Society of Sexual Health Advisers » Latest SSHA News

NHS missing key opportunities to tackle alcohol abuse

pmadden — Wed, 01 Feb 2012 20:17:20 +0000

ALCOHOL AND SEX A COCKTAIL FOR POOR SEXUAL HEALTH

On the 01/01/2012 , the Royal College of Physicians published the report of the: Alcohol & Sexual Health Working Party. The report entitled: Alcohol and sex , A Cocktail For Poor Sexual Health reviews the evidence for the link between alcohol and poor sexual health outcomes, and most importantly defines the value of interventions in sexual health settings that can reduce the associated morbidity. SSHA was represented on the working party and Health Advisers were surveyed during the formation of the report and the majority agreed they have the transferable skills to take on aspects of this work within their role.

The document has been endorsed by the Secretary of State, Andrew Lansley, who emphasised the role of the NHS to prevent ill health, and endorse sexual health clinics for their role in alcohol risk reduction.

I hope that the report will provide an incentive for Health Advisers around the UK to become involved in alcohol screening and brief interventions, as part of risk reduction work with clients.

Please contact me at richard.betournay@chelwest.nhs.uk if you had any questions.

__________________________________________

A new report from the Royal College of Physicians (RCP) and British Association for Sexual Health and HIV (BASHH) has exposed missed opportunities to tackle alcohol abuse through existing sexual health services.

More than one million young people attend sexual health clinics each year. The report argues that this provides a unique opportunity to communicate key messages relating to alcohol consumption to those who are at risk.

The report highlights clear evidence linking alcohol consumption to poor sexual health, particularly in the young:

82% of 16–30 year olds report drinking alcohol before sexual activity¹
People who drink heavily are more likely to have unprotected sex with multiple partners²
20% of white 14–15-year-old girls report going ‘further than intended’ sexually when drunk.³

Despite this strong evidence, there has been little movement towards tackling alcohol abuse through sexual health services.

Dr Simon Barton, chair of the RCP’s Alcohol and Sexual Health Working Party said:

‘The links between alcohol use and poor sexual health have been recognised for some time, yet the services available do not reflect this clear association. Failing to discuss alcohol consumption with a patient accessing sexual health services is a missed opportunity.

‘Although services that aim to tackle this problem cannot be effective in isolation, there is a real opportunity for sexual health services to support people both in identifying their behavioural risks and in empowering them to take action.

‘At a time when the NHS is looking to save £20 billion, this is a perfect example of quick-win efficiency that could save money in the long term.’

The report focuses on young people as they are among the highest consumers of alcohol, and have the highest rate of sexually transmitted infections. 16–24 year olds make up just 12% of the population, yet they account for nearly half of the sexually transmitted infections diagnosed in sexual health clinics. 65% of chlamydia infections, 50% of cases of genital warts and 50% of gonorrhoea diagnoses occur in the young.

Dr Janet Wilson, President-elect of BASHH said:

‘Everyone knows that alcohol fuels risky sex – so a sexual health check-up is the ideal time to broach the subject, to find the one in five young people attending our clinics who are at most risk and give them structured advice around alcohol consumption, referring to alcohol services where appropriate.

‘Local Authorities will be responsible for public health under current NHS reform proposals, and BASHH congratulates this report for clearly identifying the type of integrated approach needed to tackle our major public health issues.’

Key recommendations from Alcohol and sex: a cocktail for poor sexual healthinclude:

Sexual health services should provide information that highlights the link between alcohol consumption and poor sexual health outcomes and signpost sources of useful advice on drinking sensibly
All clinicians providing sexual health services should be trained in asking about drinking habits through use of a recognised screening tool
All sexual health services should develop a robust care pathway to refer patients for further support, including local alcohol services
New commissioning arrangements should ensure that the service specifications for sexual health in primary care and specialist services include opportunistic alcohol screening and brief interventions for young people.

These specific recommendations must be underpinned by a population level, evidence based initiatives, as previously advocated by the RCP. These include targeting the price, availability, and marketing of cheap alcohol.

Notes

Download the full Alcohol and sex: a cocktail for poor sexual health report.

Rapid ‘combination’ test fails to detect many cases of acute HIV infection

pmadden — Thu, 12 Jan 2012 21:09:21 +0000

Roger Pebody

Published: 06 January 2012

A rapid, point-of-care test, which aims to reduce the ‘window period’ through the detection of both antibodies and p24 antigen has poor performance in a clinical setting, researchers report in an article published online ahead of print by the Journal of Infectious Diseases. Whilst the test reliably identified people with established HIV infection, it delivered false negative results to the majority of individuals who were very recently infected with HIV.

