-05/06/20, an online survey was advertised in the staff weekly bulletin. Quantitative data was analysed in Excel and STATA v15 using descriptive statistics. Free text responses were thematically categorised using the Framework for a Systems Approach to Health Care Delivery (FSAHCD).
Results
60 people responded. Responders’ characteristics and experiences are summarised in Table 1, and reflect the staff providing ISH services during this period. 85% of staff described feeling very confident or confident in providing care in the new service model, with 77% answering yes-definitely or yes-mostly to having been provided with enough support to do this. Job satisfaction differed between staff groups, but broadly remained similar to what it had been pre-pandemic. Conditions/situations that staff felt phone assessments worked well for, include: Contraception; recurrent HSV; repeat PrEP; triage; and mild symptoms. Conditions/situations that staff felt phone assessments did not work well for, and which we should not continue to offer phone assessments for, include: Young people; vulnerable patients; dermatology; more complex GUM. Thematic categorisation of free text responses using the FSAHCD are summarised in Figure1.
Conclusions
Despite the tremendous amount of change, the majority of staff providing ISH services felt confident and supported during this time. Feedback has been used to make changes to service provision, and to staff support and roles, where issues have been identified.
P112
Sexual assault (SA) reporting amongst users of online sexual health services (SHS)
1Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
2Preventx, Sheffield, United Kingdom
Abstract
Introduction
In England and Wales, 20% of women and 4% of men over 16 years have experienced some type of SA. Survivors of SA often attend physical SHS for care relating to the SA. Consequently, reported rates of SA amongst clinic attendees can be high. Online SHS are becoming increasingly available and popular and offer many advantages over physical SHS. We aim to report the rate of recent SA disclosure amongst users of our large online STI screening service and the respective outcomes of SHS-initiated telephonic discussions.
Methods
Retrospective data regarding demographics and service outcomes were collected from adults that requested a STI testing kit between 1.1.20 and 18.2.20 and reported they were a victim of a recent sexual assault on their e-triage.
Results
We found 0.5% (54% female, 45.6% male) adults disclosed a recent sexual assault when ordering an online STI testing kit. 192 (79%) users responded and engaged in a call back discussion initiated by the e-SHS team: 87/192 (45%) users confirmed a sexual assault had taken place and 101/242 (53%) users denied an assault (particularly men) stating they had made an e-triage error. 18% users had already reported their SA to the police/sexual assault referral centre, and only one user accepted an onward referral after the telephone discussion. This study found a low reporting rate of SA amongst e-SHS users, >50% respondents later cited this was an error, 25% users did not want to discuss their SA and few accepted onward referrals.
Discussion
To our knowledge this is the first descriptive observational study looking at SA disclosures amongst users of e-services. Using e-triage to screen for a recent SA followed by service-initiated telephonic support to everyone who discloses, may not be acceptable or offer utility to all.
P113
An exploration of pharmacists’ perceptions about the pharmacy chlamydia testing service
1Newcastle University, Newcastle, United Kingdom
2Durham University, Durham, United Kingdom
3University College London, London, United Kingdom
Abstract
Introduction
Chlamydia is the most common sexually transmitted infection in England. Young people are at greatest risk of the infection. Many community pharmacies provide free chlamydia testing for young people but testing activity in this setting is very low compared to other venues. The reasons why uptake is low in pharmacies are unclear. Therefore, this study aims to understand why by exploring the perceptions of pharmacists about the service.
Methods
22 pharmacists were recruited to take part in the study through stratified sampling based on whether they provided testing or not, sex, and type of community pharmacy they worked at. One-to-one, semi-structured interviews were conducted and analysed using thematic analysis to generate themes. The responses were then re-coded under constructs of the Normalization Process Theory (NPT) model to understand how the testing service was integrated into routine work.
Results
The themes generated from analysis of the interviews are illustrated in Figure 1. Pharmacists believed that they had the clinical knowledge to counsel on chlamydia testing but disclosed that with further training they could communicate more effectively with young people, particularly young males. They perceived that young people were unaware of the testing service, which they felt led to a low request rate for the kit. They favoured a test and treat service and said it would expand service provision.
Discussion
This is the first study to use the NPT model to understand how pharmacists currently implement the chlamydia testing service and their perceptions about it. The model identified that greater collaboration with pharmacy support staff and with other disciplines was necessary to promote the service. Furthermore, pharmacy training on how to deliver a youth-friendly service and raising awareness about pharmacy chlamydia testing may facilitate uptake rate.
P114
Improving Hepatitis B primary prevention: thorough risk assessment is key
Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
Abstract
Introduction
Hepatitis B virus (HBV) is a blood borne virus (BBV). Sexual transmission is uncommon but increased by specific risk factors (RF). Acute infection increases transmission risk, can lead to fulminant hepatic failure and is a notifiable disease. Chronic infection can result in cirrhosis and hepatocellular carcinoma. Screening and vaccination are central to prevention. We assessed whether patients attending a busy urban sexual health clinic over a three-month period were risk assessed, screened for HBV (if eligible) and offered vaccination (if appropriate) as recommend by BASHH guidelines.
Methods
We reviewed the electronic patient records (EPR) of 50 randomly selected patients attending the walk-in service with ≥1 BBV RF documented.
Results
All patients in our sample had the BBV risk assessment completed. Completion rates were lower (61%) when evaluating all patient attendances over this period. 74% (n = 37) had one RF with 26% having more than one. 44% (n = 31) were MSM, while the remaining 56% had other HBV RFs. Only 50% (n = 25) of patients were screened for Hepatitis B. Vaccination was already complete in 32% (n = 16). Only 32% (n = 11/34) of eligible patients were offered vaccination.
Discussion
While RF documentation and management were good for MSM, HBV screening and vaccination in other patient groups represents a key area for improvement. Current interventions include updating our EPR BBV risk assessments, with additional RF prompts and reminders to complete this for every attendance. A new user-friendly hepatitis guideline has been developed, based on national BASHH guidance, with local PHE and viral hepatology expertise. Incorporating simplified summaries, which highlight eligibility criteria for testing and vaccination, will be particularly valuable to new or junior staff members. Areas for service improvement were highlighted through multidisciplinary departmental training. Guideline changes have been well received. Ongoing intervention will improve local individual and public health for those at risk of HBV.
P115
Evaluation of the introduction of a specialist sexual health nurse advisor to follow up children who have attended a Sexual Assault Referral Centre (SARC)
1Mountain Healthcare, Dewsbury, United Kingdom
2Locala, Bradford, United Kingdom
Abstract
Introduction
A 2019 CQC review of health services for Children Looked After and Safeguarding in our district recommended a solution be found for the gap in the follow up STI testing of children under the age of 13 (U13s) who had been sexually assaulted. Previous pathways to manage these cases had broken down with the evolution of the SARC: local paediatricians had been deskilled in child sexual abuse medicals after the contract moved to the SARC and no longer felt able to support the joint assessment of these children with their genito-urinary medicine colleagues. A pilot project was proposed. A Specialist Sexual Health Nurse Advisor (SSHNA) and strategy manager would be employed within the SARC to manage the cases of children under the age of 16 who had attended the SARC for a period of a year. The proposal included mentoring by local sexual health and contraception consultants.
Methods
a retrospective review of the cases seen by the SSHNA between June 2019 and December 2019. 77 were seen by the SSHNA: 4 male and 73 female, aged 1 to 15. 73 had experienced an acute sexual assault (within 13d). 70 had baseline screening. 74 had follow up screening, of which all were in their home. 74 had swabs/urine for CT/GC. All of these were obtained at 2w after the date of the alleged incident. 70 had bloods for HIV and syphilis. 1 Candida infection was identified.
Discussion
The pilot project was deemed a success as it had solved the issue of STI screening in a vulnerable group for whom attendance at a sexual health clinic or paediatric outpatients would have been inappropriate. The successful liaison with sexual health colleagues facilitated training of the SSHNA and pathways into care for teenagers with ongoing needs. Reassuringly no STIs were identified however in this group.
P116
A re-audit of the assessment and management of proctitis in MSM
Central and North West London NHS Foundation Trust, London, United Kingdom
Abstract
Background
Proctitis is an important presentation in MSM attending Sexual health services. It is associated with a number of aetiologies leading to morbidity and potentially facilitating onward transmission of HIV and Hepatitis-C. We re-audited the assessment and management of MSM presenting with clinical proctitis to a London Sexual health service, monitoring performance since the previous audit in 2015.
Method
A total of 75 patients coded as “non-specific proctitis” were identified from our electronic records database between September 2018 and July 2019. 51 of these records were randomly selected to audit a 95% compliance to the following standards: 1) Testing as per local guidelines to include: rectal Gonorrhoea culture and NAATs for Chlamydia / Gonorrhoea / HSV1 / HSV2 / T.pallidum; serology for Syphilis and HIV. 2) Proctoscopy examination performed. 3) Syndromic treatment prescribed according to local guidelines. 4) Documented discussion of partner notification. 5) Repeat STI screening 3 months following initial presentation.
Results
1) 68.6% tested as per guidelines, (25% improvement), 31.4% partially tested. 2) 94% were offered proctoscopy examination, (6% improvement), 6% declined. 3) 62.7% were treated empirically with a 1st line regimen as per local guidance. A further 33.3% were treated partially with 2 cases (4%) not offered any initial treatment.4) 31.4% had documented discussion of partner notification. 5) 52.9% had repeat STI screening at 3 months following initial presentation.
Conclusions
The audit highlights improvements in clinical examination and appropriate initial testing. Areas for staff development focused on stricter adherence to local treatment guidelines, recommending initiation of empirical therapy for HSV proctitis and improvement in documenting advice given on patient partner notification and repeat screening. Meeting the 95% completion for repeat screening is reliant on patient engagement and we are unable to exclude the possibility of patients re-testing elsewhere. The limitations in sampling documentation may not truly represent all patient communication.
P117
Benzathine penicillin injections for the management of syphilis: One needle or two? Comparing patient perception, pain scores and cure rates of different injection techniques
Locala, Bradford, United Kingdom
Abstract
Background
BASHH guidelines for management of syphilis recommend 2.4MU benzathine penicillin is reconstituted with lidocaine into an 8ml dose which is then split into two parts of 4ml to be injected into each buttock. Our organisation has been running 2 separately commissioned sexual health services since 2016. Service A administered injections in line with above BASHH guidance. In service B, as instructed on drug packaging insert which states a required 6ml of dilutent, it had been established practice to give only one injection with a total volume of approximately 6.3ml.
Aim
To compare these differing methods of administration and unify practice across the whole service
Method
All patients attending for treatment of syphilis with benazathine penicillin were asked to complete a short questionnaire. Before treatment they were asked if they would prefer one larger injection or 2 smaller infections (with picture explanation). Post-treatment they were asked to give a pain score of 1–10. Records were then reviewed to determine RPR response at follow up.
Results
28 patients completed the questionnaire between November 2018 and February 2020 (15 in service A and 13 in service B). 24/29 (83%) said they would prefer one large injection. Mean pain score in service A was 2.9 (range 0–5) compared to 3.0 in service B (range 0–8). 6/15 in service A and 6/13 in service B have returned so far for at least one follow up serology and all demonstrated a satisfactory fall in RPR.
Discussion
This small study suggests that a single larger volume injection is preferred by most patients. Pain scores were comparable for both techniques. Follow up rates were low but we did not find any cases of suspected treatment failure. Guidance for our whole service is now to administer one single 6.3ml injection.
P118
Stevens-Johnson reaction during neurosyphilis treatment: Probenecid or a late onset penicillin allergy?
1Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
2University of Bristol, Bristol, United Kingdom
3Population Health Sciences, University of Bristol, Bristol, United Kingdom
Abstract
Introduction
A Caucasian man who has sex with men presented with early neurosyphilis and subsequently developed a severe atypical rash on day 9 of treatment with procaine penicillin IM and probenecid. We discuss the clinical case, the potential causes, and the implications for future management.
Methods
He presented to our clinic with widespread rash, alopecia, fatigue and bilateral hearing loss having been treated for early syphilis in Dubai, one month previously with a single dose benzathine penicillin 2.4MU IM injection. We performed syphilis serology: IgM positive, TPPA>1:1280 and RPR 1:64, HIV negative. Audiogram showed bilateral sensorineural deafness. Early neurosyphilis was diagnosed. No known history of sulpha-drug allergy or any other allergies were documented. Daily procaine penicillin 2.4MU IM with oral probenecid 500mg QDS for 14 days was commenced. Steroids were not deemed necessary given his recent benzathine penicillin injection.
Results
On day 9 of treatment he developed itchy wheals. A repeat allergy history was taken, and apart from the medication that we had prescribed, no other allergens or potential causes were identified. On examination, there were approximately 10 skin-coloured indurated swellings, which were desquamated and slightly crusted, with surrounding erythema. The largest diameter was 7cm. Probenecid and procaine were immediately discontinued. He completed treatment with doxycycline. Initially, the lesions increased in number and severity but resolved following 3 days prednisolone 60mg OD. Follow up RPR confirmed effective treatment. His hearing returned to normal.
Discussion
As these lesions were consistent with Stevens-Johnson syndrome (SJS), the Immunology team advised against challenging him with either medication, as the reaction could worsen. Therefore, the culprit drug could not be determined. Prescribers should be aware that procaine penicillin and probenecid remain unlicensed in the UK and can both cause SJS unpredictably. Patients and clinicians administering treatment need to be aware that serious drug reactions can develop late in treatment.
P119
Prioritising staff well-being during COVID-19 in a busy London sexual health clinic: results from a quantitative anonymised staff survey
Sexual Health South West London, London, United Kingdom
Abstract
Introduction
The COVID-19 pandemic has challenged how the NHS operates and increased pressure on its staff. Our Sexual Health service remained open and actively prioritised staff well-being through initiatives to relieve stress and create a positive work environment. We assessed the initiatives’ impact on staff well-being.
Methods
All staff (n = 52) were asked to complete anonymous electronic questionnaires. Questions adapted from Edinburgh-Warwick Well-being Scale, Reeders Stress Scale and the Multidimensional Fatigue Inventory were used to assess well-being. A Likert scale compared their mental health prior to and during COVID-19, before and after implementing well-being initiatives: stretching exercises, dancing, mindfulness/meditation, team walks/chats, mindful colouring, masked singing, food and toiletry donations and well-being bags (containing masks, sanitising wipes, hand cream, tea and biscuits). Perceptions regarding initiative usefulness and the Trust’s and Department’s attitudes toward staff well-being were analysed.
Results
The survey response rate was 60% (31/52). Respondents were mainly female (71%), aged between 25 and 64 years, comprising of doctors (n = 6), nurses (n = 7), healthcare assistants (n = 2), health advisors (n = 5) and administrative staff (n = 6). Median (IQR) Likert-scale scores before, at the start of COVID-19 and after initiatives (Table 1) were 3.57 (2.94,3.87), 3.31 (3.14,3.58) and 3.33 (2.98,3.58), respectively (P>0.05). 74% engaged in the initiatives (Table 2). Reasons for non-engagement included embarrassment (n = 2), pointlessness (n = 6), worry about infection risk (n = 1) and not wanting to spend time with colleagues (n = 1). Three people felt pressured into participating. Nine working from home felt excluded. The most and least popular initiatives were stretching exercises and dancing, respectively. 55% and 39%, respectively, thought the Department and the Trust took their well-being seriously.
