Online triage tool improves the efficiency of a sexual health service.

Background Rising demand for sexual health services requires publicly funded service providers to ensure they are seeing members of priority populations. Sydney Sexual Health Centre in New South Wales, Australia developed an innovative online triage tool called 'Am I OK?' to support this goal. Methods This paper outlines the findings of a review that examined the use of the triage tool using retrospective cross-sectional analysis of 2017 data. Results The tool has achieved its purpose in ensuring that non-priority populations are referred to other services, consequently saving a significant amount (approximately 6months equivalent) of phone triage nurse time. Conclusion More work may need to be done to ensure that the tool is not creating a barrier for priority populations wishing to access the service.

Prevalence of rectal Mycoplasma genitalium and macrolide resistance in men who have sex with men attending Sydney Sexual Health Centre.

Background Sexually transmissible infections (STIs) have been increasing in men who have sex with men (MSM) in recent years; however, few studies have investigated the prevalence or antimicrobial resistance in rectal Mycoplasma genitalium in this group. This study aimed to determine the prevalence and predictors of rectal M. genitalium in MSM attending an urban sexual health service in Sydney, Australia, namely the Sydney Sexual Health Centre (SSHC), as well as estimate the rate of macrolide resistance. METHODS: A prospective cross-sectional analysis was conducted of rectally asymptomatic MSM having a rectal swab collected as part of their routine care. Participants self-collected a rectal swab to be tested for M. genitalium and completed a 14-item questionnaire that provided information on behavioural risk factors. The prevalence of rectal M. genitalium was determined and multivariate analysis was performed to assess the associations for this infection. Positive specimens then underwent testing for macrolide-resistant mutations (MRMs) using the ResistancePlus MG assay (SpeeDx, Eveleigh, NSW, Australia). RESULTS: In all, 742 patients were consecutively enrolled in the study. The median age was 31 years (interquartile range 27-39 years), with 43.0% born in Australia. Overall, 19.0% of men were bisexual, 22.9% were taking pre-exposure prophylaxis (PrEP) and 4.3% were HIV positive. The prevalence of rectal M. genitalium was 7.0% (95% confidence interval (CI) 5.3-9.1) overall and 11.8% in those taking PrEP. On multivariate analysis, PrEP use was significantly associated with having rectal M. genitalium (odds ratio 2.01; 95% CI 1.09-3.73; P = 0.01). MRMs were detected in 75.0% (36/48; 95% CI 60.4-86.4%) of infections. CONCLUSION: Rates of rectal M. genitalium infection were high among asymptomatic MSM attending SSHC and MRMs were detected in 75% of infections. PrEP use was found to be significantly associated with rectal M. genitalium infection. These data contribute to the evidence base for screening guidelines in MSM.

Effect of an express testing service for gay and bisexual men on HIV testing frequency in Sydney, Australia: a cohort study.

Background HIV infection in gay and bisexually active men (GBM) is an international public health concern and increasing HIV testing frequency is an important prevention goal. In this study we assessed the effect of introducing the Xpress clinic on repeat HIV testing in high-risk GBM in Sydney, Australia. METHODS: The study population consisted of higher-risk (>5 male partners in the preceding 3 months) HIV-negative GBM attending the Sydney Sexual Health Centre for HIV screening between 1 October 2009 and 31 December 2013 (12 months before Xpress was introduced and 3 years after). Poisson regression models were used to calculate the average annual trend of retesting within 6 months by quarter, and a retrospective cohort was constructed in which multivariate regression methods were used to assess the association between attendance at the Xpress clinic and repeat HIV testing in 6 months. RESULTS: Among high-risk GBM, HIV retesting increased from 32% in Quarter 1 of 2011 to 48% in Quarter 4 of 2013 (Ptrend<0.001). There was no significant trend in the proportion of high-risk GBM retesting within 6 months by quarter in the period before Xpress (1 October 2009-30 September 2010; Ptrend=0.69), but there was a significant upward trend after Xpress implementation (1 January 2011-31 December 2013; Ptrend<0.001). The summary rate ratio in the before versus during Xpress period in all GBM was 1.27 (95% confidence interval (CI) 1.15-1.40; P<0.001). In the multivariate analysis, attending the Xpress clinic was independently associated with retesting within 6 months of an initial test (adjusted OR 2.78; 95% CI 2.12-3.66; P<0.001) after adjusting for other demographics and risk factors. CONCLUSIONS: This study consistently shows that optimising current services by introducing express clinics was able to increase HIV testing frequency in high-risk GBM and should be adopted more widely.