Furthermore, this experience from Malawi echoes the findings of British researchers, published last year in Sexually Transmitted Infections.

Rapid diagnostic tests, which can be operated at the point-of-care by doctors or nurses, offer numerous advantages over conventional laboratory tests. Such devices are essential in resource-limited settings where laboratories are inaccessible or unavailable. Furthermore, as patients do not need to come back for their results on another day, far more people receive their results.

However almost all rapid tests only detect HIV antibodies, which are only detectable approximately one month after infection. In contrast, tests conducted in a laboratory may also be able to detect p24 antigen or HIV RNA, both of which are detectable earlier than this. These tests therefore shorten the ‘window period’.

Introduced in 2009, the Determine HIV-1/2 Ag/Ab Combo is the only rapid test which combines detection of antibodies and p24 antigen.

Nora Rosenberg and colleagues wished to monitor the performance of the Determine Combo test at two clinical sites in Lilongwe, Malawi. They compared the test’s results with those of other, validated tests.

Of 1009 individuals who tested, 838 were HIV-negative, 163 had established HIV-infection and 8 had acute infection (in other words, they were infected in the past few weeks). Individuals were judged to have acute infection if a laboratory test showed that they had HIV RNA but had had at least one negative result for HIV antibodies.

Among those with established HIV-infection, the test performed well. All but one individual was correctly identified, giving a sensitivity of 99.4% (95% confidence interval 96.6% – 100%).

However among the eight people with acute infection, only two were identified by the test, giving a sensitivity of 25% (95% confidence interval 3.2% – 65.1%). Moreover, these two individuals tested positive for HIV antibodies, and not for p24 antigen. While this does suggest that the antibody part of the test performs better than some other antibody tests, the p24 antigen part of the test performed poorly – but the detection of p24 antigen is key to identifying people who have recent infection.

Moreover, when the test was performed on 838 HIV-negative samples, 14 of the results for p24 antigen were false positives, further undermining the usefulness of the test in this setting.

The authors say that in this field evaluation “the sensitivity and specificity of the p24 antigen component of the test were inadequate for widespread use for detecting acute HIV infection.”

It is possible that a point-of-care test in the ‘lateral flow’ format has a much lower level of sensitivity than modern laboratory tests, which are able to detect lower concentrations of p24 antigen. An alternate possible explanation is that the test performs poorly with clade C HIV-1, the predominant subtype in Malawi.

However disappointing results have also been reported by Julie Fox of Guys’ and St Thomas’ Hospitals, London (where clade C is less common). She tested the Determine Combo test on stored samples from 36 people with HIV, each of whom had detectable p24 according to laboratory tests. Ten of them had detectable antibodies, while 26 did not (in other words, they had acute infection).

Overall, the rapid test detected p24 antigen for only half those tested, giving a sensitivity of 50% (95% confidence interval 34% – 66%).

The test failed to detect HIV infection (either via p24 antigen or antibodies) in ten of 36 cases, nine of whom had acute infection.

The researchers note that there are significant public health consequences to giving a negative HIV test result to a person whose infection is at its most infectious stage.

Specifically, Fox and colleagues recommend that combination laboratory tests are used for individuals with suspected acute infection and that health providers explain the limitations of tests to patients.

References

Rosenberg NE et al. Detection of Acute HIV Infection: A Field Evaluation of the Determine® HIV-1/2 Ag/Ab Combo Test. Journal of Infectious Diseases, online ahead of print, 2011. (Click here for the free abstract).

Fox J et al. Low rates of p24 antigen detection using a fourth-generation point of care HIV test.Sexually Transmitted Infections 87:178-179, 2011.

Taken from: http://www.aidsmap.com/en/Email-a-friend/tpl/1412195/page/2204685/

A Day of Unprotected Sex

pmadden — Wed, 11 Jan 2012 22:08:58 +0000

Partner notification for sexually transmitted infections in the modern world: a practitioner perspective on challenges and opportunities

pmadden — Mon, 09 Jan 2012 20:05:44 +0000

Gill Bell 1,
John Potterat 2

+Author Affiliations

¹Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK
²Independent Consultant, Colorado Springs, Colorado, USA

Correspondence to Gill Bell, Nurse Consultant Sexual Health Adviser, Department of Genitourinary Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; gill.bell@sth.nhs.uk

Contributors GB wrote the manuscript following email discussion with JP, who provided editorial guidance on successive drafts.