Discussion
Most staff engaged in the initiatives, which helped maintain their well-being during a stressful and anxious period. As another COVID-19 peak remains imminent, we will use the feedback to develop our well-being service to support staff effectively.
P120
Unintended consequences: assessing adverse patient outcomes due to access restriction in a semi-rural sexual health clinic
1Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
2North Devon Healthcare Trust, Exeter, United Kingdom
Abstract
Introduction
Access to sexual health services has become increasingly constrained since health-service restructuring in 2012. Since September 2019 a sexual health service in a semi-rural university town has been required to operate a cap on patient numbers in order to meet commissioning targets. Due to concerns about unmet patients’ needs (or delays) leading to adverse outcomes, a survey was run to explore access problems and attempts made to correlate with clinical outcomes.
Methods
Patients attending the walk-in service and booked appointments were surveyed once day a week for 12 weeks. Data was collected regarding: days waited for appointments (and mitigating factors), occasions turned-away from the walk-in service, attempts to access other providers for care. Clinical records of patients who waited >7 days for an appointment or were turned away at least once from the walk-in were interrogated to explore adverse outcomes as a result of delayed time to assessment.
Results
394 patients were surveyed. 126/394 had already attempted to access other healthcare services: A&E (4), GP or Student Health Centre (90), Walk-In Centre (29), ‘other’ (3). 19% of patients attending the walk-in had been turned away at least once, whilst of 149 patients who attended booked appointments, 49.7% of patients waited >7 days for an appointment and 41.6% waited ≥14 days. 142 clinical records were reviewed. Potentially adverse events were recorded in 15, for example: running out of contraceptives, not accessing emergency contraception in a timely manner and ongoing sexual contact despite harbouring untreated STIs.
Discussion
This survey provides a number of examples of potentially adverse outcomes that resulted from delayed time to assessment. Many patients had already attempted to access other healthcare services but their needs remained unmet. Further work is needed to assess the impact of restructuring of services on patient outcomes.
P121
Grab ‘n’ go: an express STI testing clinic in Scotland in response to the COVID-19 pandemic
Sandyford Intiative, Glasgow, United Kingdom
Abstract
Introduction
Methods
Data was gathered from our IT system NaSH. For a snapshot period of 36 days we examined demographics, number of attendances, DNAs, presenting complaint, positive STI tests and subsequent follow-up appointments.
Results
402 appointments made, 59 (14.7%) DNA’d. 209 identified as female (60.9%). The most common age group was 20–24, accounting for 30% of all tests. 263 (76.7%) were heterosexual, 40 (11.7%) were MSM. The most common presenting complaints were change in vaginal discharge (68, 19.8%), dysuria (53, 15.5%), PV bleeding (38, 14%) and being an STI contact (27, 7.9%). We identified 24 cases of CT (7% prevalence) and 4 (1% prevalence) cases of GC. 61 (17.8%) blood tests were performed, no new HIV or syphilis identified. Excluding routine follow-up for an STI diagnosis, 27 (7.9%) of patients went on to have a further telephone triage due to ongoing symptoms. Only 10 (2.9%) were subsequently booked in for F2F assessment.
Discussion
We have shown that F2F appointments can be avoided without compromising care by minimal contact clinics such as these. Due to the limited service in recent months, many of these patients may not have presented themselves without the “grab kit” appointments and several STIs could have been missed.
P122
‘I just called to say’: results of a patient satisfaction survey evaluating the use of telemedicine for consultations within the Oxfordshire integrated sexual health service.
1,2Oxfordshire Sexual Health Services, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
Abstract
Introduction
The COVID 19 pandemic resulted in significant restrictions for routine, non urgent clinical services, including sexual health. In line with national guidance we suspended all routine walk-in services. To preserve services for as many patients as possible we immediately implemented a remote access telemedicine service. Anticipating that this might evolve to become a permanent future model for service delivery we also sought patient opinion of the new service.
Methods
All patients who received a telephone consultation between 8th April-15th May 2020 received a text message with an anonymised patient satisfaction questionnaire. Patients who did not attend and those reporting sexual assault were excluded.
Results
898 patients were sent the survey with 174 completed responses, ∼20% response rate. Of responders, the majority were female - female 82.2% male 17.8%, reflecting our integrated contraception and GUM service. Overall, 93.7% (163/174) would use the service again, 26.2% (46/174) would prefer a face to face appointment and 4.6% (8/174) reported their needs were not met by a telephone consultation.
Discussion
Previously there has been encouraging research into the use of digital technologies for medical consultations1. There is limited existing evidence for application of these within the field of Sexual Health. Whilst telemedicine will not be appropriate for a minority of patients our early experience suggests that this modality works well for the majority of users. 93.7% would use the service again. Additionally, this service not only accommodates users but it also allows clinical staff to work remotely. This reduces footfall onto clinical sites and allows higher risk staff to continue effective working.
References
P123
Unscheduled HIV care activity in St Mary’s Hospital during the COVID peak and lock-down period
Department of Genitourinary and HIV Medicine, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, United Kingdom
Abstract
Introduction
Due to the arrival of the COVID pandemic to the UK and lockdown starting on March 23rd 2020, a restriction of unnecessary face-to-face (F2F) HIV appointments was implemented. This restriction was particularly challenging for unscheduled HIV care. In order to inform service requirements for the future, we assessed the type and rationale of clinical activity over a 10-week period encompassing the peak of COVID cases in London.
Methods
Individual notes for emergency clinic and day-ward bloods appointments were retrospectively reviewed from March 16th – May 21st 2020. Data on consultation medium (telephone vs. F2F), reason and outcome of each encounter were recorded.
Results
There were 554 emergency clinic and 40 day-ward attendances for bloods. Lockdown came into place after week one. Total F2F appointments decreased by 67% and unnecessary F2F appointments (could have been remote) decreased by 91% after week one. Before lockdown less than a third of F2F appointments had a clear rationale for in-person review. Subsequently increasing to 60–100% in the following weeks. Reasons for attendance included symptom review; follow-up for patients not established on a long-term medication regime; blood abnormalities; and IV/IM medication administration. After week three, appointments decreased by 45% and ratio of telephone consultations to F2F increased to 5:1 (1:1 prior to lockdown). Weekly prescriptions decreased by 51% following the introduction of a proactive telephone prescription service. After week eight, as new COVID cases in London dropped below 250/day, appointments for acute issues doubled.
A brief summary of activity/trends are shown in table 1 and figure 1.
Discussion
We observed a sharp decline in F2F attendances, especially unnecessary in-person reviews, coinciding with lock-down. Patient attitudes towards seeking medical advice appear to have adapted to official messages and lock-down implementation. Going forward proactive strategies to address identified patient needs (e.g. prescriptions) can help minimise future unnecessary F2F contact.
P124
Use and acceptability of Sexual Health London (SHL)
Barts Health NHS Trust, London, United Kingdom
Abstract
Background
SHL offers self-taken asymptomatic sexual health screening (SHS) in most London boroughs. Since 2018, over 200,000 Londoners have accessed the service with over 12,000 infections diagnosed. Some patients do not use the service, yet coding suggests that many could be eligible. We looked at reasons for this discrepancy.
Methods
In April 2019 we reviewed attendances eligible for SHL based on coding (T4 +/- T6/TT only). Asymptomatic patients presenting to our clinics for screening completed surveys on using SHL.
Results
204 attendances were reviewed with a median age 28 years (IQR 23–35), 52% were male and 75% were heterosexual. Of those correctly coded 66% would have been suitable for SHL with the remainder needing advice or having symptoms but no diagnosis. 176 surveys were returned with a median age of 29 years (IQR 26–34), 55% (91/176) were male and 79% (125/159) were heterosexual. 15% (26/166) had never undergone SHS and 57% (95/166) were unaware of SHL with only 20% (32/163) having used the service before. Of the 35% (53/148) who declined SHL, the only significant demographic differences occurred in those educated to degree level or above (A-level and below 10/36 vs degree level 39/55, p = 0.02). 70 participants left comments, the most common themes being misconceptions around testing offered by SHL or seeking advice from health professionals.
Discussion
A significant proportion of attendances are purportedly eligible but not suitable for SHL which is an important consideration in sexual health commissioning. There were no differences in awareness or acceptability for age, gender or sexuality. Lower acceptability was seen in those educated to degree level or above, indicating a need for targeted education around the different testing options available. Clinics should provide clear, written information on SHL for patients to allow improved access whilst retaining face-to-face services for those needing to talk to a health professional.
P125
Service users’ experiences of a large integrated sexual health (ISH) service during the SARS-CoV-2 pandemic
1University College London, London, United Kingdom
2Central and North West London NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
Delivery of ISH services underwent unprecedented change in March 2020 as a result of the SARS-CoV-2 pandemic. A service evaluation was conducted of service users (SUs) booked into phone appointments at a large ISH to understand their experience of the new service model, and to inform future service delivery.
Methods
Between 18/05/2020-30/06/2020 SUs who consented to be contacted were texted a link to an online survey following their phone appointment. Quantitative data was analysed in Excel and STATA v15 using descriptive statistics
Results
295 SUs responded to the survey. Demographic characteristics are summarised in Table 1. 51% of responders (n = 151/295) were from boroughs/areas commissioned by the service. 39% (n = 115/295) had accessed the service for the first time. Reasons for accessing the service and outcomes are summarised in Table 2. Just under 30% accessed the service because they were symptomatic; 26.8% required contraception. 16.6% of SUs were posted contraception, 26.1% were posted treatment, 12.5% were signposted to online testing and just under 1/3rd were booked a face-to-face appointment. 280 responders answered the service satisfaction questions. 71% (n = 200/280) rated the care they received as excellent, 17% (n = 47/280) as very good, 6% (n = 17/280) good, 2% (n = 5/280) fair, 2% (n = 6/280) poor, and 2% (n = 2/280) as very poor. 84% (n = 235/280) would definitely, 10% (n = 27/280 would probably, and 6% (n = 18/280) would not recommend the service to friends. 66% (n = 185/279) would be happy to have a phone assessment in future, 22% (n = 61/279) would prefer to be seen face-to-face, 4% (n = 11/279) would prefer online, 0.4% (n = 1/279) video, 5% (n = 14/279) were unsure, and 3% selected other (n = 7/279).
Conclusions
Overall, most SUs found the new model of service delivery acceptable with the majority rating the care they received highly, would recommend the service to friends, and 2/3rd would be happy to have a phone assessment in the future.
Table 1: Demographics
P126
Attendance by exception: clinical safety in a national lockdown - prove it
1Kingston Hospital NHS Foundation Trust, Kingston, United Kingdom
2Kingston Hospital, Kingston, United Kingdom
Abstract
Introduction
This cohort study of patient contacts to a SW London level 3 integrated sexual health service during initial stages of the COVID lockdown evaluated presenting complaints to a telephone management system for conversion to face to face attendances (F2F) and patient outcomes. Findings, alongside BASHH COVID pandemic guidelines, shaped clinic protocols during the ongoing and now easing lockdown.
Methods
Patients booked to the telephone management system between 30/03/2020 and 30/04/2020 were included in the analysis. Patient need was sub-categorised by clinical syndrome (vaginal discharge, dysuria) or contraceptive request and further evaluated. Additional analysis of F2F attendances versus signposting to online testing, self-management and other NHS providers was performed along with a patient feedback survey.
Results
In the study period 805 calls were received: 467 sexual health, 190 contraception, 21 sexual health and contraception and 127 other (of which 98 call-backs failed). 97 patients attended the service: 73 for F2F sexual health and 24 for contraception including a ‘click & collect’ medication service. Patients considered to have additional vulnerabilities were further managed to ensure an appropriate support offer. Repeat calls to the service were low; serving as a proxy for reassurance that initial advice had been appropriate. Further scrutiny of online patient survey feedback (low response numbers) indicated 91.97% (n = 12) satisfaction with the phone service and care or advice. Surprisingly a small proportion of respondents (n = 13) reported accessing signposted online testing (13%) or order contraception (6%).
Discussion
This analysis demonstrates phone management can be successful in the context of a lockdown. The majority of queries received optimal first-line management with over the phone advice, sign posting to online testing and pharmacies and appropriate safety netting. This approach appropriately utilised the significantly reduced level 3 clinical capacity for those most at need and has provided evidence to continue evolving into the ‘new normal’ as lockdown eases.
P127
“You guys are good at swabs!” setting up a staff and patient coronavirus testing service using existing sexual health service infrastructure in a large regional teaching hospital
1Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
2Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Abstract
Introduction
Early in the response to the coronavirus pandemic, our large Teaching Hospital asked our Sexual Health Service (SHS) team to set up a facility to test symptomatic staff and their contacts, for the 16000+ staff in the Trust. Here we describe the process and results.
Methods
The SHS team used existing staff, IT facilities and estates to set up a testing service within 24hrs of being approached. We used our existing Inform EPR, which we altered with permission. Hospital Staff, or their household (including children), who were symptomatic of covid-19 were booked electronically for a test by SHS admin team. SHS nursing staff performed testing using a specially set up drive-through facility in the car park of our existing building. The service ran in the afternoon/evening, allowing ongoing emergency SHS work to continue in the mornings. Tests were ordered and returned electronically. SHS staff used text messaging to deliver results and appropriate actions within 24hrs of swab being taken. From June 2020, we began contact tracing for positive staff and their contacts, using established Partner Notification skills in our health advising team. The service also took on testing of self-isolating pre-operative patients.
P128
Pulmonary choriocarcinoma in an HIV infected female - is it non-gestational or metastatic, following successful treatment of hydatidiform mole?
Walall Healthcare NHS Trust, Walsall, United Kingdom
Abstract
Introduction
Choriocarcinoma is a rare very malignant trophoblastic cancer, common form is gestational, arising from the trophoblast of any type of gestational event. This includes hydatidiform mole, normal pregnancy or spontaneous abortion in decreasing frequency. Non-gestational choriocarcinomas are exceedingly rare, arising from pluripotential germ cells in the gonads or midline structures (mediastinum) or in association with poorly differentiated somatic carcinomas. We report a case of pulmonary choriocarcinoma in an HIV infected female, diagnosed 4 years after treatment for a complete hydatidiform mole.