An automated, electronic, client-centred results delivery system saves time and improves workflow.

Background Traditional result notification methods, such as telephone calls, return visits and individualised emails or Short Message Service (SMS) texts, can be time consuming and may not align with client preference. We conducted a cross-sectional survey of our clients that showed that many clients prefer negative results by SMS or email, with the option to call or attend in person for positive results. Methods: We developed an innovative result-robot module in the electronic medical record that reads the electronic result and, using predefined algorithms, determines which SMS or email result template to send to the client. Results and Conclusion: Delivering automated negative results resulted in a 41% decrease in the number of clients calling for their results, demonstrating a significant efficiency gain.

ADOPTing a new method of partner management for genital chlamydia in New South Wales: findings from a pilot implementation program of patient-delivered partner therapy.

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT). METHODS: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake. RESULTS: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners. CONCLUSIONS: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.

Understanding the Targeting and Uptake of HIV Testing Among Gay and Bisexual Men Attending Sexual Health Clinics.

We assessed trends in HIV testing outcomes during a period of clinic-based initiatives introduced to increase HIV testing among gay and bisexual men (GBM) attending sexual health clinics (SHCs) in New South Wales (NSW). A cohort of 25,487 HIV-negative GBM attending 32 SHCs in NSW (2009-2015) was classified into six sub-groups each year based on client-type (new/existing), risk-status (low/high-risk), and any recent HIV testing. Poisson regression methods were used to assess HIV testing outcomes in sub-groups of GBM. HIV testing outcomes and the sub-groups with greatest statistically significant annual increases were: individuals attending (26% in high-risk existing clients with recent testing); testing uptake (4% in low-risk existing clients with no recent testing); testing frequency (6% in low-risk existing clients with no recent testing and 5% in high-risk existing clients with recent testing); and total tests (31% in high-risk existing clients with recent testing). High-risk existing clients with recent testing had a 13% annual increase in the proportional contribution to total tests. Our findings show improved targeting of testing to high-risk GBM at NSW SHCs. The clinic-based initiatives should be considered for translation to other similar settings.

Temporal Trends in Population Level Impacts of Risk Factors for Sexually Transmitted Infections Among Men Who Have Sex with Men, Heterosexual Men, and Women: Disparities by Sexual Identity (1998-2013).

Sexually transmitted infections (STIs) remain a significant public health problem worldwide. We aimed to describe the temporal trends and relative contributions of established risk factors to STIs among sexual health center attendees. This retrospective study included more than 90,000 individuals who attended a sexual health center in Sydney, Australia, during the period 1998-2013. Multivariable logistic regression models were used to identify the correlates of STI diagnoses for three groups: men who have sex with men (MSM), heterosexual men, and women separately. Trends in population attributable risk percentages (PAR%) were estimated to assess the relative contributions of the risk factors on STI diagnosis. STI diagnosis rates among sexual health clinic attendees increased by 75% from 16 to 28% among MSM and more than doubled among heterosexual men and women (7-15 and 5-12%, respectively). Inconsistent condom use, three or more sex partners, sex overseas, past STI diagnosis, and contact with an STI case collectively contributed 61, 74 and 55% of the STI diagnoses among MSM, heterosexual men and women, respectively. Increase in STI diagnosis associated with temporal trends in combined risk factors including condomless sex, multiple sex partners, past STI diagnosis, and contact with an STI case. Although the majority of the factors considered in this study have been significantly associated with STI positivity in all three groups, their overall population level contributions to the epidemic have changed substantially. Our results indicated significant disparities between the MSM and heterosexual men and women as well as sex-specific differences in terms of sexual behaviors.