Accepted 28 September 2011

Introduction

Our aim is to provide a practitioner perspective on approaches to partner notification (PN)—some old, some new—which may improve the control of sexually transmitted infections (STIs), including HIV, in a variety of settings.

PN services support patients with STI/HIV in the difficult task of informing often unsuspecting partners—past or present—of their possible exposure to an STI and hence the need to seek medical care. It is an essential component of STI management and control, protecting patients from reinfection, partners from long-term tissue damage from untreated infection and the community from onward transmission. Beneficial dimensions include ethics (duty to warn), disease control (case finding) and epidemiology (identifying factors associated with STI transmission).1

PN methods

Patients may inform partners themselves (patient referral) or supply details for a healthcare worker to notify the partner without disclosing their identity (provider referral). These approaches may be combined whereby a time frame is agreed for patients to inform partners before the healthcare worker notifies those who have not sought care (contract referral).

Patient referral is the method used most frequently, partly because most patients prefer to notify their own partners and also because provider referral is not available in some settings.2 3 The stigma attached to STIs/HIV can, however, make informing partners traumatic: Gorbach et al4found that up to one third of patients failed to tell all partners because of embarrassment or fears for personal safety or reputation. Least likely to be informed are casual and ex-partners4 5 who may have moved on to infect new partners. Provider referral is therefore an important service to protect patients from adverse consequences and reach partners who would not otherwise be informed, thereby improving disease intervention.

Variations in practice

The intensity of PN activity may vary considerably between settings, ranging from brief advice only to a more complex labour intensive process involving in-depth interactive interviews, recording partner details, provider referrals, follow-up interviews to check progress and verifying partner attendance.3 Epidemiological analysis of PN data, including network mapping, may be undertaken to inform complementary preventions activities.6 7

Evidence of effectiveness

Intensive approaches are, unsurprisingly, correspondingly more effective.8 9 In a systematic review of PN strategies, Matthews et al9 found moderately strong evidence that provider or contract referral increases the rate of partners presenting for care and that patient referral enhanced by verbal education together with patient-centred counselling improves the rate of partners treated.

At community level, there is empiric evidence that intensive PN is associated with a reduction in prevalence of STIs.10 Based on the high positivity rate among notified male partners (65%) compared with screening programmes for men (6%) in the National Chlamydia Screening Programme in England, a modelling study suggested that improving PN efficacy from 0.4 to 0.8 partners treated per case by intensifying PN efforts may be a more cost-effective case-finding strategy than increasing screening among men.11

New approaches to PN

New testing, treatment and communication technologies allow innovative ways of contacting and delivering care to partners, which may be more comfortable, convenient and timely than traditional methods.

Expedited partner therapy

Expedited partner therapy involves delivering medication or a prescription directly to the partner(s), avoiding medical examination, tests and questions that might be barriers to timely treatment. A meta-analysis of five studies found that patient-delivered partner therapy (PDPT) reduced the risk of recurrent infection in patients with chlamydia and gonorrhoea compared with patient referral, although PDPT was no more effective than supplementing patient referral with information for partners.2 An alternative approach under investigation in the UK, where medication cannot be prescribed without a consultation, is Accelerated Partner Therapy, whereby partners collect medication and a sampling kit following telephone or pharmacy consultation with a prescriber.12 PDPT is not recommended for groups at high risk of syphilis or HIV infection, whose members would benefit from a full sexual health screen.

Postal home sampling

Postal home sampling kits allow partners to take their own sample in comfort and privacy. Trelleet al2 cited two Danish trials which found that chlamydia home sampling, compared with office sampling, improved partner testing rates. Delaying partner treatment until home sampling results are available may, however, increase the risk of patient reinfection: a randomised control trial in Scotland comparing patient-delivered postal testing kits (PTK) with patient-delivered partner therapy (PDPT) and patient referral reported no difference in terms of patient reinfection or partner testing/treatment rates between allocated groups.13 However, a substantial percentage (43%; 22/51) of partners offered PTK who were verified as tested had attended a service instead of returning the PTK. When these partners were excluded from the analysis, the odds of index reinfection was twofold higher with PTK. Similarly, more than a third of partners who confirmed receipt of PDPT (35%; 16/46) also attended a service for testing.

