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Walter SR, Jackson J, Myring G, Redaniel MT, Margelyte R, Gardiner R, Clarke MD, Crofts M, McLeod H, Hollingworth W, Phillips D, Muir P, Steer J, Turner J, Horner PJ, De Vocht F. Impact of rapid near-patient STI testing on service delivery outcomes in an integrated sexual health service in the United Kingdom: a controlled interrupted time series study. BMJ Open 2023; 13:e064664. [PMID: 36631238 PMCID: PMC9835959 DOI: 10.1136/bmjopen-2022-064664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service. DESIGN Controlled interrupted time series study. SETTING Two integrated sexual health services (SHS) in UK: Unity Sexual Health in Bristol, UK (intervention site) and Croydon Sexual Health in London (control site). PARTICIPANTS Electronic patient records for all 58 418 attendances during the period 1 year before and 1 year after the intervention. INTERVENTION Introduction of an in-clinic rapid testing system for gonorrhoea and chlamydia in combination with revised treatment pathways. OUTCOME MEASURES Time-to-test notification, staff capacity, cost per episode of care and overall service costs. We also assessed rates of gonorrhoea culture swabs, follow-up attendances and examinations. RESULTS Time-to-notification and the rate of gonorrhoea swabs significantly decreased following implementation of the new system. There was no evidence of change in follow-up visits or examination rates for patients seen in clinic related to the new system. Staff capacity in clinics appeared to be maintained across the study period. Overall, the number of episodes per week was unchanged in the intervention site, and the mean cost per episode decreased by 7.5% (95% CI 5.7% to 9.3%). CONCLUSIONS The clear improvement in time-to-notification, while maintaining activity at a lower overall cost, suggests that the implementation of clinic-based testing had the intended impact, which bolsters the case for more widespread rollout in sexual health services.
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Affiliation(s)
- Scott R Walter
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joni Jackson
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gareth Myring
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruta Margelyte
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Gardiner
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael D Clarke
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hugh McLeod
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - William Hollingworth
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Phillips
- Croydon Sexual Health, Croydon University Hospital, Croydon, UK
| | - Peter Muir
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
- National Institute for Health and Care Research, Health Protection Research Unit in Behavioural Science and Evaluation (NIHR HPRU), University of Bristol, Bristol, UK
| | - Jonathan Steer
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
| | - Jonathan Turner
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
| | - Paddy J Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- National Institute for Health and Care Research, Health Protection Research Unit in Behavioural Science and Evaluation (NIHR HPRU), University of Bristol, Bristol, UK
| | - Frank De Vocht
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Lorenc A, Brangan E, Kesten JM, Horner PJ, Clarke M, Crofts M, Steer J, Turner J, Muir P, Horwood J. What can be learnt from a qualitative evaluation of implementing a rapid sexual health testing, diagnosis and treatment service? BMJ Open 2021; 11:e050109. [PMID: 34686552 PMCID: PMC8543645 DOI: 10.1136/bmjopen-2021-050109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To investigate experiences of implementing a new rapid sexual health testing, diagnosis and treatment service. DESIGN A theory-based qualitative evaluation with a focused ethnographic approach using non-participant observations and interviews with patient and clinic staff. Normalisation process theory was used to structure interview questions and thematic analysis. SETTING A sexual health centre in Bristol, UK. PARTICIPANTS 26 patients and 21 staff involved in the rapid sexually transmitted infection (STI) service were interviewed. Purposive sampling was aimed for a range of views and experiences and sociodemographics and STI results for patients, job grades and roles for staff. 40 hours of observations were conducted. 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 valued faster results and avoiding unnecessary treatment. Patients reported that they were willing to drop-off self-samples and return for a follow-up appointment, enabling infection-specific treatment in accordance with test results, thus improving antimicrobial stewardship. CONCLUSIONS The new service was acceptable to staff and patients. 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 changes played an important role in the success of the service by rapidly feeding back issues for adjustment. Visibility to staff of positive impacts on patient care is important in maintaining morale.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
| | - Emer Brangan
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Joanna M Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paddy J Horner
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael Clarke
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan Steer
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Jonathan Turner
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Peter Muir
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Mullens AB, Daken K, Lemoire J, Brownlow C, Driver G, Gow J. HIV Point of Care Testing (PoCT) at Late-Night Sex on Premises Venues (SOPV) for Gay and Bisexual Men and Other Men Who Have Sex with Men (GBMSM): A Mixed Methods Analysis. AIDS Behav 2020; 24:450-466. [PMID: 30982103 DOI: 10.1007/s10461-019-02500-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to establish 'proof of concept' for a novel approach to HIV and STI testing at a sex on premises venue (SOPV) for gay and bisexual and other men who have sex with men (GBMSM) during late night group sex theme parties. A mixed-methods approach was used, and the study aimed to: (1) Build upon existing SOPV funded service delivery and establish 'proof of concept' for this unique setting within an SOPV; (2) evaluate the uptake and feasibility/acceptability of routine HIV/STI testing for GBMSM during theme parties in SOPV; and (3) identify beliefs/perceptions regarding this health promotion activity and venue suitability. The characteristics of patrons utilising PoCT (Point of Care Testing) were established to help further reach potentially stigmatised, highly sexually adventurous GBMSM. The findings support further PoCT endeavours within MSM communities to target harder to reach communities to reduce the rate of new transmissions of HIV. Findings can inform future health promotion, screening and interventions, as well as to identify a successful method to engage harder to reach GBMSM that need further focused targeting for HIV and STI testing to reduce transmission.