Does Living Outside of a Major City Impact on the Timeliness of Chlamydia Treatment? A Multicenter Cross-Sectional Analysis.

BACKGROUND: Timely treatment of Chlamydia trachomatis infection reduces complications and onward transmission. We assessed client, process, and clinic factors associated with treatment delays at sexual health clinics in New South Wales, Australia. METHODS: A retrospective review of 450 consecutive clients with positive chlamydia results (not treated at the time of the consultation) was undertaken at 6 clinics (1 urban, 3 regional, and 2 remote) from October 2013. Mean and median times to treatment were calculated, overall and stratified by process steps and clinic location. RESULTS: Nearly all clients (446, 99%) were treated, with 398 (88%) treated in ≤14 days and 277 (62%) in ≤7 days. The mean time-to-treatment was 22 days at remote clinics, 13 days at regional and 8 days at the urban clinic (P < 0.001). Mean time between the laboratory receipt of specimen and reporting of result was 4.9 in the remote clinics, 4.1 in the regional, and 2.7 days in the urban clinic (P < 0.001); and the mean time between the clinician receiving the result until client treatment was15, 5, and 3 days (P < 0.01), respectively. CONCLUSIONS: At participating clinics, treatment uptake was high, however treatment delays were greater with increasing remoteness. Strategies to reduce the time-to-treatment should be explored such as point-of-care testing, faster specimen processing, dedicated clinical time to follow up recalls, SMS results to clients, and taking treatment out to clients.

A cross sectional study of how people diagnosed with a bacterial sexually transmitted infection inform their partners.

OBJECTIVES: To investigate the methods used by patients diagnosed with a sexually transmissible infection (STI) to inform their partners during contact tracing. METHODS: At a large Australian sexual health clinic between March and May 2010, we undertook a retrospective, cross sectional analysis of the methods used by patients diagnosed with a bacterial STI to inform their partners. RESULTS: Of the 172 index patients contacted 1 week after treatment, 163 (95%) chose patient referral, 3 (2%) provider referral and 6 (3%) could not contact any partners. Index patients nominated 1010 sexual partners of whom 494 (49%) were reported as contactable. A total of 447/494 (91%) of these partners were successfully informed; telephone (37%) and face to face (22%) were the most used methods. After multivariate analysis, predictors of using face to face contact methods were age <30 years (AOR: 2.8; 95% CI 1.4 to 5.7), fewer than 2 sexual partners (AOR 3.6; 95% CI 1.7 to 7.6) and speaking a language other than English (adjusted OR (AOR) 3.1; 95% CI 1.3 to 7.2). The single predictor of using interactive contact methods (face to face+telephone) was reporting fewer than 2 sexual partners (AOR 2.7; 95% CI 1.3 to 5.5). People diagnosed with syphilis were significantly less likely to use an interactive contact tracing method (AOR 0.24; 95% CI 0.09 to 0.67). CONCLUSIONS: Most patients diagnosed with a bacterial STI at our sexual health clinic report informing their contactable partners directly either face to face or by telephone. Electronic communications methods were more popular for people with more sexual partners and those with syphilis. Effective contact tracing requires access to a range of methods for patients to inform their partners.

It is more efficient to type: innovative self-registration and appointment self-arrival system improves the patient reception process.