Combined testing and treatment kits

Combined testing and treatment kits as in the Accelerated Partner Therapy study11 may be more acceptable, given evidence that partners may wish to know whether they are infected and/or to receive treatment regardless, without delay. These may also be more efficacious in terms of STI control, allowing accurate diagnosis and notification of other partners. The public health impact of treating partners without testing, thereby missing opportunities to diagnose other infections or treat other partners, is in under investigation (Low HTA 07/42/02).

Communication technologies

Communication technologies such as text messaging and web-based systems are increasingly used. Internet PN provides a means of notifying the increasing number of individuals exposed to an STI through internet dating sites, who may not be traceable by other means. Internet PN facilities such as inSPOT allow patients to send electronic postcards to partners without disclosing their own identity,14 though more empiric evidence is needed to demonstrate efficacy. A similar system developed by Gay Men Fighting Aids allowing both patient and provider referral via four popular dating sites is currently being piloted in eight genitourinary medicine (GUM) clinics in the UK.

The importance of follow-up

The effectiveness of PN is commonly measured in terms of process rather than impact: customarily, the numbers of partners informed, tested, treated and/or positive for infection. Such outcomes are collected by checking clinic records or telephoning the index patient to enquire about progress with PN. Patients who have had difficulty notifying partners may appreciate a second chance to request provider referral: more than half (56%) the provider referrals for gonorrhoea were agreed to at follow-up interview in a UK study.5 Follow-up patient phone calls therefore have two important functions: to facilitate PN by gentle reminder or repeated offer of assistance and to ascertain whether partners were tested and or treated to ensure measured outcomes are as accurate as possible.

Verification of partner attendance is increasingly challenging in settings where there are multiple STI screening venues without access to a centralised reporting system. In such circumstances, the number of partners with patient- or clinician-confirmed tests/treatment may be a more reliable measure of PN effectiveness than the more elusive ‘clinician-confirmed’ gold standard measure.

The frequent absence, in practice, of follow-up and verification is highlighted in a recent national UK audit, revealing that PN outcomes were not recorded for 41% of patients managed for chlamydia in GUM clinics.15 Barriers to PN follow-up and verification of partner attendance need to be explored further to improve effectiveness of PN and the validity of outcome measures currently used.

Service structure and organisation

One of the main challenges today is how best to provide efficacious cost-effective PN services for the increasing proportion of STI patients tested/treated for STIs (mostly chlamydia) in a wide range of non-specialist settings. One option is to involve staff in those services in some or all aspects of PN. The CLaSS study found practice nurses in primary care were at least as effective as GUM health advisers at eliciting partners and securing partner treatment through patient referral, with support from a research health adviser who provided training and followed up outcomes.16 The added benefit and cost-effectiveness of offering provider referral to patients with chlamydia in primary care settings is under investigation through a multicentre randomised controlled trial in the UK (HTA 07/43/01).

Evidence that some primary care staff are reluctant to assume such sensitive and time consuming duties17suggests, however, that it may be difficult to engage or sustain non-specialist involvement in PN without ongoing support from specialists. This could be provided by a centralised community PN bureau, as recommended by the National Chlamydia Screening Programme, where PN specialists would be based to coordinate activities across the community to provide training, undertake provider referrals, follow-up outcomes, develop local care and referral pathways, and monitor effectiveness.18 Further research is required to establish whether training and supporting large numbers of non-specialised staff to undertake PN interviews face to face at the time medication is given results in more cost-effective outcomes than management by a small team of specialists interviewing patients by phone. In Sweden, excellent PN outcomes (1.9 partners tested per case) for a large sparsely populated area were attributed to centralised contact tracing with telephone interviews performed by a small team of experienced staff.19 On the other hand, non-specialist staff in some settings may have better understanding of, and rapport with, affected populations and thus be in a better position to elicit partner details and notify contacts than PN specialists. For example, community health workers trained to undertake PN played a significant part in the management of a syphilis outbreak on a Native American Reservation.20 Non-clinical staff and agencies working with specific groups such as young people, sex workers or drug users might be an equally valuable resource. The role of a PN bureau would include timely responses to changes in local STI epidemiology, ensuring those best placed to undertake aspects of PN are trained and supervised as required to elicit partner details and/or trace and notify partners, follow-up progress and report outcomes. Equally important is the support of managers committed to providing the resources needed for good quality PN: without such support, in the context of competing pressures, follow-up phone calls and reporting may not be a priority. The effectiveness and efficiency of a centralised system depend upon reliable reporting from all agencies involved in PN—preferably to a central electronic database.

