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Brook G, Church H, Evans C, Jenkinson N, McClean H, Mohammed H, Munro H, Nambia K, Saunders J, Walton L, Sullivan A. 2019 UK National Guideline for consultations requiring sexual history taking : Clinical Effectiveness Group British Association for Sexual Health and HIV. Int J STD AIDS 2020; 31:920-938. [PMID: 32718268 DOI: 10.1177/0956462420941708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This guideline is an update of a previous version published in 2013. In this new version, we have reflected changes in the way sexual health services are now provided by assuming an integrated Sexual Health/Sexual and Reproductive Healthcare service. There are new recommendations for online testing, female genital mutilation (FGM), chemsex and considerations for transgender (and non-binary) individuals. Previous versions rather assumed a cis-gender clientele and so we have taken a more mechanistic approach to sex and risk without assuming gender identification. We have updated our gender terminology in line with the British Association for Sexual Health and HIV 'sexual health standards for trans, including non-binary, people' although have retained the terminology of 'men' and 'women' in a few cases where it related to other guidelines, e.g. human papillomavirus vaccination and FGM.
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Affiliation(s)
- G Brook
- GUM/HIV, Central Middlesex Hospital, London, UK
| | - H Church
- GUM, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Evans
- 10 Hammersmith Broadway Sexual Health Clinic, London, UK
| | | | - H McClean
- GUM/HIV, Wilberforce Health Centre, City Health Care Partnership CIC, Hull, UK
| | - H Mohammed
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - H Munro
- CSRH Hywel Dda HB, Wales, UK
| | - K Nambia
- Sexual Health & HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Saunders
- National Chlamydia Screening Programme, Public Health England, London, UK
| | - L Walton
- The Jefferiss Wing Centre for Sexual Health and HIV, Imperial College Healthcare NHS Trust, London, UK
| | - A Sullivan
- Chelsea and Westminster NHS Foundation Trust, London, UK
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Menon-Johansson AS, Curtis H, Mohammad H, Hamlyn E, Hughes A, McClean H, Pal N, Tayal S, Sullivan AK. Improved results demonstrated in the 2017 national audit of early syphilis management in the United Kingdom. Int J STD AIDS 2020; 31:375-379. [PMID: 32041481 DOI: 10.1177/0956462419896706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The revised British Association of Sexual Health and HIV UK guidelines on the management of syphilis were published in 2015 and this audit measures performance against those standards and recommendations. Although not included in the guideline recommendations, an exploratory question on clinics’ HIV testing policy was also included. The audit was conducted over a two-month period in 2017 in genitourinary medicine (GUM) clinics across the UK of cases presenting in 2016. A total of 161 GUM clinics participated, and data were collected for 3017 cases. The standard for adherence to recommended treatment was met (97%, standard: 97%) and almost met for documented pre-treatment syphilis serology (95%, standard: 97%). Even though only 74% of patients had a documented action in relation to informing sexual contacts (standard: 97%), the standard for contacts seen and tested per index case within four weeks was met (0.9, standard: 0.6). Finally, those clinics with a formal policy on HIV testing after a syphilis diagnosis were twice as likely to test after the HIV window period, compared to clinics without a policy; a concurrent HIV diagnosis was made in 75 (3%) patients. More work is required to standardize documented delivery of effective partner notification and a formal policy on HIV testing appears to be effective.