INTRODUCTION: In 2010, we introduced an express sexually transmitted infection/HIV testing service at a large metropolitan sexual health clinic, which significantly increased clinical service capacity. However, it also increased reception staff workload and caused backlogs of patients waiting to register or check in for appointments. We therefore implemented a new electronic self-registration and appointment self-arrival system in March 2012 to increase administrative efficiency and reduce waiting time for patients. METHODS: We compared the median processing time overall and for each step of the registration and arrival process as well as the completeness of patient contact information recorded, in a 1-week period before and after the redesign of the registration system. χ2 Test and rank sum tests were used. RESULTS: Before the redesign, the median processing time was 8.33 minutes (interquartile range [IQR], 6.82-15.43), decreasing by 30% to 5.83 minutes (IQR, 4.75-7.42) when the new electronic self-registration and appointment self-arrival system was introduced (P < 0.001). The largest gain in efficiency was in the time taken to prepare the medical record for the clinician, reducing from a median of 5.31 minutes (IQR, 4.02-8.29) to 0.57 minutes (IQR, 0.38-1) in the 2 periods. Before implementation, 20% of patients provided a postal address and 31% an e-mail address, increasing to 60% and 70% post redesign, respectively (P < 0.001). CONCLUSIONS: Our evaluation shows that an electronic patient self-registration and appointment self-arrival system can improve clinic efficiency and save patient time. Systems like this one could be used by any outpatient service with large patient volumes as an integrated part of the electronic patient management system or as a standalone feature.

SMS reminders improve re-screening in women and heterosexual men with chlamydia infection at Sydney Sexual Health Centre: a before-and-after study.

BACKGROUND: In 2009, Sydney Sexual Health Centre implemented a short message service (SMS) reminder system to improve re-screening after chlamydia infection. SMS reminders were sent at 3 months recommending the patient make an appointment for a re-screen. METHODS: Using a before-and-after study, the authors compared the proportion re-screened within 1-4 months of chlamydia infection in women and heterosexual men who were sent an SMS in January to December 2009 (intervention period) with a 18-month period before the SMS was introduced (before period). The authors used a χ(2) test and multivariate regression. Visitors and sex workers were excluded. RESULTS: In the intervention period, 141 of 343 (41%) patients were diagnosed with chlamydia and sent the SMS reminder. In the before period, 338 patients were diagnosed as having chlamydia and none received a reminder. The following baseline characteristics were significantly different between those sent the SMS in the intervention period and the before period: new patients (82% vs 72%, p=0.02), aged <25 years (51% vs 33% p<0.01), three or more sexual partners in the last 3 months (31% vs 27%, p<0.01) and anogenital symptoms (52% vs 38%, p<0.01). The proportion re-screened 1-4 months after chlamydia infection was significantly higher in people sent the SMS (30%) than the before period (21%), p=0.04, and after adjusting for baseline differences, the OR was 1.57 (95% CI 1.01 to 2.46). CONCLUSIONS: SMS reminders increased re-screening in patients diagnosed as having chlamydia at a sexual health clinic. The clinic now plans to introduce electronic prompts to maximise the uptake of the initiative and consider strategies to further increase re-screening.

Fast-track services for all? The preferences of Chinese-, Korean-, and Thai-speaking women attending a sexual health service.

BACKGROUND: Sydney Sexual Health Centre (SSHC) Xpress clinic has significantly reduced the length of stay and waiting time for clients at SSHC but is currently only available to clients who can read and understand a high level of English. This reduces access for culturally and linguistically diverse (CALD) clients. This study sought to determine the acceptability of 4 proposed components of an express clinic model among CALD clients: computer-assisted self-interview (CASI), self-collection of swabs/urine specimens, not having a physical examination, and consultation with a health promotion officer rather than with a clinician. Differences in acceptability based on language group, new or return client status, sex worker status, clinic visited status, and age were analyzed. METHODS: A cross-sectional, anonymous questionnaire was offered to all female Chinese, Thai, and Korean clients attending SSHC between March and November 2012. Multivariate regression and Pearson χ statistical analyses were conducted using STATA 12 software. RESULTS: A total of 366 questionnaires were returned from 149 Thai, 145 Chinese, and 72 Korean participants. After multivariate analysis, the only predictor of willingness to use an express model of service provision was language group: overall, 67% Thai (odds ratio, 3.74: confidence interval [CI], 2.03-6.89; P < 0.01) and 64% Korean (odds ratio, 3.58; CI, 1.77-7.25, P < 0.01) said that they would use it compared with 35% Chinese. Age, history of sex work, new or returning clients, and general or language clinic attendance did not impact on choices. Within the preference for individual components of the model, more Thai women were happy with using a health promotion officer (43.2%) than Chinese (14.1%) or Korean (8.5%) (P < 0.001); no groups were happy with forfeiting a physical examination; Thai (48.6%) and Korean (40.9%) were happier with self-swabbing than Chinese women (23.9%, P < 0.001); and more Thai were happy to use a CASI (44.2%) than Chinese (12%) or Korean (11.1%; P < 0.001). CONCLUSIONS: This research shows that the components of an express model used at SSHC are not favorable to our CALD client base. Despite a CALD express clinic having the potential to reduce waiting times, most clients did not favor reduced waiting time over being physically examined or using a CASI.