Epidemiological use of PN data

Centralising the management of PN for a community makes it possible to make the best use of epidemiological intelligence gathered during the PN process. Contact tracing takes you to where the problem is, allowing real-time surveillance of transmission networks. Data routinely collected during the PN process (who? what? where? how? when?) can provide early warning of outbreaks, reveal associated trends in sexual behaviour or mixing patterns and, through analysis of sexual network phase and structure, suggest appropriate control measures.6 7 For example, network analysis of syphilis cases in Sheffield, UK, revealed that heterosexual cases and contacts were identifiable and interconnected and thus responsive to management through PN, whereas men who have sex with men networks were more sporadic, with many untraceable partners met via the internet or saunas.7 As a result, control efforts were expanded to include internet provider referral via dating sites and outreach screening in a local sauna used by men who have sex with men.

Conclusions

PN makes a valuable contribution to both patient care and STI control. The challenge for the future is to improve efficacy and cost-effectiveness by combining traditional approaches of proven value (interactive interviews, provider referral, follow-up and verification of outcomes) with new technologies allowing partners to be notified, tested and treated more easily, thereby potentially reducing the discomfort and inconvenience for patients and partners and for reducing service costs. A centralised PN bureau may make the best use of local resources by bringing PN specialists together with clinical and non-clinical community workers, managers and commissioners to develop timely, efficient and cost-effective PN services tailored to the needs of the local community. Reliable reporting systems are essential to manage partner services efficiently and to provide reliable data on effectiveness.

Key messages

A partner notification programme which includes a provider referral service and follow-up of outcomes is an essential aspect of sexually transmitted infection management and control.
Partner testing and treatment may be expedited by patient-delivered or postal testing kits, medication or prescriptions and by communication technologies such as internet partner notification and text messaging.
Collaboration between partner notification specialists, clinical and non-clinical community workers, managers, and commissioners is necessary to ensure the best use of local resources for partner notification and management.
A centralised ‘partner notification bureau’ to manage and coordinate partner notification activities across a community may enhance effectiveness and efficiency.

Footnotes

Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ andhttp://creativecommons.org/licenses/by-nc/2.0/legalcode.

References

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2. Bell G,
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TRAINING DAYS: Motivational Interviewing

pmadden — Thu, 29 Dec 2011 08:16:23 +0000

SSHA are delighted to announce 2 courses that will be run later on in the year. The training is of particular interest to health advisers since this is a core aspect of our role, so we hope you will be able to attend. Doctors and nurses are also welcome.

Helping people reduce sexual health risk using a Motivational Interviewing approach
To prepare sexual health staff to deliver the 2007 NICE recommendation of structured one to one risk reduction discussions based on a theory of behaviour change, for people at high risk of STI or under 18 pregnancies.

Follow-up Motivational Interviewing for sexual risk reduction
To consolidate learning in the use of Motivational Interviewing, following attendance at a previous SSHA study day, or equivalent training. The focus will be on practical application with clients, using case discussions and practice exercises.

Venues

Study day type and trainers

Date

Royal Hallamshire Hosp. Sheffield.

Introductory day: Gill Bell and Dorinda Thirlby

Saturday 28th January 2012

0930 – 1630

Lunch provided

Royal Hallamshire Hosp. Sheffield.

Follow-up day: Gill Bell and

Dorinda Thirlby

Saturday 12^th May 2012

0930 – 1630

Lunch provided

Chelsea and Westminster Hospital SW10

Introductory day:

Heather Wilson and

Donal Traynor

Saturday 28 April 2012

0930 – 1630

Lunch provided

Chelsea and Westminster Hospital SW10

Follow-up day:

Heather Wilson and

Donal Traynor

Saturday 19 May 2012

0930 – 1630

Lunch Provided

Cost per day: £60.00 for SSHA members / £75.00 for non-SSHA members

The fee covers expenses and honoraria for the trainers and is not for profit.
Places can be provisionally booked but will only be confirmed when payment has been received or your organisation/Trust has agreed to pay.
Payment methods are described on the application form below.
Receipts will be issued to allow delegates to claim the fee back from their Trust/organisation, or the local STIF co-ordinator.
Confirmation letters, venue details and a timetable will be sent by email (or post if no email address) prior to the study day.
Seven days notice or place reallocated – full refund. Last minute/no notice or place not reallocated – no refund

Places are limited so book early to avoid disappointment.