Case report
A 47-year-old female was admitted in June 2019 with a one week history of pleuritic chest pain and shortness of breath. She was diagnosed HIV positive in 2006, with a nadir CD4 of 229 cells per cu mm. She delayed starting antiretroviral therapy till March 2014, when CD4 declined to 172 cells per cu mm. She was treated for a complete hydatidiform mole in 2015 and discharged from Charing Cross Hospital after 1 year. She was fitted with a Mirena coil in March 2017 for menorrhagia. Chest Xray showed evidence of right pleural effusion and CT scan showed a 8cmx8cm low density mass in right lower lung with effusion. Her BHCG was raised at 24,494 IU/L. She was referred and had chemotherapy at Charing Cross hospital with weekly cycles for 5 months after which the BHCG had normalised. However, it began to increase again and now a combination of surgery and chemotherapy is planned.
Discussion
This could well be a non-gestational trophoblastic tumour and genetic analysis is currently being performed. It is possible that her prolonged imuno-compromised state may well have contributed to either the development of this tumour de-novo or a metastatic disease following the complete hydatidiform mole.
P129
Management of chronic prostatitis using NICE guidelines at the John Hunter Clinic
Chelsea and Westminster NHS trust, London, United Kingdom
Abstract
Introduction
Chronic prostatitis (CP) is a common condition that has a multifactorial aetiology. NICE acknowledges that CP can be difficult to treat and that effective management can be guided by UPOINT, a symptom classification system to determine clinical phenotype. NICE recommends that those with recurrent infection should be referred to Urology to exclude underlying urological abnormality.
Aims
To assess the management of chronic prostatitis with reference to NICE guidelines, and the use of the UPOINT system.
Methods
A case note review of all men with chronic prostatitis attending JHC between January 2019 and December 2019.
Results
20 patients were seen over the 1 year period, 12 were new patients. The average duration of symptoms at presentation was 5 months. All 20 cases had documentation of UPOINT. Fourteen patients had urinary symptoms, of which 4 had obstructive urinary symptoms, and of these 1 was started on tamsulosin and 3 were discussed with Urology. Eight patients had psychosocial dysfunction, 3 were referred to community psychological support. Twelve patients had organ specific. Fifteen patients were treated with antibiotics, 9 had confirmed infection. Of these, 2 were referred to Urology and 4 had complete resolution after antibiotic treatment. Four patients reported neurological symptoms and 0 patients had tenderness.
Discussion
The audit highlights the heterogeneity in the presentation and management of chronic prostatitis. In all cases, there was documentation of UPOINT which was used to guide management. Antibiotics were used in patients without confirmed bacterial infection due to the possibility of cryptic organism. Furthermore, of those with confirmed infection, 3 patients continue to have recurrent symptoms despite antibiotic treatment and have not yet been referred to Urology.
Conclusion
Chronic prostatitis is a difficult to manage condition due to the variation in presentation and the use of UPOINT can help guide management.
P130
Sexually transmitted infections in England: the state of the nation
1Terrence Higgins Trust, London, United Kingdom
2BASHH, London, United Kingdom
Abstract
Introduction
There is a gap in national ambition around and understanding of sexually transmitted infections (STIs) in England. With concerning trends, it is imperative to understand the situation in order to tackle it. This report brings together the current knowledge on STIs in England, looking at the trends in STIs, who they are affecting, why we are seeing these trends, and why some people are more affected than others.
Methods
This was a secondary research project using a literature review, compiling publically available data on STIs in England. Databases and search engines were used to collect the data including google scholar, and PubMed. Grey literature, academic journals and policy documents were included. Framework analysis was then used to identify key themes. A data summit involving key stakeholders was carried out to corroborate and prioritise the findings.
Results
STI trends in England were identified. 8 key themes were identified- Inequalities, national vision and priority, behaviours, a lack of prevention options, the need for sustainable sexual health services, access, awareness and information, and visibility and stigma. Issues highlighted included the disproportionate burden of STIs among men who have sex with men and some BAME communities, as well as identity erasure, including trans and non-binary people, in the surveillance data. Gaps in the available research were identified.
Discussion
There were 447,694 new diagnoses of STIs in England in 2018, against a backdrop of deep funding cuts and demand outstripping availability for sexual health services. The report highlighted structural inequalities, compromised sexual health services with reduced access, and issues of STI stigma, all amid a lack of research and data. The political context of public health funding cuts, minimal strategic vision, and fragmented commissioning, have done little to improve STIs in England. A number of recommendations for improvement and further research were made.
P131 Withdrawn
P132
Real-time and enhanced surveillance of STIs in England (RESTI)
Public Health England, London, United Kingdom
Abstract
Background
Sexually transmitted infections (STIs) are highly dynamic, and the continued rise and occurrence of outbreaks burden the populations that are most affected. Emerging threats for STI control include the rise of antimicrobial resistance, novel pathogens, new clinical presentations of familiar pathogens, and transmission within new risk groups due to changes in human behaviour. Real-time and enhanced surveillance is needed for efficient public health action.
(i) Continuous routine surveillance assessed frequently by combining, matching, and critically appraising monthly outputs of laboratory and clinical datasets to triangulate exceedances and changes in STI trends.
(ii) Enhanced surveillance to supplement the routine data, through multidisciplinary approaches, including spatial epidemiology, social sciences, and state-of-the-art bioinformatics, applied in collaboration with internal partners, and through external partnerships with academia.
(iii) Active investigation of exceedances, coordinated with stakeholders at the local authority level to obtain and interpret enhanced clinical, epidemiological and laboratory data.
(iv) Fit-for-purpose surveillance outputs produced following design thinking principles, disseminated to engage stakeholders across the health sector and foster local and international collaborations.
Operational research to improve data quality is conducted across all domains.
Current activities:
• Monitoring the syphilis action plan: developing new metrics using data from sexual health clinics, the Infectious Diseases in Pregnancy Programme, and Blood Services.
• Informing qualitative research to understand the rise of heterosexually transmitted syphilis.
• Real-time monitoring of antimicrobial resistant gonorrhoea to evaluate the effect of ceftriaxone monotherapy in drug susceptibility.
• Investigating factors behind changes in trends of Lymphogranuloma venereum.
• Examining and investigating exceedances and clusters of sexually transmitted shigellosis among men who have sex with men.
P133
Cost saving antriretroviral switch: a patient perspective
1Ysbyty Gwynedd, Bangor, United Kingdom
2Cardiff Royal Infirmary, Cardiff, United Kingdom
Abstract
Introduction
In recent years there has been increasing pressure within the NHS for cost saving. One area identified for cost saving has been switching form branded antiretroviral therapy (ART) to generic formulations. In 2017 our department performed and audit that showed that swapping patients from branded ARVs to generic formulations was cost effective. (1) However, we had not previously looked at whether this change was acceptable to our patients.
Methods
We retrospectively identified patients who had been switched from branded to generic medications. In order to assess the acceptability of ARV switch to our patient cohort, we distributed a questionnaire for them to complete. It asked about how they felt about the switch, if they experienced any negative outcomes or if they would swap back to their previous medication if possible.
Results
36 patients were identified with 34 questionnaires returned. 7 were excluded as the forms were mostly incomplete or the swap was not due to cost saving, leaving a total of 27 questionnaires. When asked about whether they remembered if they had written information, 18 patients (67%) said yes. 24 patients (89%) felt that they were not pressured to make the swap and 26 patients (96%) reported no side effects or adverse events. 23 patients (87%) reported that they would stay on the new medications with only four patients (15%) documented their wishes to swap back to their original ARVs citing increased pill burden, side effects and fear of the unknown as reasons for this.
Discussion
The majority of patients were happy with the swap suggesting that approaching patients regarding cost saving ARV swap is acceptable to the majority of patients. However, it is important to factor in patient wishes before any implementation.
P134
Management training programme for GUM/HIV specialist trainees: outcome from a QIP
Imperial College Healthcare NHS Trust, London, United Kingdom
Abstract
Introduction
Management training has been a curriculum requirement for GUM/HIV trainees for many years and has often been seen as difficult to accomplish, with many attending a generic course in their final year. We provided an in-house GUM/HIV management training programme, using a QI framework, with an aim to improve learning and introduce a culture of management training embedded throughout training, moving away from it being a static final year requirement. This was felt to be superior to a generic course due to the inclusion of specific content with the large amount of change that has occurred in sexual health in recent times.
Methods
A survey was conducted of local GUM/HIV trainees prior to commencing the programme, which started in April 2018. It included lectures (covering topics suggested in the initial survey e.g. GUM/HIV funding, commissioning etc.), a formal shadowing programme and establishing a culture of embedding audit/QI into daily work. The survey was then repeated to establish results.
Results
The repeat survey showed an improvement in overall mean score for satisfaction in management training (6.2/10 to 7/10) and an improvement in knowledge was seen in most topics (see image). Feedback from the programme was good and the median number of audit/QI projects per trainee increased from 2 to 2.5.
Discussion
Overall an improvement was seen in satisfaction and self-assessed knowledge of management topics after 1 year. The increase in audit/QI projects may be evidence of this. A regular management training programme has now been established and engagement of trainees has led to further topics for lectures being suggested. Other centres may wish to consider the introduction of a GUM/HIV specific management training programme for their Specialist Trainees throughout their training to allow them to expand their general and sexual health specific management knowledge.
P135
The 11th National Genitourinary Medicine (GUM) taster day
St George’s University Hospital NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
The Genitourinary Medicine (GUM) taster day was established in 2009 and aims to provide an insight into a career in GUM before applying for specialist training.
Methods
The day was held in London on 7/10/19. Attendees completed a questionnaire on the booking process, demographics, grade, workplace and interest in a career in GUM. Data was entered into an Excel spreadsheet.
Results
81 attendees, 73/81 (90%) female, 8/81 (10%) male. 100% questionnaire response rate. Majority 40/81 (49%) Foundation Year 2 (table 1). 53/81 (65.4%) were working in/around London, most 29/81 (36%) in a medical specialty, 2/81 (2%) GUM/HIV, 12/81 (15%) GP, 8/81 (10%) surgical specialty, 8/81 (10%) psychiatry, 28/81 (35%) other. 21 (26%) junior doctors listed no detractors to the specialty and 4 (5%) listed no attractors. 152 attractors and 68 detractors to the specialty were listed in total. Attractors: variety of work 21/77 (27%), perceived work/life balance 20/77 (26%), diverse patient cohort 16/77 (21%), interesting work 13/77 (17%), medical component 8/77 (10%). Detractors: concern about lack of jobs 18/60 (30%), general medical training 16/60 (27%), lack of GUM experience 6/60 (10%). 2 juniors reportedly told to avoid the specialty by GUM staff. Following the taster, 41 (51%) were considering a career in GUM, 36 (44%) unsure, 4 (5%) decided not to pursue GUM. 77 were considering other specialties, including: GP 29/77 (38%), Obstetrics and Gynaecology 16/77 (21%), Infectious Diseases 11/77 (14%), Psychiatry 10/77 (13%).
Discussion
Following the taster the majority were still considering a career in GUM despite no experience of the specialty. Work/life balance and the variety of work were the main attractors from this predominantly female audience with concern over lack of jobs and introduction of general medical training the main detractors.
P136
What should Britain’s fourth National Survey of Sexual Attitudes and Lifestyles (Natsal-4) ask?: responses and reflections from our stakeholder consultation
1University College London, London, United Kingdom
2NatCen, London, United Kingdom
3University of McGill, Montreal, Canada
4London School of Hygiene and Tropical Medicine, London, United Kingdom
5University of Glasgow, Glasgow, United Kingdom
Abstract
Introduction
The fourth decennial Natsal survey (Natsal-4) - a representative survey of around 10,000 members of the general population - is due to start fieldwork in 2022. A key and early part of Natsal-4 development involved us consulting stakeholders (those working in sexual health, education and wellbeing), and the interested public about topics to be included in the fourth wave of the survey.
Methods
During June and July 2019, we conducted an open consultation for completion online or via email, promoted via Twitter, Natsal’s website, journals, and conferences – including BASHH 2019. Consultees scored broad topic areas (5-point scale; 5 being most important) from previous Natsal surveys and new proposed topics (gender identity, pornography, use of technology, and sexual wellbeing). Consultees could also suggest improvements to existing questions, new topics, and topics for deletion.
Results
294 people completed the survey (online and via email); 90% as individuals, 10% on behalf of organisations. All new topics scored highly, with two new topics in the top 5 (table). Notably, there was strong support for additional questions on consent and sexual violence in the scoring (table) and free text responses. There were few suggestions to remove topics. Many consultees suggested new/ updated topics, including sex work, non-monogamous relationships, BDSM/kink, pubic grooming, body image and FGM. General improvements included making the questionnaire less heteronormative and considering gender identity; “I’m glad that gender identity has appeared in the questionnaire."
Discussion
Engaging with stakeholders has been critical for shaping Natsal-4. The team has since systematically reviewed consultees’ proposals, and prioritised topics. Questions have been refined through expert and lay stakeholder input and cognitive testing. The next stage is a fieldwork pilot, which, due to COVID-19, has been postponed to summer 2021, preparation for which will involve further stakeholder engagement to ensure Natsal-4 continues to be fit-for-purpose for a new era.
P137
Audit of Trichomonas Vaginalis diagnosis and management in the South West of England
1Torbay and South Devon NHS Foundation Trust, Torbay, United Kingdom
2Devon Sexual Health, Northern Devon Healthcare NHS Trust, Exeter, United Kingdom
Abstract
Introduction
Globally, Trichomonas Vaginalis (TV) is the most common non-viral sexually transmitted infection. In the UK it is uncommon and has an estimated prevalence of 0.3% in the sexually active population, although this is thought to be an underestimate. A retrospective review of TV cases managed in the South West (SW) of England was undertaken to assess management against British Association of Sexual Health and HIV (BASHH) 2014 guidelines.
Methods
7/11 centres submitted data pertaining to TV cases diagnosed within a 2-year period (January 2018 – December 2019) using a standardised questionnaire.
Results
A total of 200 cases were reviewed (up to 40 from each centre). 98% of cases were in females, with an overall average age of 33. 97% of female patients were symptomatic, with discharge and localised itch/discomfort most commonly reported. No males were symptomatic. Microscopy, antigen testing and culture were the most frequently used diagnostic methods, with only one service using nucleic acid amplification testing (NAAT). In centres using multiple testing methods, only 20% tested positive on more than one modality. 93% were treated with a recommended antibiotic course. Test of cure (TOC) was carried out in 47%, although only 5 patients had ongoing symptoms. There were 18 treatment failures. 3 patients failed metronidazole-based regimens more than once but responded to tinidazole.
Conclusions
TV is largely diagnosed in older symptomatic women in the SW, as per usual understanding of this condition in the UK. Only one service in the SW is routinely using NAATs despite the BASHH recommendation that this is the gold-standard. Concordance rates between testing modalities were low. TOCs were performed quite routinely despite not being a BASHH recommendation. Treatment failure was relatively common (9%). Routine use of NAATs in more services may clarify the true prevalence of this condition in the SW of England.