New Xpress sexually transmissible infection screening clinic improves patient journey and clinic capacity at a large sexual health clinic.

INTRODUCTION: In December 2010, a new "express" testing service (Xpress) was implemented alongside routine clinics at a large sexual health clinic. Xpress involved a computer-assisted self-interview, self-collected samples and enrolled nurse staffing. We evaluated the impact of the service on patient journey, staff costs, and clinical capacity. METHODS: In the first 5 months of Xpress, we calculated the median waiting time and length of stay, staff hours and costs, and utilization. We compared these attributes to the same months in the previous year. RESULTS: In the Xpress period, 5335 patients were seen (705 in the Xpress clinic, 4630 in routine clinic), 11% more than the 4804 in the before period. Staff hours were 13% greater in the Xpress period compared with the before period (3567 vs. 3151). The cost per patient seen in the Xpress period was lower compared with the before period ($26.79 compared with $28.48). The median waiting time in the Xpress period was 19 minutes (interquartile range, 8-36; 10 in Xpress clinic and 17 in routine clinics) compared with 23 in the before period (P < 0.01). The median length of stay in the Xpress period was 40 minutes (interquartile range, 27-58; 21 in Xpress clinic and 40 in routine clinics) compared with 43 in the before period (P < 0.01). The utilization rates were 67% in the Xpress period (40% in the Xpress clinic and 74% in routine clinics) compared with 76% in the before period (P < 0.01). CONCLUSION: The Xpress clinic improved the patient journey, and although not fully used, more patients were seen overall in the clinic with minimal additional costs. Marketing of the Xpress clinic is underway.

Client feedback and satisfaction with an express sexually transmissible infection screening service at an inner-city sexual health center.

BACKGROUND: Sydney Sexual Health Centre (SSHC) commenced a fast-track sexually transmissible infection clinic, the Xpress Clinic (Xpress) pilot for asymptomatic clients in March 2010, using a computer-assisted self-interview and self-collected samples. This study examines client satisfaction and changes in intended screening frequency among clients of Xpress. METHODS: This was a cross-sectional study of all clients attending Xpress clinics during the initial 6 months. All clients were requested to complete a survey based on a previously validated questionnaire. Results were stratified by sex, sex of sexual partners, age, and sex work status. RESULTS: Of the 243 clients who attended Xpress, 145 (60%) returned questionnaires. The 2 most common reasons for choosing Xpress clinic were reduced waiting time (n = 42/138 [30%]; 95% confidence interval [CI], 23%-38%) and reduced length of consultation (n = 16/138 [12%]; 95% CI, 7%-17%).When asked if they would have come to SSHC anyway if Xpress was not an option, men who have sex with men (MSM) were more likely than non-MSM to say that they would come for screening anyway (77% MSM vs. 59% non-MSM, P = 0.034). Youth younger than 25 were less likely than those 25 years and older to have come for screening anyway (53% vs. 79%, P = 0.012).Most (n = 101/138 [73%]; 95% CI, 65%-80%) considered that they would test for sexually transmissible infections more frequently in the future using the Xpress model. Client satisfaction levels were high, with most respondents reporting that they would return to Xpress (n = 119/142 [83%]; 95% CI, 77%-89%) and would recommend it to friends (n = 122/142 [86%]; 95% CI, 79%-90%). CONCLUSIONS: Most clients were highly satisfied with all aspects of Xpress and reported intentions to retest using this model of care.

