Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign.

OBJECTIVES: Routine HIV screening is recommended in those UK hospitals and primary care settings where the HIV prevalence is > 0.2%. For hepatitis B virus (HBV) and hepatitis C virus (HCV), however, testing is targeted at at-risk groups. We investigated the prevalence of these blood-borne viruses (BBVs) during a routine testing pilot in UK Emergency Departments (EDs). METHODS: During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in areas of high HIV prevalence offered routine tests for HIV, HBV and HCV to adults having blood taken as part of routine care. Patients who tested positive were linked to care. RESULTS: A total of 7807 patients had blood taken during their ED visit; of these, 2118 (27%) were tested for BBVs (range 9-65%). Seventy-one BBV tests were positive (3.4%) with 32 (45.1%) new diagnoses. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed). Those aged 25-54 years had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV. Assuming the cost per diagnosis is £7, the cost per new case detected would be £988 for HCV, £1351 for HBV and £2478 for HIV. CONCLUSIONS: In the first study in the UK to report prospectively on BBV prevalence in the ED, we identified a high number of new viral hepatitis diagnoses, especially hepatitis C, in addition to the HIV diagnoses. Testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.

2015 European guidelines for the management of partners of persons with sexually transmitted infections.

BACKGROUND: Partner management is the process of identifying the contacts of a person infected by a sexually transmitted infection (STI) and referral to a health care provider for appropriate management. It represents a public health activity. METHODS: This guideline is produced by the IUSTI European Guideline Editorial Board and EDF Guideline Committee. RESULTS: It provides recommendations concerning the infections that require partner management, the lookback periods for this STI and the main steps to follow for partner management (offering support to patients, notifying partners, identification of contacts). Partner management is voluntary and needs to be performed with respect to human rights, social, cultural and religious behaviours. CONCLUSIONS: In European countries, there are different approaches to the partner management; some common type of actions can enhance the fight against STI.

Missed opportunities for HIV diagnosis: a three-year audit in the West of Scotland.

BACKGROUND: National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentation. An audit of new HIV diagnoses in Glasgow was performed to assess local performance against these guidelines and estimate the proportion of patients presenting who had previous missed opportunities for diagnosis. METHODS: A retrospective case note review of 339 patients diagnosed from September 2008 to September 2011 was performed. Documented past medical history was assessed for HIV clinical indicator conditions prior to HIV diagnosis and prior review by medical services. RESULTS: Ninety (26%) individuals had at least one documented clinical indicator condition prior to HIV diagnosis, of whom 80 had prior contact with at least one speciality. This group also had a lower mean nadir CD4 count (258 cells/cmm versus 393 cells/cmm, p = <0.005) and were more likely to be severely immunocompromised at diagnosis, with a CD4 count below 50 cells/cmm (31% versus 9%, p = <0.005). AIDS-defining illnesses were also more common (31% versus 8%, p ≤ 0.005) as was HIV-related mortality (p ≤ 0.005). CONCLUSION: Additional support and training are required to increase adherence to HIV-testing guidelines within primary and secondary care in order to prevent ongoing late presentation with both individual clinical and public health implications.

Improvement is needed in the documentation and HIV testing of children of HIV-positive women.

We assessed our unit's documentation of the HIV status of 146 identifiable existing children of 146 women audited, out of our total cohort of 329 HIV-positive women. For 23 women (16%) there was no documentation of the presence or absence of children. For 81 children of 43 (29%) women the HIV status was unknown. Of these children, at least eight (5.5%) reside in the UK and could be accessed for testing. It is essential that documentation and testing of children of HIV-positive women takes place to prevent potentially fatal late-stage presentations of AIDS and onward transmission of HIV as young people become sexually active.

Characteristics of men who pay for sex: a UK sexual health clinic survey.