P138
Student feedback from a new interactive sexual health e-learning course is as good as the previous face-to-face teaching
1Unity Sexual Heath, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
2University of Bristol, Bristol, United Kingdom
3Population Health Sciences, University of Bristol, Bristol, United Kingdom
Abstract
Introduction
It is imperative that medical students can demonstrate capability in sexual history taking in preparation for patient-centred consultations as doctors. As part of 2.5 days of sexual health teaching, year 4 Bristol University medical students attend a three hour experiential ‘Sexual History Taking Workshop’ (adapted from the BASHH “Toolkit for Sexual History taking” 2004), in groups of 10–12 with a tutor (consultant/registrar). During the COVID-19 pandemic, we moved this from a face-to-face to a virtual platform for the remaining 65 students. Students completed pre-recorded lectures and e-learning case studies prior to the workshop.
Methods
Using a technology-enhanced learning moderator to support each session, we facilitated 6 role-plays for each group and smaller breakout ‘rooms’ to practise risk assessment skills. Tutors used the Race model to engage students in experiential learning by facilitating immersive role-playing and feedback. Students completed pre and post-self-perceived assessment tools regarding their knowledge skills and attitudes to sexual history taking. This was compared to the feedback from face-to-face workshops from multiple previous years.
Results
Student feedback confirms the sexual history taking e-workshop performed as well as face-to-face workshops with 3%(2/64) students feeling they could “take a sexual history” beforehand increasing to 86%(50/58) afterwards (p < 0.001), similar to the face-to-face format (p-value 0.6). Overall 60% rated the on-line course ‘excellent’, 40% ‘good’.
Discussion
There was a significant improvement in self-perceived inventory pre and post-e-workshop. Through this innovative approach, we have uncovered unexpected advantages for teaching a range of students with diverse attitudes, beliefs, and learning styles by providing an inclusive and safe space to explore and apply these. Qualitative student feedback revealed specific benefits of virtual workshops including the creation of a non-threatening environment in which they could engage at their own pace. Students also report it will help prepare them for telehealth consultations in the future.
P139
Evaluation of the BASHH STI Foundation (STIF), intermediate course
1Sexual Health Dept, NHS Lanarkshire, Lanarkshire, United Kingdom
2BASHH STI Foundation committee, London, United Kingdom
3Imperial College Healthcare NHS Trust, London, United Kingdom
Abstract
Introduction
BASHH launched the STIF education programme in 2002. It provides training to nursing and non-specialist medical staff in knowledge; skills; and attitudes required for diagnosing; managing; and preventing STIs. STIF Intermediate involves one-to-one clinical training, and assessment within a GUM clinic setting. Revalidation is required every 5 years. This project aimed to assess the impact of the STIF intermediate course on delegates’ work practices, and views on revalidation.
Methods
An online questionnaire was successfully delivered to 424 delegates who completed STIF intermediate in the prior 6 years. 94 responded (22% response rate).
Results
28% were doctors; 70% were nurses; 4% were Sexual Health Advisors. 80% worked in Sexual Health or HIV. At least 10% worked in primary care. 91% of respondents worked in England. Key motivators were gaining new, or consolidating knowledge and skills, and career progression. (see table 1)
94% improved knowledge; 93% improved clinical skills. 89% used their knowledge and skills several times per week. (see table 2). 99% of respondents have, or would, recommend the competency. 19% reported no challenges. The most common challenges reported were the volume of e-learning, and difficulty getting time out of work to do clinical sessions with their trainer. 47% have either revalidated, or plan to in the next 2 years. Of those meeting this criteria, 89% were aware of CPD requirements, or how to access information. 60% have undertaken, or plan to undertake other STIF competencies.
Discussion
This competency is largely undertaken for career progression, and honing knowledge and skills. It translates to a change in practice. Many respondents encourage others to undertake the competency, or plan to undertake further competencies. Challenges being signed off and revalidating should be addressed to continue to make the competency accessible in the context of Sexual Health service pressures. STIF intermediate remains relevant, well regarded, and recognised professionally.
P140
Gender and sex in sexual health research: what should we measure and how? Methodological development work for Britain’s fourth National Survey of Sexual Attitudes and Lifestyles (Natsal-4)
1University College London, London, United Kingdom
2NatCen Social Research, London, United Kingdom
3Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
Abstract
Introduction
Many social surveys have purported to measure ‘sex’, but this has been through interviewers’ observation of outward appearance (e.g. clothing, name). In Natsals -1, -2, and -3, decennial large-scale probability sample surveys of the British general population (www.natsal.ac.uk), this approach was used to make assumptions about the respondents’ anatomy in the rest of the questionnaire. This is not appropriate and results in some misclassification. Although often used interchangeably, sex and gender refer to different concepts, and can differ. Here, we considered what aspects of sex and gender are relevant for a sexual health survey, and how these can be measured in a way that captures diversity, is acceptable, and is comprehensible to the general population. This informed development of questions for Natsal-4.
Methods
First, we reviewed international literature for questions about gender/sex in social surveys, censuses and sexual health research, including BASHH recommendations. Second, we conducted stakeholder engagement. Third, we synthesised the findings from both activities into questions deemed appropriate for use with general population samples. Finally, questions were cognitively tested among 30 members of the general population (including three people who identified as trans/had a trans history).
Results
Several questions from the literature had undergone general population testing, however, there were no definitive or ‘harmonised’ questions. No existing set of questions captured the elements of sex and gender most relevant for a sexual health survey. Few studies addressed how to tailor detailed sexual partnership questions to account for trans partners. Our developed questions were found to be well understood and accepted by both trans and non-trans people in cognitive testing.
Discussion
We used a multi-stage process to identify a set of questions that seem to balance the needs of a diverse group of participants. These questions are subject to further piloting before being finalised for inclusion in Natsal-4.
P141
Routine epidemiological treatment of sexual contacts of Chlamydia trachomatis, Neisseria Gonorrhoeae and infectious Syphilis - are we doing any harm?
1School of Medicine, University of Southampton, Southampton, United Kingdom
2Solent NHS Trust, Southampton, United Kingdom
Abstract
Introduction
UK and European guidelines (2018) recommend epidemiological treatment (ET) of sexual contacts (SC) of individuals with Chlamydia trachomatis (CT), Neisseria Gonorrhoeae (GC) and infectious syphilis (IS). Rising rates of antibiotic resistance especially in GC calls for improved antibiotic stewardship. A recent Australian study challenged the practice of routine ET after finding a lower infection prevalence in SC of MSM with CT, NG and IS. We aimed to evaluate the prevalence of infection in SC of CT, GC and IS attending a large urban UK sexual health clinic to assess appropriateness of routine ET.
Methods
Retrospective service evaluation of 100 consecutive SC of CT and GC and 50 consecutive SC of IS seen between 01/01/2018-31/12/2018. Demographic, clinical, sexual history data, laboratory results of CT, GC, HIV and syphilis were collected from EPR. We recorded whether ET was offered, treatment used and side effects recorded.
Results
Discussion
We recorded a high infection prevalence, mostly asymptomatic, in SC of CT, GC and IS. Every infected contact was treated at first visit. Our results suggest that deferring treatment of contacts until results to improve antibiotic stewardship should be carefully balanced against the risks of patient defaulting follow-up and onward transmission from untreated infection. ET is accepted, well tolerated and appears to be of most benefit for CT contacts.
P142
Infants exposed to HIV and coinfection in pregnancy – the current picture using UK population level surveillance data
1Integrated Screening Outcomes Surveillance Service, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
2Infectious Diseases in Pregnancy Screening Programme, Public Health England, London, United Kingdom
Abstract
Background
People living with HIV frequently experience acquired and blood-borne coinfections. Infants born to women living with HIV (WLWH) with coinfection during pregnancy may be at increased risk of adverse outcomes (e.g. vertical/congenital infection), meaning increased management and monitoring are required. Using population-level surveillance data, we describe the current picture of infants exposed to HIV and coinfection in pregnancy.
Methods
Public Health England’s Infectious Diseases in Pregnancy Screening Programme’s Integrated Screening Outcomes Surveillance Service (ISOSS) conducts surveillance of all pregnancies in WLWH, their infants, along with any children diagnosed with HIV in the UK. Data on Hepatitis B (HBV) and syphilis (screened for in pregnancy) and hepatitis C (HCV) coinfection are also collected. Descriptive statistics summarise infants born 2009–2018 to WLWH with information on maternal coinfection (for 8832/10675), reported to ISOSS by December 2019.
Results
Overall 7.2% (636/8832) of infants were coinfection-exposed: 4.7% (413/8832), 1.4% (126) and 1.4% (120) to HBV, HCV and syphilis respectively. Twenty were exposed to ≥1 coinfection: 4 HBV/HCV, 10 HBV/syphilis, 5 HCV/syphilis, 1 to all. Among coinfection-exposed infants: 19% were born to mothers diagnosed with HIV during pregnancy, most to mothers born abroad (92% v 84% in non-exposed (p < 0.001)) and 15% of infants were born <37 weeks (vs 12% non-exposed, p = 0.048). Congenital infection was reported in 0.8% infants: syphilis (3), HBV (1), HCV (1); 0.3% (2/621) infants were HIV-infected.
Conclusions
One in 14 infants born to WLWH in the UK are exposed to coinfections, underscoring the importance of monitoring sexual health in pregnancy to facilitate appropriate management of mothers and infants and prevent congenital infection and/or other adverse pregnancy outcomes. As ISOSS expands to monitor the other screened for infections in pregnancy (syphilis and HBV), greater insights will be provided into outcomes and the factors driving these to further inform guidelines and policy.
P143
Using programme theory to evaluate complex sexual health interventions: evidence from the process evaluation of the LUSTRUM trial of Accelerated Partner Therapy (APT)
1UCL, London, United Kingdom
2Glasgow Caledonian University, Glasgow, United Kingdom
3Glasgow Caledonian Institution, Glasgow, United Kingdom
4University of Glasgow, Glasgow, United Kingdom
Abstract
Introduction
Updated MRC complex intervention guidance advocates the use of programme theory within intervention development and evaluation. We present the programme theory for APT and show how it will be used in the process evaluation of the LUSTRUM trial.
Methods
An initial programme theory for APT was developed through an iterative, multi-level synthesis using process and outcome data from pilot studies, existing literature and pre-trial qualitative work conducted with patients, healthcare professionals and the public. The programme theory presents the main elements and interactions between the context, the problem addressed by APT, key intervention components, mechanisms of action and APT outcomes.
Results
APT was implemented under three inter-related contextual conditions: long-standing issues maintaining high STI prevalence and STI stigma, changes in patient expectations for sexual healthcare and a rapidly changing sexual environment. The core problem being addressed by APT is the combination of high levels of STI transmission, more undiagnosed infections and greater unmet need in the population. Key intervention components consist of additional choice of partner notification strategies and support to notify partners for index patients; phone consultations with sex partners and the provision of APT packs containing self-sampling STI kits and chlamydia treatment for sex partners; extensive training and support for healthcare professionals and centralised follow-up. Various mechanisms operate at intersecting levels to achieve the primary outcome of reduced chlamydia positivity after three months.
Discussion
Defining APT intervention programme theory provides a rigorous way of exploring what the intervention consists of, how it relates to the context in which it is implemented and how the intervention is thought to work. This provides a useful framework for evaluation of sexual health interventions. Key dimensions of the programme theory will be used to analyse data from patients, sex partners and healthcare professionals for the process evaluation of the LUSTRUM trial of APT.
P144
Measuring the impact of a Domestic Abuse Coordinator (DAC) in an acute trust
1Standing Together Against Domestic Violence (STADV), London, United Kingdom
2Chelsea and Westminster Hospital NHS Foundation Trust (CWFT), London, United Kingdom
Abstract
Introduction
Domestic abuse (DA) has major sequelae on survivors’ health, with significant costs attached for the NHS. Training in DA is recommended across the health economy to improve identification, intervention and specialist support for patients. CWFT has offered such training since 2007. Between 2016–2018 we had a part-time external government funded DAC. By October 2018, the post became full-time funded by CW+ charity and in October 2019, fully Trust funded under the safeguarding team. The DAC is hosted by the Trust but employed by STADV. We aimed to measure and describe the educational impact of a DAC, as part of our organisational DA response.
Methods
DA training data was compared from the year prior to October 2016, until September 2019. Staff numbers and educational impact evaluations are presented.
Results
In the year prior to the DAC, 8 training sessions were co-led by one Trust physician and STADV. Having a part-time DAC led to a 502% increase in training, over 55 sessions. The following year saw a 351% increase over 60 sessions, plus e-learning rollout. Once full-time, there was a further 19% increase over 123 sessions, with a 105% increase in e-learning. A tiered training structure was developed, with Trust monitoring systems, and DA content incorporated within mandatory safeguarding training. Level 4 DA training included ‘Train the Trainer’ courses. The DAC drove a 3118% increase in staff training, with 285 current DALs, across 17 specialities, 65% from priority areas including emergency departments, maternity, burns and sexual health. Staff evaluations highlighted improved: awareness; enquiry; confidence in escalating concerns; and referrals to co-located specialist support.
Discussion
DACs are pivotal to a sustainable health model in a continually changing workforce. Embedding the role under safeguarding, but hosted by a specialist service, ensures the ongoing professional development needs of staff are expertly supported and patients benefit from improved responses.
P145
Howdy partner! – syphilis review in a rural countywide sexual health service
North Cumbria Integrated Care Foundation Trust, Cumbria, United Kingdom
Abstract
Background
Following a 5.5% rise in the prevalence of syphilis in 2018 PHE developed a syphilis action plan. We have reviewed our syphilis cases in 2019 to determine where to target our health promotion.
Method
Retrospective review of all syphilis diagnoses in a rural countywide sexual health service in 2019, using the auditable outcome measures from the BASHH syphilis guidelines.
Results
There were 52 diagnoses; 44M (85%); 27 (52%) homosexual, 19 (37%) heterosexual & 6 (12%) bisexual; median age 34 years (range 17–79); majority (89%) White British. 8/26 (31%) eligible on PrEP; 6 (12%) HIV positive. 34/47 (72%) reported contacts outside the county. 18/50 (36%) documented to have met contacts online. We recorded RPR/VDRL prior to treatment for all and 16/24 (67%) 6/12 post treatment in keeping with BASHH standards. We recorded 50/52 (96%) patients fully adhered to the recommended treatment (BASHH standard 97%). Partner notification (PN) did not meet BASHH standards with only 40/52 (77%) of cases having an agreed contact action; 0.3 ratio of contacts per index case reported by the index case and 0.3 confirmed by a healthcare worker (BASHH standard 0.6 and 0.4 respectively).
Discussion
Data collection pertaining to PN was complex, time consuming and subjective. There were over 200 uncontactable contacts for this small cohort. Nearly ¾ of cases reported contacts from outside the county and more than 1/3 met partners online; these are likely to be higher since not all contacts will have been reported and the EPR proformas do not include tick boxes for online partners. Our department is developing an online presence in collaboration with LGBT groups. We are considering the use of online PN and have subsequently employed a Health Advisor. We must work with our EPR providers to drive change and improve the fluidity of electronic PN.