DOWNLOAD APPLICATION FORM

SSHA welcomes the draft briefing paper: Guidance on HIV Prevention in MSM

pmadden — Mon, 05 Dec 2011 20:10:16 +0000

2^nd of December 2012

Dear Phil,

Draft Briefing Paper: Guidance on HIV Prevention in MSM

The National Professional Committee of the Society of Sexual Health Advisers welcomes the proposed the draft Briefing Paper: Guidance on HIV Prevention in MSM and would like to add that we would fully endorse it.

Best Wishes

Martin Murchie

President of the Society of Sexual Health Advisers

Martin.murchie@nhs.net

www.ssha.info

Opponents of equality spend £10k+ on adverts

pmadden — Thu, 01 Dec 2011 20:33:47 +0000

Dear friend,

Conservative religious groups in Scotland have today splashed out over £10,000 on adverts in national newspapers opposing equal marriage.

The adverts, which appeared in today’s Daily Record, Herald and Scotsman, announce “a new campaign” against equality called “Scotland for Marriage”.

The advert text is as follows [with our comments in brackets]:

“For one man and one woman,

For children, [but not the children of LGBT families]

For love, [but not love between same-sex couples]

For life, [but not the lives of LGBT people]

For good, [if good means discrimination and prejudice]

For Scotland, [but only the 19% of it that agrees with unfair marriage]

For marriage [but only for the people the unfair marriage campaign approve of]

A new campaign group to support marriage and to oppose any plans to redefine it. Scotland for Marriage.”

The campaign is organised by the following groups, all of which are well known for opposing all moves towards LGBT equality:

· CARE for Scotland
· The Catholic Bishops’ Conference of Scotland
· The Christian Institute
· Destiny Churches, Scotland
· The Evangelical Alliance
· The Family Education Trust

In addition to expensive adverts, the campaign is splashing their cash on new websites, branded t-shirts, bags, banners, mobile advertising, and the production of over 200,000 campaign postcards in an attempt to buy democracy.

They say that they have now collected over 20,000 signed postcards against equal marriage – so every consultation response we can secure in favour is vital.

We need YOU to take action today

Here are three things you can do now to make a real difference:

1) Take the Friends and Family Challenge: Get THREE of your friends and family members to respond this week:http://www.equalmarriage.org.uk/consultation.php

2) Share on Facebook & Twitter - Post the online consultation link to encourage your Facebook friends and Twitter followers to respond: http://www.equalmarriage.org.uk/consultation.php

3) Donate to the campaign – help us match the campaign resources of the opponents of equal marriage.

Online: http://www.justgiving.com/equalmarriage

By mobile: Text LGBT77 £10 to 70070 to donate £10 or whatever you can afford.

Every penny of your donation will go directly to the equal marriage campaign to win LGBT equality in Scotland.

Running a national campaign is expensive, for example:

· £5 = campaign letters to 12 potential supporters
· £10 = a pack of materials for a local LGBT group
· £25 = 250 consultation response forms
· £100 = Equal Marriage briefing packs for 20 MSPs
· £4000 = the cost of a half page advert in a national newspaper!

We don’t have the money for national press adverts, but we do have our voices – please use yours today.

Yours for equality,

Tom French

Policy Coordinator,

The Equality Network

The Equality Network is a registered Scottish charity (SC037852) at 30 Bernard Street, Edinburgh, EH6 6PR.

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INVITATION TO RESPOND: CONSULTATION ON MANAGEMENT OF HIV-INFECTED HEALTHCARE WORKERS

pmadden — Thu, 01 Dec 2011 20:13:22 +0000

Dear All

We are inviting written responses to this consultation paper by 9^th March 2012. Please send your response with the completed Respondent Information Form (see “Handling your Response” below) to:

Sexualhealth@scotland.gsi.gov.uk

HIV Healthcare Worker Consultation

Health Protection Team,

Scottish Government,

3EN, St Andrews House,

Regent Road,

Edinburgh EH1 3DG

If you have any queries contact Rebekah Carton on 0131 244 2295.

We would be grateful if you would use the consultation questionnaire form provided.

This consultation, and all other Scottish Government consultation exercises, can be viewed online on the consultation web pages of the Scottish Government website at http://www.scotland.gov.uk/consultations.

The Scottish Government has an email alert system for consultations, http://register.scotland.gov.uk. This system allows stakeholder individuals and organisations to register and receive a weekly email containing details of all new consultations (including web links). It complements, but in no way replaces SG distribution lists, and is designed to allow stakeholders to keep up to date with all SG consultation activity, and therefore be alerted at the earliest opportunity to those of most interest. We would encourage you to register.