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Affiliation(s)
| | - H Curtis
- British HIV Association, London, UK
| | | | - E Hamlyn
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - H McClean
- Royal Society of Medicine, Cheshire, UK
| | - N Pal
- Berkshire Healthcare Foundation Trust, Garden Clinic, Upton Hospital, Slough, UK
| | | | - A K Sullivan
- Chelsea and Westminster NHS Foundation Trust, London, UK
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Bhaduri S, Curtis H, McClean H, Sullivan AK. The British Association for Sexual Health and HIV 2016 UK national audit and survey of clinic policies in relation to risk assessment, HIV testing and follow-up. Int J STD AIDS 2018; 29:1142-1145. [PMID: 29749877 DOI: 10.1177/0956462418771778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This national audit of 142 clinics demonstrated that the majority of clinics surveyed had policies and agreed clinical practice for alcohol and recreational drug enquiry, as well as documentation of HIV test refusal, although this was not the case in 24% of clinics as regards alcohol usage, 21% of clinics as regards recreational drugs use and 43% of clinics as regards chemsex usage. Regarding management of HIV test refusal, there was no policy or agreed practice in 13% of clinics with respect to men having sex with men (MSM) attenders, and in 18% of clinics for heterosexual attenders. Seventy percent of clinics had HIV point of care tests (POCT) available. Recommendations include: all clinics should have a policy of routine enquiry about alcohol, recreational drugs and chemsex, all clinics should record reasons for HIV test refusal and all clinics should provide testing alternatives to improve uptake, e.g. point of care testing or home sampling.
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Affiliation(s)
- S Bhaduri
- 1 Worcestershire Health and Care NHS Trust, Arrowside Unit, Alexandra Hospital, Worcestershire, UK
| | - H Curtis
- 2 British Association for Sexual Health and HIV, London, UK
| | - H McClean
- 3 City Healthcare Partnership, Wilberforce health Centre, Hull, UK
| | - A K Sullivan
- 4 Chelsea and Westminster NHS Foundation Trust, London, UK
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Menon-Johansson AS, McClean H, Carne CA, Estreich S, Knapper C, Sethi G, Smith A, Sullivan AK. Improved sexual history taking in the 2012 BASHH asymptomatic screening re-audit. Int J STD AIDS 2013; 25:360-2. [PMID: 24047881 DOI: 10.1177/0956462413504555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective asymptomatic screening for sexually transmitted infections is an important public health service because a significant proportion of sexually transmitted infections do not present with symptoms. In 2009, the National Audit Group of the British Association of Sexual Health and HIV (BASHH) audited the management of asymptomatic patients and recommended increased documentation about oral and anal sex, regional strategies for nucleic acid amplification test (NAAT) use for gonorrhoea, improved screening for hepatitis B in men who have sex with men and an increase in screening for HIV. The 2012 audit used web-based forms to collect submissions from 180 consultant-led centres (65% response rate) that included episodes of care from 6669 asymptomatic patients. An improvement was demonstrated for all the areas measured during the 2009 audit. A doubling of gonorrhoea testing using NAATs was seen and yet 10% of asymptomatic patients continued to have microscopy despite these tests not being recommended by BASHH guidelines. This audit recommends universal adoption of gonorrhoea NAATs across the United Kingdom.
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Affiliation(s)
- A S Menon-Johansson
- Burrell Street Sexual Health Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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McClean H, Radcliffe K, Sullivan A, Ahmed-Jushuf I. 2012 BASHH statement on partner notification for sexually transmissible infections. Int J STD AIDS 2013; 24:253-61. [PMID: 23970656 DOI: 10.1177/0956462412472804] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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McClean H, Sullivan AK, Carne CA, Warwick Z, Menon-Johansson A, Clutterbuck D. UK national audit against the key performance indicators in the British Association for Sexual Health and HIV Medical Foundation for AIDS and Sexual Health Sexually Transmitted Infections Management Standards. Int J STD AIDS 2013; 23:742-7. [PMID: 23104750 DOI: 10.1258/ijsa.2012.012034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A national audit of practice performance against the key performance indicators in the British Association for Sexual Health and HIV (BASHH) and HIV Medical Foundation for AIDS Sexual Health Standards for the Management of Sexually Transmitted Infections (STIs) was conducted in 2011. Approximately 60% and 8% of level 3 and level 2 services, respectively, participated. Excluding partner notification performance, the five lowest areas of performance for level 3 clinics were the STI/HIV risk assessment, care pathways linking care in level 2 clinics to local level 3 services, HIV test offer to patients with concern about STIs, information governance and receipt of chlamydial test results by clinicians within seven working days (the worst area of performance). The five lowest areas of performance for level 2 clinics were participating in audit, having an audit plan for the management of STIs for 2009-2010, the STI/HIV risk assessment, HIV test offer to patients with concern about STIs and information governance. The results are discussed with regard to the importance of adoption of the standards by commissioners of services because of their relevance to other national quality assurance drivers, and the need for development of a national system of STI management quality assurance measurement and reporting.