P146
Identifying trends in STI re-infection rates
Locala, Bradford, United Kingdom
Abstract
Aim
Preventing STI re-infections is a key performance indicator within our sexual health service contract. We sought to identify factors associated with risks of re-infection and identify areas of practice that could be improved
Methods
From GUMCAD we identified individuals who had 2 or more separate episodes of a diagnosed STI in a 12 month period. Patient records were then reviewed.
Results
92 individuals had 2 or more infections. 48 (52%) were female. 16 (17%) were men who have sex with men (MSM). 63 (68%) were under the age of 25. Risk reduction advice was given to 55 (60%) and condoms offered to 40 (44%) at first episode of infection. Partner notification PN) was performed and outcome documented in 86 (94%) at first infection. Failure of a partner to comply with treatment was identified in 5 cases.
Discussion
Patients under the age of 25 appear to be at significant risk of re-infection. PN was completed in the majority of patients, suggesting that PN alone does not always prevent re-infection. Similarly re-infection from an untreated partner was not a common factor. The offer of condoms was low, however this may have been due to documentation. Patients were less likely to be given risk reduction advice if they had initially attended and been treated as a contact and subsequently tested positive. Re-infection rates continue to be review with results presented at team meetings. Changes in practice have included addition of tick box prompts to templates to document “condoms offered” and “risk reduction advice given” on our electronic proformas. We now also include risk reduction advice by SMS along with a positive result message and with any PN follow up interaction.
P147
Exploring factors that may help to stratify risk of infection in contacts of Chlamydia: is epidemiological treatment always necessary?
1Devon Sexual Health, Exeter, United Kingdom
2Northern Devon Healthcare NHS Trust, Barnstable, United Kingdom
3University of Exeter, Exeter, United Kingdom
Abstract
Introduction
Existing guidance recommends partner notification (PN), screening and an offer of epidemiological treatment for contacts (PNCs) of Chlamydia (CT) within relevant look-back periods, whilst acknowledging that there is limited evidence to support specific time frames. With the need for rigorous antibiotic stewardship in mind, this project aimed to inform local guidelines on epidemiological treatment, by examining chlamydia positivity rates for PNCs against a number of variables.
Methods
A one-year retrospective sample of patients coded PNC (n = 414) in a semi-rural sexual health clinic was analyzed. The following variables were recorded: age, sexual orientation, days since last sexual contact (LSC) with index patient (IP), symptoms, partner type, use of condoms and chlamydia test result. Analyses considered chlamydia positivity at various time points since LSC, as well as sexuality and partner type.
Results
Overall, 48% (197/414) of PNCs had a positive CT test. PNCs presenting for testing within 30 days of LSC (340) with the IP had a positivity rate of 50% vs 37% in patients who presented after this time (74). Those more likely to be positive were heterosexuals (51% positive vs gay or bisexual partners (GBM) 21%), regular partners (58%) vs casual (37%), and those who did not use condoms (49%) vs those who did (34%). There was no difference in positivity rate in those who had symptoms (49% vs 47% of those who were asymptomatic).
Discussion
It is possible to identify a number of variables that are seemingly associated with a lower chlamydia positivity rate. These variables could help to risk stratify PNCs presenting to sexual health clinics and in cases deemed low risk, epidemiological treatment could be withheld pending screening results. That being said further research would be required to establish the risk of adverse outcomes should treatment be delayed, including CT associated Pelvic Inflammatory Disease (PID) and onwards transmission.
P148
Syphilis in heterosexual individuals is rising: a local response to improve case finding
1Unity Sexual Health, University Hospital Bristol and Weston NHS Trust, Bristol, United Kingdom
2University of Bristol, Bristol, United Kingdom
3PHE South West Regional Laboratory, National Infection Service, Public Health England, Bristol, United Kingdom
4National Institute for Health Research, Health Protection Research Unit in Behavioural Science and Evaluation in Partnership with Public Health England, University of Bristol, Bristol, United Kingdom
5Population Health Sciences, Bristol, United Kingdom
Abstract
Introduction
In 2019, 18/101(18%) of all infectious syphilis cases (coded A1-3) seen in a large urban sexual health clinic (SHC) were diagnosed in heterosexuals. Clinicians noted this increasing during 2020. Due to concerns about rising rates of congenital syphilis and for outbreak management, we investigated these cases to inform local pathways and expedite diagnosis.
Methods
The electronic patient records of all new infectious syphilis diagnoses from January to June 2020 were reviewed to identify presenting symptoms and missed opportunities for testing. The results were compared to the local data from 2018 and 2019.
Results
Table 1 demonstrates a change in sexual orientation of presenting individuals since 2018. Of 65 syphilis cases in 2020, 13/65(20%) were in heterosexual males and 14/65(22%) in heterosexual females. 29/65(47%) had a rash, 19/65(29%) a genital ulcer, 7/65(11%) an oral ulcer, 13/65(20%) lymphadenopathy and 17/65(26%) fever. 29/65(45%) presented to their GP with syphilis-associated symptoms prior to attending a SHC. Of these, 16/29(55%) were not tested in primary care or referred to a SHC. 2/65(3%) had presented to hospital initially and had a hepatitis.
Discussion
The first 6 months of 2020 showed a large rise in the proportion of heterosexuals diagnosed with syphilis compared to 2018 and 2019. Over half of cases were missed during presentation to primary care. In response, educating colleagues in non-GUM settings about this change, its implications for public health and the need for enhanced screening in antenatal care has become a priority for our service. We have collaborated with Public Health England (PHE) to add syphilis testing to four new test requesting panels: ‘lymphadenopathy’, ‘rash’, ‘hepatitis’ and ‘pyrexia of unknown origin’. PHE have informed primary and secondary care. In six months’time we will review the number of diagnoses made through use of these panels.
P149
Very high prevalence of trichomoniasis in a women’s prison
1Central and North West London NHS Foundation Trust, London, United Kingdom
2Frimley Health NHS Foundation Trust, Surrey, United Kingdom
3SODEXO Justice Services, Surrey, United Kingdom
Abstract
Introduction
In 2019, we tested for Trichomonas vaginalis (TV) PCR in prison in accordance with local guidelines (symptomatic women). Prevalence of TV in GUM clinics locally is 2%. After the higher prevalence was noted, we offered the test to everyone presenting for sexual health, cervical or antenatal screening and reported the exceedance to Public Health England (PHE) to investigate whether it was an outbreak.
Methods
We looked at the characteristics of those who tested positive for TV using the electronic patient record system.
Results
In total, 37/124 (30%) tested positive for TV in the first 10 months of 2020. Ethnicity was not fully documented, but the majority were white British, mean age 34. Mean length of incarceration prior to diagnosis was 1 month. 2/37 (5%) were pregnant, 13/37 (35%) had symptoms. 5/37 (13.5%) tested positive for a second STI. There are 4 wings of the prison and 23/37 (62%) were from the same wing (Wing A) but not resident at the same time.
Discussion
Previous studies from USA and other countries of women entering prison have reported a TV prevalence of 22%–47%. We searched for data from GUMCAD, PHE prison network as well as the BASHH special interest group and could not find similarly high figures elsewhere within the UK. Women residing in ‘Wing A’ were those who needed to detoxify from drugs or alcohol but there was no association found from GUMCAD reports of TV in people who inject drugs. We have put measures in place, informing all the residents about TV, offered extra barrier protection and organised TV screening days on the wings.
P150
Global prevalence of chlamydia, gonorrhoea and trichomoniasis in men who have sex with men: a systematic review and meta-analysis
1Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
2London, London, United Kingdom
3Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
Abstract
Introduction
Chlamydia, gonorrhoea and trichomoniasis are three of the most common curable sexually transmitted infections (STIs) among men who have sex with men (MSM), despite the availability of effective diagnostics and single-dose treatments. We conducted a meta-analysis to produce the first global pooled prevalence estimates to our knowledge for these curable STIs in this key population.
Methods
We searched MEDLINE, Embase, LILACS and AIM databases for studies conducted between January 2000 and September 2019 providing point estimates for any of these STIs in MSM. Each point estimate for overall prevalence was corrected using a standard method based on the sensitivity and specificity of each assay. Random effects models were applied to generate pooled estimates and forest plots for each infection by Sustainable Development Goal (SDG) and World Health Organisation (WHO) regions. We also conducted sensitivity analysis on variables determined a priori.
Results
After screening 6,901 papers, we included 138 publications and 308 point estimates from 49 countries. Globally, the pooled prevalence estimate of infection with any of these STIs was 6.6% (95% CI: 5.8–7.5). Chlamydia prevalence was8.1% (95% CI: 7.1 to 9.1) pooled from 121 studies and 143,889 MSM tested. Gonorrhoea prevalence was 5.7% (95% CI: 4.6–6.9) pooled from 117 studies and 119,112 MSM tested. Trichomoniasis pooled prevalence estimates were established for two regions, both of which were 0.0%. In contrast, there were point estimates for chlamydia and gonorrhoea to calculate pooled prevalence estimates in six out of eight regions.
Conclusion
Evidence-based interventions are urgently needed to meet the SDGs for 2030 given that chlamydia is three-times and gonorrhoea is eight-times more prevalent in MSM compared to the general male population.
Figure 1: Pooled prevalence estimates of each STI in MSM, by SDG and WHO region.
Figure 2: Pooled prevalence estimates for chlamydia and gonorrhoea.
P151
Collaborative working to deliver a community sexual health (SH) drop-in service for trans and non-binary communities: A review of the first year
1Leeds Sexual Health, Leeds, United Kingdom
2Leeds and York Partnership NHS Trust, Leeds, United Kingdom
3Yorkshire Mesmac, Leeds, United Kingdom
Abstract
Introduction
Trans and non-binary communities report dysphoria and actual or perceived transphobia when accessing SH services. Many potential factors contribute to health inequality or reluctance to use services eg. Gendered/binary systems, lack of provider education, or trans men being excluded from cervical screening recall.
Methods
In February 2019, our Sexual Health Service, in collaboration with a local SH charity - set up a community, trans and non-binary SH drop-in service. The monthly, doctor-led service runs alongside existing trans and non-binary support groups at the charity and is supported by Gender Outreach Workers. The service offers SH screenings, vaccinations, contraception and cervical screening. We reviewed the first year of this clinic from February 2019-January 2020 inclusive.
Results
During this 12-month period, there were 40 appointments and 24 patients seen (12 trans-women, 7 non-binary, 5 trans-men). The mean age was 35 years (range 21–66), ethnicity 100% white-British, 17 (68%) had not accessed local SH services before.
Of 24 service users: 20 (83%) had chlamydia/gonorrhoea NAATs with one positive result (pharyngeal chlamydia). 21 (88%) had bloods for HIV, syphilis and Hepatitis B/C according to risk, with no new cases found. Eight people (33%) had HPV vaccination and ten (42%) received hepatitis B vaccination. One intrauterine contraception was inserted and two cervical screens done (both with normal results).
Conclusions
Our clinic has improved access to SH care for trans and non-binary communities in our region. While the uptake of SH screening has been good in this group, infection rate has been low and uptake of contraception and cervical smears also low. Partnership working and engagement of the local Gender Identity Service has been pivotal to the clinic’s success. The future aim of the clinic is to ensure we reach those most in need of SH care especially trans men and those engaging in higher risk sex.
P152
Are psychosocial interventions effective at increasing condom use among black men? A systematic review
1University of the West of England, Bristol, United Kingdom
2Barts Health NHS Trust, London, United Kingdom
Abstract
Background
Since the late 1980s, people of Black ethnicity have experienced a disproportionately high burden of STIs in the England, with the most recent STI data illustrating that the highest rates of STI diagnoses in England occurred among people of Black ethnicity. Theory-informed interventions promoting safer sex behaviours, including correct and consistent condom use, among population groups adversely affected by poor sexual health are needed.
Methods
A systematic review was conducted to examine the evidence of effectiveness of psychosocial interventions at increasing condom use among Black men. Nine databases (MEDLINE, CINAHL Plus, AMED, EBSCOhost, Information Science & Technology Abstracts, PsycARTICLES, PsycINFO, PsycBOOKS) were searched for qualifying intervention studies alongside grey literature searching.
Results
A total of 17 studies met the inclusion criteria. Six studies reported weak evidence of statistically significant positive intervention effects. Interventions were multifactorial in their design and included condom perception and acceptability, skills building, knowledge building, a combination of knowledge and skills building, and racial inequalities or life-coaching. Five studies reported mixed findings and six studies reported no intervention effects.
Conclusions
This review identified scientifically weak evidence highlighting the potential of multifactorial interventions to increase condom use among Black men, mainly from US settings. Common psychosocial components across promising interventions included STI/HIV knowledge, identifying personal motivators, enhancing motivation to change behaviour, goal setting and condom use skills building. The multifactorial nature of interventions provide obscure evidence on the successful components of interventions with positive effects. The limited generalisability of studies and lack of evidence around cultural specificity suggests future research should aim to acquire a better understanding of the sexual health behavioural experiences and motivators of Black men in the UK to inform culturally relevant and tailored interventions.
P153
Sexual behaviour and STI/HIV testing among heterosexual-identifying MSM in high-income countries: an individual participant data meta-analysis
1Institute for Global Health, UCL, London, United Kingdom
2Institute of Epidemiology and Health Care, UCL, London, United Kingdom
3Sigma Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
4Centre for Social Research in Health, UNSW, Sydney, Australia
5Kirby Institute, UNSW, Sydney, Australia
6School of Public Health and Social Policy, University of Victoria, Victoria, Canada
7School of Population Health, University of Auckland, Auckland, New Zealand
Abstract
Introduction
Sexual behavioural and health differences are known to exist between gay- and bisexual-identifying men who have sex with men (gay-MSM; bisexual-MSM), but less is known about heterosexual-identifying MSM (heterosexual-MSM). We hypothesised that heterosexual-MSM may exhibit different sexual and STI/HIV testing behaviours to non-heterosexual-MSM with implications for infection control, health promotion and sexual healthcare.
Methods
We harmonised individual participant data (IPD) from four cross-sectional behavioural surveys of 198,301 MSM (heterosexual-MSM:1,223; bisexual-MSM:26,029; gay-MSM:171,049) conducted in Western Europe (2010; n = 118,762), Australia (2010–2017; n = 57,016), Canada (2011, 2015; n = 14,445) and New Zealand (2008, 2011, 2014; n = 8,078). We conducted IPD meta-analysis using logistic regression to calculate adjusted odds ratios (AOR) comparing heterosexual-MSM with bisexual-MSM and gay-MSM in reporting of key sexual behaviours specifically with non-steady male partners and STI/HIV testing (confounder adjustment: age, education, self-reported HIV status, and year).