Sensitivity of 20-minute voiding intervals in men testing for Chlamydia trachomatis.

BACKGROUND: Men are recommended to not urinate for at least 1 hour before urine testing for Chlamydia trachomatis, but some studies have shown that recent urination does not impact test sensitivity for nucleic acid amplification tests. The objective of this study was to estimate the sensitivity of chlamydia testing using samples obtained 20-minutes post void. METHODS: We recruited men returning to Sydney Sexual Health Centre for treatment of urethral Chlamydia trachomatis infection between July 2009 and February 2011. A short questionnaire was used to elicit symptoms, and 2 first-void urine samples were collected-the first after the standard 1 hour minimum and the second 20 minutes later. Men with clinical or microbiologic evidence of urethritis, men receiving antibiotic treatment, and those who had urinated within the last hour were excluded. Samples were tested using Roche COBAS Amplicor PCR. The proportion of samples testing positive at 20 minutes post void was determined using the 1-hour post void sample as a gold standard. RESULTS: Thirty-one men with confirmed chlamydia infection were included in the analysis. Of these, 29 of 31 (93.5%) were positive at 20 minutes (95% CI: 78.6%-99.2%). CONCLUSIONS: The sensitivity of 20-minute voiding intervals in asymptomatic men remains reasonably high relative to standard voiding intervals. Removing the barrier of a 1-hour voiding interval should be considered during opportunistic screening.

A prospective descriptive study of women attending a colposcopy clinic.

This paper reports the findings of a prospective convenience sample cohort study investigating self-reported purpose of pap smears and worry interference associated with having abnormal pap smear results in women attending a public colposcopy service between 05 April and 19 December 2003. Intrusive thoughts about cancer have been postulated to be associated with dysfunction in women at increased risk of developing breast or ovarian cancer. A study designed questionnaire and the Multidimensional Health Locus of Control was completed by the women whilst waiting to have colposcopy. This study shows that Asian women need to have information about abnormal pap smear results explained well in order to avoid intrusive thoughts and anxiety. It also demonstrates that nurses provide a key role in providing information that leads to less concern and better understanding of the concepts.

What would be missed if we didn't screen men who have sex with men for oral chlamydia trachomatis? A cross-sectional study.

UNLABELLED: Background This study aimed to describe oropharyngeal chlamydia (OCT) in gay and bisexually active men (GBM) attending a large urban sexual health clinic in Sydney and determine what proportion of cases would be missed if screening was not routine. METHODS: Retrospective data were extracted for all GBM with a positive OCT result between 1 October 2012 and 31 April 2014. The control group consisted of patients who had a negative OCT result on their first visit during the study period, and each patient was only counted once. RESULTS: A total of 74 of 2920 GBM (0.03, 95% CI: 0.02-0.03) were diagnosed with OCT. The 2920 GBM had a total of 11226 OCT tests performed, demonstrating OCT test positivity of 0.006 (95% CI: 0.005-0.008). A total of 62 sexually transmissible infections (STIs) were diagnosed at other sites: 34 rectal chlamydia (CT), 12 throat gonorrohea (GC), 7 urine CT, 7 rectal GC, 1 infectious syphilis and 1 non-gonoccal urethritis (NGU) case. Of the 74 OCT cases, 56 (0.76, 95% CI: 0.64-0.85) were treated with Azithromycin; 51 (69%) as part of standard treatment for their STI co-infection (34 rectal CT, 12 throat GC, 7 urine CT, 7 rectal GC, 1 NGU case) and a further five (7%) were treated as contacts. The remaining 18 people (0.24, 95% CI: 0.15-0.36) would not have been treated unless they were tested specifically for OCT. CONCLUSION: Overall, two-thirds of the OCT cases received appropriate treatment and only a small number of cases would have been missed had routine screening not been performed. With an extremely low overall test positivity of 0.6%, screening for OCT at our service adds little to population level health control.