Handling your response

We need to know how you wish your response to be handled and, in particular, whether you are happy for your response to be made public. Please complete and return the Respondent Information Form which forms part of the consultation questionnaire (a word version is also attached) as this will ensure that we treat your response appropriately. If you ask for your response not to be published we will regard it as confidential, and we will treat it accordingly.

All respondents should be aware that the Scottish Government are subject to the provisions of the Freedom of Information (Scotland) Act 2002 and would therefore have to consider any request made to it under the Act for information relating to responses made to this consultation exercise.

The proposals in this consultation document apply to Scotland, but the other Home Countries will be carrying out similar consultations.

THE SCOTTISH GOVERNMENT CONSULTATION PROCESS

Consultation is an essential and important aspect of Scottish Government working methods. Given the wide-ranging areas of work of the Scottish Government, there are many varied types of consultation. However, in general, Scottish Government consultation exercises aim to provide opportunities for all those who wish to express their opinions on a proposed area of work to do so in ways which will inform and enhance that work.

The Scottish Government encourages consultation that is thorough, effective and appropriate to the issue under consideration and the nature of the target audience. Consultation exercises take account of a wide range of factors, and no two exercises are likely to be the same.

Typically Scottish Government consultations involve a written paper inviting answers to specific questions or more general views about the material presented. Written papers are distributed to organisations and individuals with an interest in the issue, and they are also placed on the Scottish Government web site enabling a wider audience to access the paper and submit their responses. Consultation exercises may also involve seeking views in a number of different ways, such as through public meetings, focus groups or questionnaire exercises. Copies of all the written responses received to a consultation exercise (except those where the individual or organisation requested confidentiality) are placed in the Scottish Government library at Saughton House, Edinburgh (K Spur, Saughton House, Broomhouse Drive, Edinburgh, EH11 3XD, telephone 0131 244 4565).

All Scottish Government consultation papers and related publications (eg, analysis of response reports) can be accessed at: Scottish Government consultations (http://www.scotland.gov.uk/consultations)

The views and suggestions detailed in consultation responses are analysed and used as part of the decision making process, along with a range of other available information and evidence. Depending on the nature of the consultation exercise the responses received may:

indicate the need for policy development or review
inform the development of a particular policy
help decisions to be made between alternative policy proposals
be used to finalise legislation before it is implemented

Final decisions on the issues under consideration will also take account of a range of other factors, including other available information and research evidence.

While details of particular circumstances described in a response to a consultation exercise may usefully inform the policy process, consultation exercises cannot address individual concerns and comments, which should be directed to the relevant public body.

Regards,

Rebekah Carton

BBV & Sexual Health Team

3EN, St Andrew’s House
Regent Road, Edinburgh, EH1 3DG
Telephone: 0131 244 2295
Fax: 0131 244 2157

SSHA welcomes the proposed BASHH statement on Partner Notification

pmadden — Wed, 30 Nov 2011 20:22:42 +0000

30^th November 2011

Dear Hugo,

The Society of Sexual Health Advisers welcomes the proposed BASHH statement on Partner Notification.

Please find the below comments from the National Professional Committee of the Society of Sexual Health Advisers on the Proposed statement

Area of Interest: NPC Society of Sexual Health Advisers

Comments:

Paragraph 2

At least one discussion (consultation) on PN SHOULD BE ADDRESSED (conducted) BY A sexual health adviser, or other professional trained in Sexual Health Advising or in PN should be offered to(take place/be conducted) people found to have the infections listed below. Trained in PN means that the practitioner has attained documented competency in PN provision (this be linked to the SSHA competency document) PN is a core component in the management of HIV/STIs. Therefore IF PN IS NOT ADDRESSED THE REASON FOR THIS SHOULD BE DOCUMENTED.

After paragraph 2 we feel it would be important to mention that “PARTNER NOTIFICATION SHOULD BE ADDRESSED ON AN ONGOING BASIS FOR CHRONIC VIRAL INFECTIONS SUCH AS VIRAL HEPATITIS’S (hepatitides) AND HIV”

Look Back Intervals Paragraph

“The appropriate look-back interval for PN should be used. The table below lists the infections for which PN should be offered, along with the corresponding look-back intervals”. SSHA feel it is important to clarify that these look back intervals are for guidance only and the sexual history and knowledge of infections should be looked at in a case by case basis as there may be sexual contacts that fall out of the parameters of these look back intervals.