Results
Among men reporting non-steady male partner (s) in the past year (74.2% of heterosexual-MSM; 79.5% of bisexual-MSM; 73.4% of gay-MSM), any anal intercourse (AI) with non-steady partner (s) was reported by fewer heterosexual-MSM (76.7%) than bisexual-MSM (82.2%; AOR = 0.58; 95%-CI:0.46–0.74) or gay-MSM (85.6%; AOR = 0.49; 95%-CI:0.38–0.63). Among MSM reporting AI with non-steady partners, there was no difference in reporting condomless AI (CAI) between the three groups (45.0%, 45.4%, and 48.1% respectively). Among MSM reporting CAI with non-steady partners, reported STI testing in the past year by heterosexual-MSM (44.5%) was similar to bisexual-MSM (41.6%; AOR = 0.75; 95%-CI:0.57–1.00) but lower than gay-MSM (61.6%; AOR = 0.45; 95%-CI:0.34–0.59). Among men not previously diagnosed with HIV and reporting CAI with non-steady partners, 41.5% of heterosexual-MSM reported testing for HIV in the past year compared with 46.8% of bisexual-MSM (AOR = 0.72; 95%-CI:0.54–0.96) and 67.2% of gay-MSM (AOR = 0.34; 95%-CI:0.25–0.45).
Discussion
Low levels of STI/HIV testing among heterosexual-MSM suggest these men are inadequately engaged with appropriate sexual healthcare. Health promotion efforts and interventions that support these men are needed.
P154
Do we really know what’s going on - A review of child exploitation presentations to sexual health clinic
1Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
2St Helens and Knowsley NHS Trusts, St Helens, United Kingdom
Abstract
Introduction
Child Sexual Exploitation (CSE) and Child criminal exploitation (CCE) is widespread but underreported. Increased attention has been focused on County lines gangs and child victims. This project set out to explore attendances to a sexual health clinic of those suspected to be victims of CSE/CCE to examine patterns of attendance and missed opportunities of identification.
Methods
All young people (YP) discussed in the local Multi Agency Child Exploitation meeting (MACE) for the first time from Jan 2018 to Jan 2019 were identified. Data was collected on attendances to the local sexual health clinic (SHC) in the preceding 3 years.
Results
53 YP were discussed for the first time in the local MACE meeting from Jan 2018 to Jan 2019. Ages ranged from 11 to 17 yrs, 60% (32/53) male, 40% (21/53) female. More cases had an element of suspected CCE, 53% (28/53) rather than CSE, 28% (15/53). Of these 53 YP, 14 had attended the SHC in the previous 3 years a total of 54 times. 50% (7/14) were CCE, 3/14 were CSE. Although the majority of the YP discussed at MACE were male, only 9% (5/54) attendances at SHC were with males. Most attendances occurred at the young person clinic,61%(33/54) and were mostly for contraception and emergency hormonal contraception. All YP had a safeguarding proforma completed at initial presentation which was updated at over 85% of attendances.
Discussion
Young females at risk of exploitation were found to be frequent attenders at the SHC, in contrast to young at risk males. Majority of cases discussed at MACE were of suspected CCE and this is reflected in SHC attendances. National tools exist to help health professionals identify YP at risk of CSE, https://legacy.brook.org.uk/attachments/Spotting-the-signs-CSE-_a_national_proforma_April_2014_online.pdf) but further understanding of CCE signs in persons attending sexual health clinics is needed.
P155
Meeting the complex sexual health needs of transgender men (TGM) attending an integrated sexual health clinic
1,2 Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Abstract
Introduction
Transgender men (TGM) have complex sexual and reproductive health needs relating to their gender identity, sexual behaviour, physiology and anatomy. A sensitive and holistic approach considering an individuals need for contraception, bleeding control, cervical screening, sexually transmitted infection screening, prevention and management is required. We conduct an audit to determine if the care received by TGM attending our service considered all of these.
Method
Retrospective analysis of electronic patient records (EPR) identified 18 transmen (born female but identity as male) having attended our service between 1/1/2017 and 31/12/2019. All had their attendance documented on a male proforma, 3 also having a female proforma. Documentation of sexual behaviour, contraception, vaccinations and smear history together with the testing, advice and treatment they received were reviewed.
Results
27% were not sexually active attending for bleeding control. Two had undergone gender reassignment surgery. Five TGM reported female partners. 62% sexually active TGM had male sexual partners, subsequently considered MSM, all reporting oral sex, seven vaginal sex and six receptive anal sex. 6/7 receiving vaginal sex had contraception discussed (one hysterectomy). Only 61% MSM had all appropriate sites screened for chlamydia and gonorrhoea, 100% HIV tested, 6/8 offered hepatitis B vaccination, 5/8 received advice on PreP. Five patients were diagnosed with a STI.
Discussion
Overall 73% Transmale patients were sexually active. 62% having sex with men.46% reported high STI risk receptive anal sex from a casual male partner. 61% reported vaginal sex. Both STI screening and contraception was appropriately offered in 100% however not all sites were screened and PreP was often missed. Only 2 had documentation of cervical smears which may reflect use of a male proforma not including this. Education of clinicians to better meet the complex healthcare needs of TGM, to appropriately target sexual health advice and a review of appropriate proforma use is planned.
P156
Impact of routine enquiry on detection rates of female genital mutilation in a sexual health clinic setting
Central and North West London NHS Foundation Trust, London, United Kingdom
Abstract
Introduction
Female genital mutilation (FGM) is thought to be underreported in the UK, indicating missed opportunities to treat psychological and physical consequences and to safeguard female family members. In 2018 we introduced routine enquiry about FGM to all females attending our sexual health (SH) services. We aimed to compare and quantify detection of FGM before and after routine enquiry was introduced.
Methods
Electronic patient records were interrogated to compare FGM detection rates 9 months before and 9 months after the introduction of routine enquiry about FGM.
Results
Introducing routine enquiry led to 74% of female attendances being asked about FGM and a six-fold increase in the detection rate compared to the same time period before routine enquiry:
Discussion
Following the introduction of routine questioning, FGM enquiries increased to 74% and the detection of FGM increased six-fold. Some women had not previously disclosed FGM and over a quarter reported at least one complication relating to FGM. All FGM cases were performed outside of the UK. Routine enquiry about FGM in SH services can detect previously undisclosed FGM, allow opportunities to manage complications and ensure adequate safeguarding. We recommend all SH services implement routine enquiry about FGM.
Characteristics of women with FGM:
P157
Beyond the binary: how we’re failing to meet the sexual health needs of trans, non-binary and gender diverse people
Terrence Higgins Trust, London, United Kingdom
Abstract
Introduction
Little is known about the sexual health needs and knowledge of trans and non-binary people making it challenging to design effective health promotion and clinical services for them. Our survey of sexual health and HIV knowledge, attitudes and experience aimed to address this.
Methods
An online survey collecting quantitative and qualitative data was conducted 9–25 November 2019, promoted via targeted social media advertising.
Results
209 responses. Wide range of gender identities reported: non-binary 98 (45%), trans man 69 (31%), gender queer 48 (22%), gender non-conforming 41 (19%) and trans woman 32 (15%). Self-reported knowledge of STIs/BBVs varied (Figure 1) and was, excluding HIV, generally low. Most reported moderate-to-low knowledge of bacterial STIs, viral hepatitides, genital warts and shigella. 89 (46%) reported condomless sex in the last 12 months, yet 93 (45%) had never tested for HIV; 25% were unaware of PrEP; 44% unaware of PEP. Many reported other sexual health risks in the last year: 27 (13%) felt pressured into having sex, 13 (6%) were victims of sexual assault, 12 (6%) took drugs to have sex, 8 (4%) reported transactional sex. 109 (52%) didn’t feel fully in control of their sexual choices, 80% reporting feeling negative about themselves, 71% low mood/depression, 32% pressure from partners and 9% being influenced by drugs/chemsex. 40 did not feel comfortable attending sexual health services (SHS), 16 citing a lack of trans competence in care. 121 offered recommendations on how SHS could be more inclusive.
Discussion
Low-to-moderate knowledge of STIs/HIV demonstrate a need for targeted sexual health information including navigating sex, consent and empowerment, whilst sign-posting to high-quality prevention, testing and support services. SHS must adapt to ensure that trans and non-binary people feel comfortable accessing their services; including staff training, accessible venues and resources, and collecting correct gender data.
P158
Sexual health beyond the binary: assessing transgender and non-binary individuals’ (TNB) needs and their use of online sexual health services (SHS)
1Chelsea and Westminster Hospitals NHS Foundation Trust, London, United Kingdom
2Preventx, Sheffield, United Kingdom
3Lloyd Online Doctor, London, United Kingdom
Abstract
Introduction
There is limited evidence of TNB using online SHS and no reported PHE data on sexually transmitted infection (STI) rates amongst TNB attending terrestrial SHSs. TNB are approximately 25% less likely to test for HIV or attend SHS compared to cisgender individuals. TNB experience high rates of violence, mental health illness, substance misuse, housing/employment/financial instability and stigma, which constitute significant barriers to obtaining healthcare. Online SHS may improve access for this population. We are a large UK online SHS. Asymptomatic users complete an e-consultation and receive an STI testing kit by post or via collection from terrestrial SHS. We describe socio-demographic data, STI diagnoses and behaviour risks of TNB users of e-SHS.
Method
Demographic data, triage responses, service outcomes and STI results were collected from TNB who registered with the e-SHS between 30.4.19 and 31.12.19.
Results
Of 119329 registered users, 504 (0.42%) identified as TNB. 463 kits were ordered and 355 kits returned and tested by 302 unique users, between 30.4.19 and 31.1.20. 75.2% users opted for a postal kit versus collecting one (24.8%). 99.4% returned kits included extra-genital site testing for gonorrhoea and chlamydia (throat + rectal). Kit return rate was 78.4%, blood attempt rate was 90.6% and 86.9% returned blood samples were sufficient for testing. Prevalence rates were: 5.5% syphilis, 4.8% chlamydia, 3.4% gonorrhoea and 4.3% (13/300) HIV. Users had emergency (16%) or general (34%) contraceptive needs, and 11–20% engaged in high-risk sexual practices e.g. chemsex.
Discussion
<1% of our e-SHS users identify as TNB. Despite using an asymptomatic service, this group showed a high prevalence of STIs/HIV. Given the barriers TNB face accessing traditional healthcare, using e-SHS appears acceptable to some. However, they have other healthcare needs that can’t entirely be met online. Terrestrial and e-SHS must work collaboratively to effectively support/protect this vulnerable population.
P159
Floppy babies with anaemia
Manchester University NHS Foundation Trust, Manchester, United Kingdom
Abstract
Introduction
There has been an increase in reported cases of congenital syphilis (CS) in the United Kingdom mirroring the rise of new syphilis diagnoses in females between 2009 and 2018. Prospective reporting to the Integrated Screening Outcomes Surveillance Service (ISOSS) will accurately provide insight into cases without perceptive risk for transmission.
Methods
We present two recent cases of CS managed at our centre alongside our Paediatric colleagues.
Results
1. A 15-week old female was admitted with decreased movement of her left upper and lower limb, which was normal and symmetrical at birth. A skeletal survey demonstrated multifocal, polyostotic periosteal reactions affecting upper and lower limbs. Additionally, a widespread erythematous, desquamative rash was positive on treponemal polymerase chain reaction testing confirming the diagnosis. Her mother’s syphilis serology was negative in early pregnancy with no subsequent test performed. 2. An 11 week old male was admitted with hepatosplenomegaly, anaemia and thrombocytopenia alongside a bloody nasal discharge since birth. His mother was treated for early syphilis during pregnancy with initial serological response but postnatally found to have increased. Infant syphilis serology at 11 weeks was consistent with a diagnosis of CS. Both cases responded clinically to intravenous Benzylpenicillin.
Discussion
Our cases are intrapartum infections with significant infant morbidity, although following diagnosis there were good initial clinical outcomes. In response to addressing the national increase in rates of infectious syphilis, Public Health England produced an action plan advocating four ‘prevention pillars’ fundamental to the control the disease, one of which aims to maintain “high antenatal screening coverage and vigilance for syphilis throughout antenatal care.” Universal third trimester re-screening has also been considered by Public Health England but the recommendations, currently for consultation, do not recommend this due to high numbers that would require re-screening to prevent one case of CS and infant morbidity, which is not cost-effective.
P160
Pritelivir: a novel treatment for multidrug resistant Herpes Simplex Virus type 2
Manchester University NHS Foundation Trust, Manchester, United Kingdom
Abstract
Introduction
Herpes simplex virus (HSV) reactivation can cause significant morbidity in allogeneic stem cell transplant (SCT) patients with an additional risk of aciclovir resistance following prolonged exposure, with rates approaching 25% in this group. Such patients can prove challenging often needing second-line agents to control symptoms.
Method
We present a Haematology patient with HSV reactivation and resistance managed with pritelivir.
Results
A 72 year old HIV-negative lady with a background of allogeneic SCT for myelodysplastic syndrome presented with widespread ano-genital ulceration due to HSV type 2 causing great pain and immobility. Her case was complicated by chronic graft versus host disease (GVHD) requiring immunosuppression and extracorporeal photophoresis. She responded poorly to Aciclovir and subsequent testing confirmed a thymidine kinase (T288M) mutation conferring high level resistance. The extensive ulceration did not respond to Valaciclovir, Foscarnet or Cidofovir and topical Imiquimod was not tolerated. After consultation with local virologists and leading national and international experts, the helicase-primase inhibitor Pritelivir was acquired on compassionate grounds. This produced a marked improvement in her lesions and her pain was significantly improved. She experienced no side effects from the Pretelivir and reported high patient satisfaction with the treatment response. Sadly, after 3 weeks of successful treatment with Pritelivir, the patient died after developing pneumonia and respiratory failure; this was compounded due to GVHD, continuing immunosuppression and frailty due to prolonged period of immobility. This was likely unrelated to the Pritelivir.
Discussion
Pritelivir proved an effective and safe treatment of drug resistant HSV type 2 infection in a case with prior treatment failure.
P161
Service evaluation of GUM and HIV Clinic at an inner city category B male prison in the United Kingdom
1St George’s University Hospital Foundation Trust, London, United Kingdom
2St George’s, University of London, London, United Kingdom
Abstract
Introduction
The World Health Organisation states that people in prisons have the same right to healthcare as those in the community. We have provided a weekly in-reach Genitourinary medicine (GUM) and HIV clinic since October 2003, to a local, inner city, category B male prison. This houses 1600 males, 21% on remand but also 53% who have been sentenced. Previous literature describing the experience of setting up a GUM clinic in a male prison highlighted unexpectedly high did not attend (DNA) rates.
Methods
A retrospective, 6 month data analysis was carried out on all GUM/HIV prison appointments between 1/9/18-28/2/19. Patient demographics, clinical presentations and diagnoses were recorded for each consultation in addition to DNA rates.
Results
Of 203 scheduled appointments, 101 (50%) were attended. 71 patients attended clinic at least once during the study period. Mean age 36 years (range 18–70 years) with most (41%) 25–34 years. 29/71 (41%) white, 20/71 (28%) Black and 14/71 (20%) Mixed. Most common reasons for attendance (Table 1.) were HIV routine follow-up 26/101 (26%) and genital symptoms 26/101 (26%). Overall, 36% of attendances were HIV related and 54% GUM related. There were no new HIV diagnoses during the period.