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Affiliation(s)
- H McClean
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK.
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McClean H, Carne CA, Sullivan AK, Radcliffe KW, Ahmed-Jushuf I. Chlamydial partner notification in the British Association for Sexual Health and HIV (BASHH) 2011 UK national audit against the BASHH Medical Foundation for AIDS and Sexual Health Sexually Transmitted Infections Management Standards. Int J STD AIDS 2012; 23:748-52. [DOI: 10.1258/ijsa.2012.012035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper reports on chlamydial partner notification (PN) performance in the 2011 BASHH national audit against the British Association for Sexual Health and HIV (BASHH) Medical Foundation for AIDS Sexual Health (MedFASH) Sexually Transmitted Infection Management Standards (STIMS). There was wide regional variation in level 3 clinic PN performance against the current standard of index case-reported chlamydial PN, with 43% (regional range 0–80%) of clinics outside London meeting the ≥0.6 contacts seen per index standard, and 85% of clinics (regional range 82–88%) in London meeting the ≥0.4 standard. For level 2 clinics, 39% (regional range 0–100%) of clinics outside London met the ≥0.6 standard, and 43% (regional range 40–50%) of clinics in London met the ≥0.4 standard. Performance for health-care worker (HCW)-verified contact attendance is also reported. New standards for each of these performance measures are proposed for all level 3 clinics: ≥0.6 contacts seen per index case based on index case report, and ≥0.4 contacts seen per index case based on HCW verification, both within four weeks of the first partner notification interview. The results are discussed with regard to the importance of adoption of standards by commissioners of services, relevance to national quality agendas, and the need for development of a national system of PN quality assurance measurement and reporting.
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Affiliation(s)
- H McClean
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - C A Carne
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - A K Sullivan
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - K W Radcliffe
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - I Ahmed-Jushuf
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
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Abstract
A focused repeat national audit of sexual history-taking was conducted in genitourinary (GU) medicine clinics in the UK in 2010, addressing several areas of practice under-performance identified in the baseline 2008 national audit. The case-notes of 4285 patients were audited. An increase in documentation was observed for all measures, except legibility which was unchanged. Despite the overall improvement, several measures (chaperone offer, condom usage and four of five aspects of HIV risk assessment) remained below target.
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Affiliation(s)
- A K Sullivan
- National Audit Group, British Association for Sexual Health and HIV, Royal Society of Medicine, London, UK.
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McClean H, Carne CA, Sullivan AK, Menon-Johansson A, Gokhale R, Sethi G, Mammen-Tobin AG, Daniels D. National audit of asymptomatic screening in UK genitourinary medicine clinics: case-notes audit. Int J STD AIDS 2011; 21:506-11. [PMID: 20852202 DOI: 10.1258/ijsa.2010.009572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A national audit of screening of asymptomatic patients seen in UK genitourinary medicine clinics in 2009 was conducted against the national guidelines. Data were aggregated by regions and clinics in regions, allowing practice to be compared within and between regions, as well as to national averages and against national guidelines. The case-notes of 4428 patients were audited. Performance was over 80% against the national guidelines for screening of asymptomatic heterosexual men, men who have sex with men (MSM) and women for chlamydial, gonorrhoeal, syphilis and HIV infections. However, the recommended method of endocervical culture for gonorrhoea was performed in only 65% of women, with a further one-quarter being screened with endocervical or vulvovaginal nucleic acid amplification tests (NAATs). Although significant NAAT use for gonorrhoea was seen in all groups, testing for gonorrhoea by culture is still recommended as a first-line test on invasive samples. Over 80% of MSM, who were not known to be immune, were screened for hepatitis B. Urethral microscopy was performed in 22% of heterosexual men and 17% of MSM, and cervical microscopy in 12% of women.