BACKGROUND: Populations surveys in the United Kingdom have documented a doubling in the number of men paying for sex over the decade 1990 to 2000. We report the prevalence of this behaviour in men attending a sexual health clinic, and describe their characteristics. METHODS: Retrospective case note review. RESULTS: Of 2665 men completing a standard health screening questionnaire, 10% (267) reported paid sex. We reviewed case notes of 258 men. The mean age was 34.7 years. The majority reported paying women, with 4.3% paying men for sex. Men reported paying for sex abroad (51%), locally (40%), or elsewhere in the United Kingdom (11%), with only 1.7% paying for sex both in the United Kingdom and abroad. The majority (66%) had paid for sex in the previous 12 months, and 27% were repeated users of prostitutes. Almost half the men (43%) paid for sex while in another relationship. Unprotected vaginal sex was more common in men who had paid for sex abroad. None of the men had HIV infection, but 20% had a sexually transmitted infection (8% chlamydia, 1.3% gonorrhoea, 7% non-gonococcal urethritis, and 1.1% syphilis) CONCLUSION: Routine questions about commercial sexual contacts could allow targeted health promotion and harm minimisation for this group of men, protecting their partners-both unsuspecting and commercial.

Use of a staff administered structured questionnaire to identify relevant life-style issues and social-health determinants in a sexual and reproductive health service.

OBJECTIVE: To evaluate a staff-administered questionnaire to identify life-style issues and social-health determinants. DESIGN: Structured questionnaire administered by a health professional after dealing with the primary reason for attendance. SETTING: Community-based UK sexual and reproductive health service. POPULATION: First 1329 selected clinic patients comprising 1018 women attending Family Planning and 161 women plus 150 men attending Genitourinary Medicine; 47% were aged under 25. MAIN OUTCOME MEASURES: Identification of relevant health-risk taking, life-style issues, and unaddressed health concerns. Participants were offered appropriate support, information and referrals. RESULTS: Two hundred and sixty-four (23%) of the Family Planning women and 83 (52%) of the Genitourinary Medicine women [plus 103 (69%) of the men] reported two or more sexual partners in the last year. A third of participants denied regular condom use. Six per cent of women and 5% of men questioned had previously been forced to have sex. Eleven per cent of men admitted to having paid for sex and 9% of women disclosed physical assault (one-quarter in the home). Eight per cent of women and 7% of men had unresolved issues relating to previous miscarriage, termination, or stillbirth. CONCLUSIONS: It is possible to identify relevant life-style issues and social determinants of health during routine practice using a staff-administered questionnaire. The resulting information may not otherwise have been disclosed and may impact significantly on health and care delivery. The information collected provides opportunities for both individuals and service planners to address wider health needs.

Client and staff views on facilities and services, before and after the convergence of sexual, reproductive and women's services.

OBJECTIVE: To evaluate client and staff views on existing facilities and services, before and after the convergence of sexual, reproductive and women's services. METHODS: Evaluation involved questionnaire survey of clients and staff, one-to-one interviews with staff and review of routinely collected clinical activity data. RESULTS: The integration of the three services led to a reduction in stigma associated with attending sexual health services. Despite some staff concerns, the number of men attending the services did not decrease. There was increased satisfaction with the new service, especially the quality of facilities. There were increased numbers of referrals between clinical services in the Sandyford Initiative. CONCLUSIONS: Sexual, reproductive and women's services can be integrated to provide improved facilities for clients.

The Sandyford Initiative: creating added value to health and health care.

The Sandyford Initiative in Glasgow brings together Family Planning, Genitourinary Medicine and the Centre for Women's Health in a new partnership which aims to provide integrated health and social care in a manner which reflects a social model of health. The Steve Retson Project for Gay Men's Sexual Health is also situated within the Sandyford, providing clinical services within the context of a social model of health. The Initiative is managed by the Greater Glasgow Primary Care NHS Trust but has been developed as a result of joint working between three main services, Greater Glasgow Health Board, Glasgow City Council and a number of voluntary organisations. By working to a social model of health, the intention is to ensure that the detection and management of health problems takes into account the social and economic determinants of health and that the provision and practice of health care reflects the social needs of the user. As such the Initiative is expected to make a significant contribution to the sexual health of men and women and the general and reproductive health of women in the Greater Glasgow area and beyond. The core of the Initiative is housed in premises tailored to the needs of the services and their users although satellite services are being planned. In addition to the core clinical and non-clinical care there are services designed to respond to the needs of specific groups such as young people, black and ethnic minority communities and disabled people, in order to improve access and uptake by previously marginalised groups. It is recognised that often the relationship between health and social service providers and their users becomes strained. Implementation of the Sandyford Initiative is intended to inspire confidence and contribute effectively to improving health and managing complex health problems.