Discussion
The range of patient demographics reflects the diversity of the prison population. Our results show there is demand for both HIV and sexual health care. Our DNA rate is high although this data does not identify the reasons for this. Subsequently, a coding system has been introduced to better understand our high DNA rates in order to maximise use of resources where possible.
P162
Sexual health beyond the binary: assessing transgender and non-binary individuals’ (TNB) needs and their use of online sexual health services (SHS)
1Chelsea and Westminster Hospital, London, United Kingdom
2Lloyds Online Doctors, Brighton, United Kingdom
Abstract
Introduction
Numbers of transgender and non-binary (TNB) people in the UK are unknown. Rates of sexually transmitted infections including HIV amongst them are also unknown. Given that they suffer significant socioeconomic and stigma-related disadvantages impacting on health access and outcomes, the burden of morbidity and unmet need is likely to be significant. It is plausible that increased use of e-sexual health services (eSHSs), such as the NHS service Sexual Health London (SHL), could provide acceptable and accessible solutions.
Methods
In order to describe demographics, STI diagnoses and behaviour risks of TNB users of SHL between 30.4.19 and 31.01.20, demographic data, triage responses, service outcomes, STI results and service evaluations were collected from TNB service registrants.
Results
Of the 119329 users who registered, 504 (0.42%) identified as TNB/other. Of these, 302 users requested 463 kits and returned 355 within the time period (77.4% return rate). 99.4% of dispatched kits included throat and rectal swab testing for gonorrhoea and chlamydia. Prevalence rates were: 5.5% syphilis, 4.8% chlamydia, 3.4% gonorrhoea. 0.7% HIV positive. HIV prevalence was 4.3% (13/302), including 11 previously diagnosed cases. 11–20% of users engaged in high-risk practices such as chemsex or commercial sex working. 98% of TNB users would recommend SHL to their friends and family.
Discussion
This is the first study of its kind to assess the electronic SHS tendencies amongst TNB people. Our cohort showed a high prevalence of STIs including HIV, and high prevalence of risk environments. Using e-SHSs appears acceptable. However, not all their identified sexual healthcare needs can be safely met entirely online, given the frequently complex nature of their presentations. Terrestrial and e-services must work collaboratively to support and protect this vulnerable population.
P163
A matter of guesswork...are sexual health services still meeting the needs of male sex workers?
1Royal Bournemouth Hospital, Bournemouth, United Kingdom
2University of the West of England, Bristol, United Kingdom
Abstract
Introduction
Male sex workers (MSW’s) are reported to have poorer sexual health outcomes in comparison to their female counterparts, often experiencing barriers to accessing prevention or treatment services with little research evidencing their experiences. This audit aims to examine the prevalence and attendance needs of MSW’s accessing a local sexual health service to further inform interventions to support their wellbeing.
Method
A retrospective audit was undertaken using GUMCAD coding to identify sex worker (SW) attendances to the GUM department at Royal Bournemouth Hospital between 01/01/2019 and 31/01/2020. Notes were reviewed to examine demographic characteristics, services provided and sexual health outcomes.
Results
16 SWs were identified in the audit. 19% (3/16) were registered as a new patient, 81% (13/16) had previously attended. All were female; the average age was 34 years (range 20–60 years). 69% (11/16) identified as heterosexual, 25% (4/16) bisexual and 6% (1/16) pansexual. 44% (7/16) presented with symptoms, 13% (2/16) attended following a sexual assault and 6% (1/16) as a contact of an infection. All patients undertook routine sexual health testing. 19% (3/16) received screening at extra genital sites for chlamydia and gonorrhoea. No further treatment was required for any of the attendees.
Discussion
SW’s accessing sexual health services attended with symptoms, as a contact of an infection or following a sexual assault generally requiring services outside the scope of asymptomatic home testing. MSW’s were under represented in clinical attendances. Further research exploring broader experiences of men selling sex for money (MSSM) would address barriers or improve in service disclosure of sex work and assist in the development of meaningful interventions to improve sexual health outcomes. Additional training materials around ascertaining SW status in a consistent and non-judgemental way could enhance the quality of data collected.
P164
Supporting the transition of special educational needs & disability (SEND) young people (YP) accessing schools-based relationship and sex education (RSE) into clinical community integrated sexual health services (ISHS)
Spectrum Community Health CIC, Wakefield, United Kingdom
Abstract
Introduction
We provide a co-dependent ISHS and RSE programme. We wanted to offer SEND students the same educational and inclusion opportunities as mainstream students; which supported them to be able to confidently access our ISHS by providing them with a high quality evidence based RSE programme, which adapts and reacts to the needs of YP, and improve our ISHS provision for SEND YP.
Methods
Through different engagement opportunities with various stakeholders, the following materials were developed. 1. A suite of lessons for SEND YP. 2. A clinical communication aid, used in both the education sessions and the clinical setting.
Results
By the end of the pilot study 90% (N = 19) stated that they could identify the difference between healthy and unhealthy relationships. 95% of students said they would be ‘comfortable’ or ‘fairly comfortable’ in saying “No” in dangerous situations. 100% of students could explain the difference between public and private locations. 90% were able to name at least one person or place they could go to for support and advice on relationships and health. The clinical communication aid was made available in all our clinical sites for use both by clinical team and SEND patients.
Discussion
The provision of an RSE programme to SEND YP, and utilising the communication aid, in lessons and clinics, supports SEND YP to independently access mainstream ISHS, as with those patients without SEND. This enables the YP to have a patient-led, confidential consultation and provides some reassurance to clinicians there is good understanding and informed consent during that discussion.
P165
Development of a child sexual exploitation risk reduction (CSE) programme (RESPECT) within integrated sexual health services (ISHS)
Spectrum Community Health, Wakefield, United Kingdom
Abstract
Introduction
The organisation has a well-established co-dependent ISHS and Relationship and Sex Education programme. The RESPECT programme was designed following identification of a gap in local support which focused on young people (YP) displaying low levels of protective factors. It is delivered before any potential escalation to CSE which would require statutory service involvement. It is a 6-week programme, aimed at 11–18 years old males and females, who are displaying risk factors for CSE and who would benefit from some educational support around keeping safe, relationships and sexual health. It aims to equip YP to self-manage potential risk areas such as unhealthy relationships, online safety, and consent. Whilst building confidence, self-esteem, and encouraging YP to understand their own values and the importance of creating a support network, including positive peers and trusted adults.
Method
Session materials were co-produced with YP through pilot sessions with focused feedback on learning and impact. Delivery is via student-led group activities using a question-based model which is underpinned by the risk and resilience evidence-based approach to building protective factors and resiliency.
Results
March 2019 to March 2020 has seen:
1 45 6-week programmes delivered to 236 YP, with low level CSE risk factors.
2 An additional 52 1:1 sessions delivered to those who find group activity challenging/difficult.
3 The evaluation of protective factors sees an increase of over 80% at the end of the course compared to the beginning.
4 Feedback we have received shows that the intervention helps young people to feel more confident in managing their safety and ‘speaking out’.
Discussion
This course is valuable in supporting YP who have already been identified as having been exposed to some level of risk, to protect themselves from further harm, avoid escalation, know how to access help, and make safer choices throughout their lifespan.
P166
Coronavirus (COVID-19) and young people’s sexual health
1St Helens and Knowsley Teaching Hospitals NHS Trusts, St Helens, United Kingdom
2Central and Northwest London NHS Foundation Trust, London, United Kingdom
Abstract
Background
COVID-19 has reduced health-seeking behaviour in the UK including in sexual health services (SHS). This review describes changes in sexual health attendances among young people (YP) within a semi-rural service setting (A) and at large urban setting (B) during the weeks preceding and following lock-down.
Results
Our findings (table 1) confirmed a large fall in attendances across all age ranges in keeping with reconfiguration of services during COVID 19. In those aged under 18 years there was a disproportionately larger reduction in attendances compared to those aged 18 and over, particularly in setting A.
Attendances for Emergency Contraception (EC) were compared (table 2). During the first 6 weeks of lock-down no under 18 year olds sought EC from SH services (100% reduction).
Discussion
The fall in attendances at SHS may not be attributed to a risk reduction. YP may be experiencing multiple barriers due to lack of access and ineligibility for online testing, particularly in vulnerable YP. The potential adverse effect on YP sexual and reproductive health outcomes remains unclear. Innovative service provision involving YP with multi agency partnership is needed to engage and prioritise YP access to sexual health care.
P167
Unaccompanied asylum-seeking children attending sexual and reproductive health services: an analysis of national surveillance data and clinical data from a local service
1Central and North West London NHS Foundation Trust, London, United Kingdom
2University College London, London, United Kingdom
3Public Health England, London, United Kingdom
Abstract
Background
Unaccompanied Asylum-Seeking Children (UASC) are at risk of poor sexual and reproductive health (SRH). We compare the characteristics of potential UASC with other young attendees at SRH services nationally and describe characteristics of a UASC cohort from a SRH clinic.
Method
We undertook descriptive analysis of pseudonymised data from 2016–2018 on young people aged 13–17 using: 1. National surveillance data (GUMCAD). 2. Clinic data on UASC attending a London SRH service. No national surveillance code exists for UASC, so birth in one of the top 8 countries of origin^ for UASC (T8CO) became a proxy measure in GUMCAD. Data analysed in Excel and Stata 15.
Results
336,119 attendees aged 13–17, recorded in GUMCAD in 2016–2018; 83% female, and 84% White British (Table 1). Non-UK born attendees increased by 7.3%, while attendees from T8CO were stable. Attendees from T8CO were ethnically diverse (42% Asian or Black African); and 46% female.
Local clinic data on known UASC attendees (n = 46), showed 90% were male with a median age of 16 (IQR16-17). The majority (72%) were Black African, with 90% born in a T8CO. 98% accepted STI testing, with STIs diagnosed in 4.5%. 24% disclosed non-consensual sex.
Conclusion
Using a proxy indicator for UASC (T8CO), it appears the number of potential UASC attending SRH services nationally is small and stable. Compared to other young people captured in GUMCAD, this group are more ethnically diverse and more likely to be male. UASC cohort data shows a similar pattern. Strikingly, one-in-four reported non-consensual sex. Our ability to identify UASC’s access to SRH services is compromised by the lack of a surveillance code. We recommend use of a national surveillance code for UASC and are undertaking qualitative work to further explore service provision to this group. ^ T8CO countries (between 2016–18) include: Afghanistan, Albania, Eritrea, Ethiopia, Iran, Iraq, Sudan & Vietnam.
P168
Gendered differences in sexual practices and uptake of health and sex work specific services among off-street sex workers
1University of Manchester, Manchester, United Kingdom
2London School of Hygiene and Tropical Medicine, London, United Kingdom
Abstract
Introduction
Among sex workers, low levels of sexual health and sex work-specific service engagement, testing, and unsafe practises are linked to increased risk of HIV and STI transmission. We examine gendered differences in sex workers sexual health testing, unprotected sex and service uptake.
Methods
Data was taken from a cross-sectional survey of sex workers recruited from street and indoor settings in London between June and December 2019. Eligible participants had provided direct sexual services in the last 3 months and completed a structured questionnaire on a tablet or online. We offered voluntary testing for HIV, Gonorrhoea and Chlamydia. We examined differences in sexual health and service use by gender and risk in cis-men compared to cis-women.
Results
181 responses were included in analysis (Cis-men = 62, Cis-Women = 115, Transgender = 15). A higher proportion of men experienced recent self-reported STI than cis-women and transgender workers (39.62% vs 9.73% vs 13.33% p = 0.0001). Cis-men also reported higher levels of unprotected sexual contact with their previous client compared to cis-women (OR 3.2 [95%CI 1.46–6.772]). However, unprotected sexual contact substantial across both cis-men and cis-women (64.1% vs 36.19%). Cis-gender participants previously attending drop-in were more likely to have had an HIV test (OR17.78 [95% CI 2.291 – 137.924]). Gender was also seen to affect the odds of having had an HIV test (ORadj10.1 [95% CI = 1.790–57.342]). Service attendance varied by gender. Table 1
Conclusions
Findings suggest that male sex workers who sell sex have lower service utilisation across sex worker targetted services and higher prevalence of STIs, this may high light a gap in sex workers targeted healthcare. These issues may lead to higher levels of HIV/STI transmission and poorer sexual health.
P169
A case report of a 15yr old trafficked across county lines during the COVID-19 pandemic
Northwest London University Teaching Hospital, Harrow, United Kingdom
Abstract
A 15 year old female contacted the sexual health clinic during the coronavirus pandemic distressed. It was difficult to complete a telephone consultation due to her distressed state. She was immediately given an appointment to attend in accordance with our COVID-19 protocol. She was accompanied by her mother and placed in a clinic room where she was telephoned in clinic to ensure social distancing was maintained. During the consultation she disclosed she was taken from London by friends she knew to an unknown location and held captive for at least three weeks. The intention according to her was to traffic drugs in another part of England. She was drugged and vaguely remember a number of males entering the room repeatedly. Her mother who has a language barrier reported her missing and a search ensued. She managed to escape through an opened window and made her way back to London. Exploring the history further she regularly went missing but always returned home. She was never known to social services and lived with her parents. She was adamant she did not want the police involved and declined a referral to HAVEN as she felt very angry by what had occurred. She had never been in a sexual relationship. Full sexual health screening was done, and she was referred to social work, psychologist and all other safeguarding agencies. The paediatric team also reviewed her and decided against a chain of evidence. Her distress and emotional state heightened when she learned she tested positive for both Chlamydia and Gonorrhoea. This case proved a major challenge during the pandemic due to multiple visits for vaccinations, test of cures and face to face consultations were prolonged due to anxiety. The staff felt overwhelmed having to use PPE and face masks when communicating to a tearful patient. She continues to engage.
P170
South Africans women’s constructions of sexual consent
University of Cape Town, Cape Town, South Africa
Abstract
Introduction
Current understandings of sexual consent do not always acknowledge the effect of overarching social norms and ideals on how sexual consent is constructed. This research explored how women construct sexual consent using a feminist framework that focused on the use of discourses to analyse how power shapes these understandings. We aimed to gain insight into how women talk about sexual consent and the forces they identified as influencing their understandings.
Methods
Five focus group discussions were conducted with female students from a university in South Africa.
Results
The analysis yielded three primary discourses in women’s talk of sexual consent: Consent as a Woman’s Call, Consent Without Desire, and Consent as Willingness.
Discussion
This work contributes to the existing literature on sexual consent by highlighting the context-specific nature of sexual consent and the ways in which power shapes women’s constructions of sexual consent in the context of heterosexual relationships.