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Affiliation(s)
- H McClean
- BASHH, The Royal Society of Medicine, London, UK.
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Carne CA, McClean H, Sullivan AK, Menon-Johansson A, Gokhale R, Sethi G, Mammen-Tobin AG, Daniels D. National audit of asymptomatic screening in UK genitourinary medicine clinics: clinic policies audit. Int J STD AIDS 2011; 21:512-5. [PMID: 20852203 DOI: 10.1258/ijsa.2010.009573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Of clinics responding to the audit, 99 and 97% have policies that are compliant with the British Association for Sexual Health and HIV National Guidelines for testing of asymptomatic men and women for HIV and syphilis, respectively. All clinics offer men, and all but one clinic offer women, screening for chlamydial infection with nucleic acid amplification tests (NAATs), as recommended by the guidelines. However, for gonorrhoea screening one-third of clinics offer men urine or urethral NAATs, and one quarter of clinics offer women endocervical, vulvovaginal or urinary NAATs, and not endocervical culture, and these practices are not compliant with the guidelines. Eight clinics did not specify whether they routinely offer testing for gonorrhoea in women. One-third of clinics routinely perform rectal and oropharyngeal screening for gonorrhoea in men who have sex with men (MSM), but fewer screen for chlamydia, regardless of sexual history which is stated as a determinant of offering screening at these anatomical sites. Finally, one-fifth of clinics offer urethral microscopy to asymptomatic heterosexual men and MSM, and about one half of clinics offer urethral culture for detection of gonorrhoea in asymptomatic women, even though these practices are not compliant with the guidelines.
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Affiliation(s)
- C A Carne
- BASHH, The Royal Society of Medicine, London, UK
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Abstract
A national audit of sexual history-taking was conducted in genitourinary medicine clinics in the UK in 2008. Data were aggregated by region and clinic, allowing practice to be compared between regions, as well as to national averages and against national Guidelines. In this paper the case-notes of 4121 patients were audited. A high proportion of the case-notes were deemed to be completely legible. In other respects there is considerable inter-regional variation in the adherence to national Guidelines. Interventions are especially required to improve documentation of practice in discussing condom use, HIV risk assessment, offer of a chaperone and assessment for hepatitis B vaccination and hepatitis C testing, and issues concerning sexual contacts.
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Affiliation(s)
- C Carne
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - H McClean
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - S Bhaduri
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - R Gokhale
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - G Sethi
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - D Daniels
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
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Abstract
Provision of a confidential, private environment for sexual history-taking was provided in almost all clinics. However, less than half of the clinics had a policy displayed about their confidentiality policy in waiting areas, although more had this available by other means. About two-thirds of clinic information/advertising literature included information about the need to take a sexual history. Sixty percent of clinics assessed clinician communication skills as part of service quality. Most clinics had policies relating to patients whose first language is not English, but only around half of clinics had policies for hearing difficulties and learning difficulties. Policies are also lacking in some clinics for documentation of the offer of chaperones and assessment of the competency of under-16-year-olds to consent to history-taking and examination.
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Affiliation(s)
- H McClean
- The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
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McClean H, Sutherland J, Searle S, Howarth P. An exploratory study of information-giving used to promote chlamydial test-seeking by students at a college family planning clinic. Br J Fam Plann 2000; 26:209-12. [PMID: 11053877 DOI: 10.1783/147118900101194814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Partnership working, involving workers in various aspects of sexual health and a large UK further education college, took place to give information about genital tract chlamydial infection in order to promote chlamydial urine testing (LC(x) Chlamydia trachomatis Assay Abbott Diagnosis Division) for a limited period at the college's family planning clinic. Female students were more likely to report awareness about the availability of testing and to access the testing service. Uptake of testing was largely contemporaneous with information-giving work and sharply declined after information-giving had ceased. A small population of test seekers (including partners of index cases) was generated, which harvested a rate of genital tract chlamydial infection similar to that found in family planning and genitourinary medicine clinics.
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Affiliation(s)
- H McClean
- Consultant in Sexual Health Medicine, Lansdowne Clinic, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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