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A hot topic for health: Results of the Global Sauna Survey. Complement Ther Med 2019; 44:223-234. [PMID: 31126560 DOI: 10.1016/j.ctim.2019.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Sauna-bathing is an ancient tradition that is gaining popularity across the world as a wellness tool. There is a growing body of medical evidence supporting the role of saunas, or whole-body thermotherapy, as a form of treatment for a range of health issues. However, the demographics, motivations and experiences of current sauna bathers have not yet been explored on a global scale. This study is designed to explore these themes. DESIGN An online 71-item questionnaire compiling information on the individual characteristics, sauna-related habits and perceived health and wellness experiences of regular sauna bathers was conducted from October 2016 to October 2017. The validated 'SF-12' quality of life scoring tool was incorporated into the questionnaire to measure physical and mental indicators of well-being. RESULTS Of 572 logins recorded, 482 valid responses were generated. Both men (51.3%) and women (48.7%) were represented, and respondents were predominantly well-educated (81.8%), non-smoking (90.6%), regularly-exercising (78.8%) individuals of normal-to-overweight status (87.1%) who sauna-bathed approximately 1-2 times per week. The key reasons indicated by respondents for sauna-bathing included relaxation/stress reduction, pain relief and socializing. Nearly a third of respondents reported medical conditions and of this subset, those with back/musculoskeletal pain and mental issues cited the greatest improvements in their conditions with sauna-bathing. Of all respondents, 83.5% reported sleep benefits after sauna use. Analysis of well-being scores after stratifying respondents into three groups by sauna-bathing frequency (group I: <5 times per month; group II: 5-15 times per month; group III: >15 times per month) revealed group II respondents had slightly higher mental well-being scores (Kruskal-Wallis testing: H = 6.603 > ꭔ2 of 5.991, p = 0.0368, df = 2 with post hoc analysis using Mann-Whitney U test: p = 0.016) as compared to respondents who were sauna-bathing less frequently (group I). No respective differences were detected between the physical well-being scores of any of the three groups. Adverse reactions to sauna-bathing were recorded as mostly minor (93.1%), including primarily symptoms of dizziness, dehydration and headache. However, there were two reports (0.3%) of chest pain and eye irritation requiring hospitalization. CONCLUSIONS This cross-sectional study documents that sauna-bathing participants, particularly those from Finland, Australia and the United States, are motivated to use saunas predominantly for relaxation, reporting health benefits especially around mental well-being and sleep, with relatively few adverse effects. While these results reinforce some of the known health benefits of sauna bathing, they indicate that further research and better dissemination of existing evidence is needed to fully develop the sauna's potential as a therapeutic intervention.
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Tobin K, Edwards C, Flath N, Lee A, Tormohlen K, Gaydos CA. Acceptability and feasibility of a Peer Mentor program to train young Black men who have sex with men to promote HIV and STI home-testing to their social network members. AIDS Care 2018; 30:896-902. [PMID: 29482342 DOI: 10.1080/09540121.2018.1442553] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Young Black men who have sex with men (YBMSM) experience persistently high rates of undiagnosed HIV and other sexually transmitted infections (STIs) and testing rates remain sub-optimal. Home-based testing (HBT) has been found to be acceptable among MSM and while awareness about HBT is relatively high, uptake has been low. Peer-based approaches have been shown to be effective in reducing HIV risk behavior, yet have not been used to increase utilization of HBT. The purpose of this study was to assess acceptability and feasibility of a program to train YBMSM as Peer Mentors to use and promote HIV and STI home-based testing and specimen collection to their social network members. Fifteen YBMSM ages 18-30 completed in-depth structured interviews and were asked to talk with their social network members about home-based testing. Participants reported acceptability of the Peer Mentor role and two-thirds had conversations with diverse social network members (e.g., male and female, sex partners, friends, family). Facilitators of peer outreach included the novelty of home-based testing, confidence about accuracy of the tests, and resources for linkage to care. Barriers included concerns about negative responses and disclosure of sexual identity/behavior. Results of this study suggest that YBMSM are willing and able to promote HBT to their social networks. This is a promising approach to increasing dissemination of HBT kits for both HIV and STI testing.
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Affiliation(s)
- Karin Tobin
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Catie Edwards
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Natalie Flath
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Alexandra Lee
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Kayla Tormohlen
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Charlotte A Gaydos
- b Division of Infectious Diseases, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
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Freeman-Romilly N, Sheppard P, Desai S, Cooper N, Brady M. Does community-based point of care HIV testing reduce late HIV diagnosis? A retrospective study in England and Wales. Int J STD AIDS 2017; 28:1098-1105. [PMID: 28118802 DOI: 10.1177/0956462416688573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate if patients diagnosed in community clinics have higher baseline CD4 cell counts than those diagnosed in Genitourinary medicine (GUM)/HIV clinics. We undertook a retrospective review of baseline CD4 cell counts for patients receiving a reactive HIV test in community-testing clinics. Eleven local HIV clinics were contacted to determine the baseline CD4 cell counts of these patients. Baseline CD4 cell counts of those diagnosed in the community were compared with mean local GUM/HIV clinic and median national baseline CD4 cell count for their year of diagnosis. Clients diagnosed in community settings had a mean baseline CD4 cell count of 481 cells/mm3 (SD 236 cells/mm3) and median baseline of 483 cells/mm3 (interquartile range 311-657 cells/mm3). This was significantly higher than those diagnosed in the GUM/HIV clinic local to the community-testing site (mean baseline CD4 397 cells/mm3, p = 0.014) and the national median for that year (336 cells/mm3, p < 0.001). HIV testing in community settings identifies patients at an earlier stage of infection than testing in clinical settings.
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Affiliation(s)
| | - Paula Sheppard
- 2 London School of Hygiene and Tropical Medicine, London, UK
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