As good as it gets? Retention in care of people newly diagnosed with HIV at the Sydney Sexual Health Centre.

A retrospective review of all new HIV positive patients attending the Sydney Sexual Health Centre in 2012 and 2013 was performed to ascertain the retention in care rates, proportion that achieved viral suppression, number of SMS reminders sent and counselling uptake. Ninety-six patients had a retention rate of 66%. Thirty-three patients (34%) were not retained in care, 16 (17%) were knowingly attending another healthcare service with 17 (18%) categorised as lost to follow up. Counselling referrals had a 74% (71/96) uptake (95%CI: 5.08-69.69, P<0.001), with SMS reminders sent in 97% (93/96) of cases (95%CI: not possible with zero count cells, P=0.038). Overall, the clinic performed well compared with international standards but the lost to follow-up rate remains a concern.

An alternative model of sexually transmissible infection testing in men attending a sex-on-premises venue in Sydney: a cross-sectional descriptive study.

Background: Sydney Sexual Health Centre (SSHC) partnered with a large sex-on-premises venue, South Eastern Sydney Local Health District HIV and Related Programs Unit and AIDS Council of NSW (ACON) to develop and implement a community-based sexually transmissible infection (STI) screening model co-located in a sex-on-premises venue. This paper describes the process, the outcomes and examines the cost of this model. Methods: A retrospective cross-sectional study of gay and bisexual men (GBM) attending a STI testing service co-located in a sex-on-premises venue in Sydney city between the 1 November 2012 and 31 May 2014. Results: A total of 402 patrons had 499 testing episodes in the study period. Testing patrons were a median of 39.5 years of age, 221 (55%) were born overseas, 85 (21%) spoke a language other than English at home and 54 (13%) had a STI at first testing. A total of 105 (26%) testing patrons had never tested for a STI before. Of the 297 (74%) who had been tested before, 83 (21%) had not been tested within the last 12 months. A total of 77 STIs were detected in 63 people over 499 testing episodes, giving a STI positivity rate of 15% in the testing episodes. The prevalence of rectal chlamydia was the highest at 8% followed by pharyngeal gonorrhoea at 3%. A total of 97% of testing patrons were successfully relayed their results via their preferred methods within a median of 7.5 days. Conclusion: This paper highlights that offering STI screening in a community-based setting was an effective and low-cost alternative to traditional testing services.

Text message reminders do not improve hepatitis B vaccination rates in an Australian sexual health setting.

OBJECTIVE: To evaluate the impact of text message reminders (short messaging service (SMS)) on hepatitis B virus (HBV) vaccination completion among high risk sexual health center attendees. MATERIALS AND METHODS: In September 2008, Sydney Sexual Health Centre implemented an SMS reminder system. The authors assessed the impact of the reminder system on HBV vaccination rates among patients who initiated a course. The authors used a chi-square test and multivariate logistic regression to determine if SMS reminders were associated with second and third dose vaccine completion, compared with patients prior to the intervention. RESULTS: Of patients sent SMS reminders in 2009 (SMS group), 54% (130/241) received 2 doses and 24% (58/241) received 3 doses, compared to 56% (258/463) (P = 0.65) and 30% (141/463) (P = 0.07) in the pre-SMS group (2007), respectively. Findings did not change after adjusting for baseline characteristics significantly different between study groups. There were no significant differences in completion rates among people who injected drugs, HIV-negative gay and bisexual men (GBM), and HIV-positive GBM. Among sex workers, travelers, and people who reported sex overseas, second and third dose completion rates were significantly lower in the SMS group compared to the pre-SMS group. In the SMS group, 18% of those who only had one dose attended the clinic within 1-18 months and 30% of those who had 2 doses attended in 6-18 months, but vaccination was missed. DISCUSSION: SMS reminders did not increase second or third vaccine dose completion in this population. CONCLUSION: Clinician prompts to reduce missed opportunities and multiple recall interventions may be needed to increase HBV vaccination completion in this high risk population.