P171
Predicting sexual risk behaviours in a sample of undergraduate university students in the UK
1Nottingham Trent University, Nottingham, United Kingdom
2Universidade de Coimbra, Coimbra, Portugal
3University of Bournemouth, Bournemouth, United Kingdom
Abstract
Introduction
University students in the UK are an under-researched, though high-risk population. They may engage in either ‘volitional’ sexual risk behaviours, which are pursued with increased personal volition, such as condomless vaginal, anal and oral sex; or ‘non-volitional’ behaviours which are pursued with limited personal volition (i.e. because one feels coerced or is being paid to do so). Drawing on the Health Adversity Risk Model (HARM), this study examines the predictors of volitional and non-volitional sexual risk behaviours among British and European Union (EU) students in the UK.
Methods
A convenience sample of 431 mainly heterosexual undergraduate students completed a cross-sectional survey including demographic questions and measures of identity threat, psychological distress, coping styles, non-suicidal self-injury (NSSI), and volitional and non-volitional sexual risk behaviours. Data were analysed using independent samples t-tests and structural equation modelling.
Results
Female students and British students exhibited higher levels of psychological distress, NSSI and sexual risk behaviours than males and EU students, respectively. Moreover, female and EU students were more likely to adopt psychologically adaptive coping styles than male and British students, respectively. The structural equation model suggests that the relationship between gender and citizenship and sexual risk-taking is mediated by identity threat, psychological distress, coping styles and NSSI. Psychologically adaptive coping styles are not protective against sexual risk-taking but rather determine the type of sexual risk behaviour: the re-thinking/planning coping style is associated with volitional risk behaviours and the social engagement coping style with non-volitional behaviours.
Discussion
Consistent with HARM, identity threat and psychological distress are associated with sexual risk-taking. Social and cultural norms are key to understanding and predicting the onset and nature of sexual risk-taking. Practical interventions for enhancing sexual health in students must focus on enhancing psychological wellbeing but also on targeting specific types of sexual risk behaviour.
P172
ScotTransPrep: exploring transgender and non-binary people’s knowledge and attitudes towards sexual health, HIV and preventive strategies
Queen Margaret University, Edinburgh, United Kingdom
Abstract
Introduction
Transgender people and those with a non-binary gender identity suffer multiple societal disadvantages that impair their ability to access adequate healthcare, including in sexual health and HIV prevention, and globally are 49x more likely than the general population to be HIV positive. This study aimed to identify knowledge about sexual health, barriers to access experienced by Scottish trans/nonbinary (T/NB) people, and their suggestions for improvement.
Method
The author conducted six semistructured interviews with T/NB Scottish adults, recruited in person, via social media and sociosexual apps, and thematically analysed data using a modified Integrative Behaviour Model (Wood et al 2017).
Results
Participants were well informed regarding identifying their own sexual health needs, and about HIV prevention including PrEP. However, significant barriers, including stigma about trans identities and sexual behaviours, non-inclusively designed services, undertrained staff, financial and time constraints, community behavioural norms, mental health comorbidity, and prioritisation of gender affirming care over sexual health prevented people from accessing care. Concerns about NHS mismanagement and maltreatment has led many to seek private healthcare, paving the way for a two-tier system and worsened inequalities. Suggestions for improvement by participants included dedicated transgender sexual health clinics with staff training, community re-education, and more investment in adequate, timely access to NHS gender care.
Discussion
To achieve the above suggestions and improve T/NB health, sexual health services would need to be better funded, and substantially and visibly trans-inclusive. Ideally targeted services should be trans-led or with substantive trans community input, and adopt an intersectional approach that bolsters the most vulnerable. Trans people cannot achieve optimal health and wellbeing without support from healthcare staff and the wider community, including access to gender-affirming care.
P173
Preaching beyond the converted: using stakeholder engagement and co-production to translate research into recommendations and resources to improve the sexual health of people of Black Caribbean heritage
1University College London, London, United Kingdom
2Public Health England, London, United Kingdom
Abstract
Introduction
In Britain, people of Black Caribbean heritage (BC) are disproportionately affected by STIs. Evidence from a mixed-methods study suggested that addressing these inequalities, requires improving knowledge of STIs, highlighting STI risks associated with concurrency, improving the understanding of consensual sex, and empowering women. We present the results of a 2-stage research translation exercise conducted with BC community and public and sexual health sector (PSHS) stakeholders.
Methods
We convened a translation team, comprising researchers, epidemiologists, public health policymakers and health promotion specialists, with established relationships with BC charities. Through national and local networks, we invited key stakeholders to facilitated workshops in November 2019 and January 2020. The community workshop (n = 8) preceded the PSHS workshop (n = 15), so community views could be considered by PSHS. Attendees discussed the research findings and priorities for sexual health policy and practice, reviewed existing sexual health promotion materials, and suggested key features of culturally appropriate interventions. The translation team thematically analysed feedback and identified effective messages and media for BC sexual health promotion and PSHS training and development.
Results
Stakeholders agreed educational, audio-visual resources, endorsed by trustworthy and relatable organisations, featuring people from multiple ethnicities, and containing powerful words, such as ‘empowerment’ and ‘consent’, would be culturally appropriate. Stakeholders suggested, to avoid unintentional stigma, resources should be co-produced alongside communities and delivered by culturally competent workforces. Following stakeholder engagement, the research needs were refined, prioritising the following PSHS actions: raising awareness of STIs among BC; PSHS workforce development; and community involvement in the design and delivery of sexual health interventions.
Discussion
Engaging BC communities and PSHS enabled active reflection on research findings, cultural perspectives, professional practice and the broader context in which BC experience poorer sexual health. Stakeholder engagement enhanced the accessibility of research, informed research translation into national guidance, and enabled co-production of feasible recommendations and calls to action.
P174
The relationship between socioeconomic deprivation and chlamydia screening in England – an analysis of national surveillance data, 2015–2019
Public Health England, Colindale, London, United Kingdom
Abstract
Introduction
The National Chlamydia Screening Programme (NCSP) provides opportunistic screening to sexually active 15–24 year-olds in England. Chlamydia screening through internet self-sampling services has increased in recent years, however, it is unclear whether this has been equitably provided. We investigated the association between deprivation and internet testing for chlamydia in England.
Methods
Data from the GUMCAD STI and CTAD Chlamydia surveillance systems were used to identify chlamydia tests delivered by internet services to 15–24 year-olds between 2015–2018 in England. These data were matched to 2019 Index of Multiple Deprivation (IMD) quintiles, a residential area-level measure of deprivation, and the 2011 urban and rural area classifications. The association between deprivation quintile and internet testing (yes/no) was determined using logistic regression models stratified by gender and adjusted for age, year of the test, ethnicity, area classification and geographical region.
Results
In 2018, 213,086 (17%) of all 1,214,902 chlamydia tests among 15–24 year olds were internet tests, an increase of 170% since 2015. In 2018, 16% and 18% of internet tests were in the least and most deprived quintile, respectively; 88% were in urban areas. Among women, after adjustment for confounders, the odds of being tested through an internet service increased with each year (adjusted odds ratio (aOR) for 2018 vs. 2015: 3.19 [95%CI:3.15–3.22], p < 0.001). The odds of being tested through an internet service were higher in urban (vs. rural areas) (aOR: 1.11 [95%CI:1.10–1.12], p < 0.001), and were higher for people living in the least deprived quintile (aOR: 1.24 [95%CI:1.23–1.26], p < 0.001; vs. the most deprived quintile). Similar trends were seen among men.
Discussion
The findings provide evidence that internet testing for chlamydia has increased since 2015. However, people living in more deprived and rural areas are less likely to be tested for chlamydia by an internet service. These findings highlight potential socioeconomic barriers to accessing chlamydia testing online.
P175
Supporting trans people’s sexual health: information and service needs. An online survey
1Public Health England, London, United Kingdom
2University of Bedfordshire, Luton, United Kingdom
3Homerton University Hospital Trust, London, United Kingdom
4The National LGB&T Partnership, London, United Kingdom
Abstract
Introduction
A survey was done to better understand trans people’s needs and experiences when accessing health services for reproductive health (RH) and sexual health (SH) care. This analysis focuses on the SH aspects of the survey.
Methods
An online survey recruited trans people via trans community groups, NHS choices, PHE networks, SH and RH services, GP surgeries, Facebook and Twitter in the autumn of 2017. The survey covered a wide range of aspects on SH and RH including their SH wellbeing and needs. Experiences accessing healthcare services, socio-demographic characteristics, SH relationships and sex education are described in this analysis.
Results
The analysis consisted of 597 trans people aged over 15. Nearly three quarters (72.0%; 246/342) were sexually satisfied with their current or most recent relationship and over half (57.4%; 236/411) were sexually comfortable with their body. Only 13.5% (50/370) of those who had worries about having sex sought professional help. Three quarters had condomless sex in the last month (74.4%; 206/277), nearly a third with more than one sex partner (27.2%; 56/206). Around half (51%; 207/409) never had an STI test. Of those who had an STI test in the last year, 40% (80/202) were diagnosed with an STI. Nearly three in five (57.1%; 234/410) had never tested for HIV.
Discussion
Low rates of STI and HIV testing along with a high level of STI diagnoses were reported by the survey participants. Further action is required to address the health requirements of trans people who are not fully accessing the services available for their sexual health needs. More accessible and trans people-inclusive SH and RH services are required offering comprehensive SH information.
P176
Exploring sexual health clinicians’ attitudes to advising patients to disclose their genital herpes simplex virus (HSV) diagnosis to their sexual partners
1Brook Young People, Liverpool, United Kingdom
2Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
3Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Abstract
Introduction
BASHH guidelines recommend that clinicians should advise patients with genital HSV that disclosure in all relationships is advised since it is associated with lower transmission risks and may protect against legal action. The aim of this evaluation was to explore attitudes to this guidance of sexual health practitioners in the North West of England.
Method
This service evaluation involved a mixed-methods online questionnaire emailed to sexual health clinicians, followed by semi-structured interviews to explore attitudes in greater depth.
Results
The questionnaire was completed by 29 clinicians (19 doctors, 8 nurses, 2 health advisors), with 10 practitioners (8 doctors, 1 nurse, 1 health care assistant) interviewed. 60% of questionnaire participants and 90% of interviewees advised disclosure in all relationships as per guidelines, although many also acknowledged that this may be difficult for patients. Clinicians’ reasons for advising disclosure included legal repercussions, trust in relationships, and their own attitudes should they be the partner. Others felt that well informed patients should make their own decisions, with disclosure unnecessary until establishment of a long term relationship, provided other transmission reduction steps were taken. Stigma was identified as the most common barrier to disclosure for patients, with others including fear of relationship breakdown, legal issues, and potential onwards disclosure by the partner. Potential facilitators to increase disclosure included better disease specific education for patients (clinician delivered and written), health promotion campaigns to reduce stigma, health advisor input, clarification of legal issues, training for non-sexual health clinicians, and ‘trivialising’ the condition to reduce patient distress.
Discussion
A majority of clinicians give advice around disclosure of HSV in line with BASHH guidelines, whilst acknowledging that there are many barriers to disclosure occurring in all relationships. Financial pressures on sexual health services in the UK may inhibit services’ ability to introduce potential facilitators identified by clinicians to support disclosure.
P177 Withdrawn
P178
Evaluation of the SpeeDx PlexPCR VHS assay for the molecular detection of herpes simplex virus, varicella zoster virus and Treponema pallidum in lesion swabs
1West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, United Kingdom
2SpeeDx Pty Ltd, Sydney, Australia
Abstract
Introduction
Infections caused by herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), Treponema pallidum and varicella zoster virus (VZV) can all cause skin, mouth and genital lesions which can be clinically indistinguishable. Rapid differential diagnosis is important to ensure appropriate treatment can commence and contact tracing can be performed where appropriate. The primary objective of the current study was to compare the performance of a commercially available, multiplexed, PCR assay for detection of HSV-1 and 2, VZV, and Treponema pallidum (
Methods
A challenge panel of 250 archived samples previously tested using in-house assays was assembled and tested with the
Results
Positive and negative agreements between
Discussion
The
P179
Age- and sex- specific incidence of first episode genital herpes simplex virus (HSV) type 1 and 2 in attendees at sexual health services in the North West Coast area in 2016–18
1St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom
2Abacus Sexual Health, Mersey Care NHS Foundation Trust, Liverpool, United Kingdom
3Liverpool University Hospitals NHS Foundation Trust, Macclesfield, United Kingdom
4Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom
5St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, United Kingdom
6Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
7Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
Abstract
Background
Public Health England (PHE) monitors HSV through GUMCAD code C10 which does not distinguish between HSV-1 and -2 despite their different natural histories. This study aimed to determine the age and sex specific incidence of HSV-1 and HSV-2 in the North West of England in 2016–18.
Method
Retrospective review of all patients attending 8 sexual health services in the North West of England from 2016–18 with first episode genital herpes, identified using GUMCAD code C10A. Patient demographics were matched against HSV type from PCR swab results.
Results
2857 patients had an HSV PCR positive result, of whom 69.0% (1978) were female, 52.5% (1504) had HSV-1, and 47.5% (1360) HSV-2. Males were more likely to have HSV-2 and females HSV-1. 46.4% (1327) of HSV was seen in patients <25 years.
Table: Age and sex specific incidence of HSV
In 86.6% (767/886) male patients with sexuality data available, HSV-2 was more common in heterosexuals (58.5%, 391/668), and HSV-1 in men-who-have-sex-with-men (65.7%, 65/99).
Discussion
HSV-1 remains the most common cause of anogenital HSV, although this was only in patients <25 years, and does not apply to all populations. We recommend that PHE should introduce virus specific codes for HSV-1 and -2 to allow national epidemiological data review.
P180
Improving HPV vaccination adherence through text message reminders
Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
Abstract
Introduction
Human Papilloma Virus (HPV) is a common sexually transmitted infection. Acquisition of oncogenic HPV types in men who have sex with men (MSM) increases their risk of oropharyngeal and anogenital cancers. To reduce risk, the UK implemented an HPV vaccination programme (2018) for MSM aged < 45 years, targeting oncogenic HPV types 16 and 18. Three doses are delivered at 0, 1 and 6 months. However, not all patients complete the schedule. To improve adherence, we implemented a text message reminder for patients who had failed to complete the course.
Methods
An initial audit was conducted to identify MSM who started HPV vaccination between October 2018 – March 2019. The proportion of patients with a completed vaccination course was measured at 11 months. A single text message reminder was sent to those who had not completed the course. Responses were assessed two months later.
Results
Between October 2018 – March 2019, 256 patients (median age 28) started HPV vaccination. 53.1% completed the course. Older age was a weak predictor for vaccination completion (odds ratio 1.05, p = 0.02, logistic regression analysis). The response rate to reminders was 12.5%, significantly increasing the proportion of patients with a completed course to 57.4% (p = 0.002, McNemar’s test). The cost of the text message was negligible.
Discussion
Course completion is key to the efficacy of this programme. Data in women suggests that protection against CIN 2/3 is maximised in those completing the full course. This project demonstrated that a single text message reminder is a quick and cost-effective method for enhancing completion rates. We are also surveying patients to determine their views of this vaccination programme and the factors that influence compliance.