Table

SSHA have added 2 columns for consideration for this document a column on PN needs actively reviewed out and whether the offer of provider referral is appropriate

Infection	Look back intervals for partner notification	PN NEEDS REVIEW	OFFERPROVIDER REFERRAL
Chancroid	10 days prior to onset of symptoms. Consider epidemiological treatment.	YES	YES
Chlamydial infection	Symptomatic male index case: 4 weeks prior to the onset of symptomsFemale and asymptomatic male index cases: 6 months, or the last sexual contact, whichever gives rise to the longer interval CURRENT PARTNER AND PREVIOUS 1 (1+1) CAN BE APPLIED WHERE THE SEXUAL HISTORY INDICATES ( SEE SSHA MANUAL) THIS STANDARD FALLS BELOW BEST PRACTICE AND COMMONLY MEANS THAT ONLY THE CURRENT PARTNER IS TRACED AND THEREFORE DOES NOT ADDRESS PUBLIC HEALTH		YES
Gonorrhoea	Symptomatic male index case: 2 weeks prior to the onset of symptomsFemale and asymptomatic male index cases: 12 weeks, or to the last sexual contact, whichever gives rise to the longer interval. (IS THERE NFORMATION ON THE CHANGE OF AETIOLOGY OF GC THAT IT HAS A LONGER INCUBATION PERIOD IE: NOW SEE CLIENTS WHO MAY HAVE HAD ASSYMPTOMATIC GC FOR UP TO 6/12	YES	YES
Hepatitis A	2 weeks prior to and one week after the onset of jaundice. Based on risk assessment of cases without jaundice.	YES	YES
Hepatitis B INFECTIOUS OR CHRONIC DIFFERS WHAT ABOUT VL TESTING	Contact tracing should include any sexual contact (vaginal or anal sex, or oro-anal sex) or INJECTING ( DIFFERENT FROM NEEDLE PARTNERS SHARING IE SHARING DRUG PARAPHERNALIA) needle-sharing partners during the period in which the index case is thought to have been infectious. The infectious period is from two weeks before the onset of jaundice until the patient becomes surface antigen negative. In cases of chronic infection, trace contacts as far back as any episode of jaundice or to the time when the infection is thought to have been acquired, although this may be impractical for periods of longer than two or three years. Arrange hepatitis B screening of children who have been born to infectious women, if the child was not vaccinated at birth. For screening of other non-sexual partners who may be at risk, discuss with the CCDC or equivalent. (? Consider testing contacts +/ children of patients with evidence of past infection)	YES	YES
Hepatitis C THIS NEEDS TO BE CONSISTENT WITH NATIONAL HEPC GUIDANCE WHAT ABOUT VL /RNA TESTING	Contact tracing should include any sexual contact (vaginal or anal sex, or oro-anal sex) or ~~needle-sharing partners~~ or INJECTING CONTACTS( DIFFERENT FROM NEEDLE SHARING IE SHARING DRUG PARAPHERNALIA (paraphernalia) during the period in which the index case is thought to have been infectious. The infectious period is from two weeks before the onset of jaundice in acute infection. If there was no acute infection trace back to the likely time of infection (e.g. blood transfusion, first needle sharing) although this may be impractical for periods longer than two or three years. Consider (advise) testing children born to infectious women. For other non-sexual contacts thought to be at risk, discuss with the CCDC or equivalent.	YES	YES
HIV infection	Contact tracing should include any sexual contact (vaginal or anal sex, or oro-anal sex) or ~~needle-sharing partners~~ or INJECTING CONTACTS ( DIFFERENT FROM NEEDLE SHARING IE SHARING DRUG PARAPHERNALIA (paraphenalia) during the period in which the index case is thought to have been infectious. Based on a risk assessment, which should take into account sexual and HIV testing history, history of possible seroconversion illness, recent infection testing algorithm (RITA) for HIV infection result (where available) and CD4 cell count.	YES	YES
LGV infection	30 days prior to the onset of symptoms. Consider epidemiological treatment of sexual contacts.	YES	YES
Non-specific genital infection (including non-chlamydial, non-gonococcal urethritis and cervicitis in men and women respectively)	Symptomatic index case: 4 weeks prior to the onset of symptomsAsymptomatic cases: 6 months, or the last sexual contact, whichever gives rise to the longer interval A QUESTION: WHOS DOING ASYMPTOMATIC SLIDES THESE DAYS. and RE 6/12 WE HAD SOME DISCUSSION ABOUT WHETHER THIS IS STANDARD PRACTICE WE WOULD DEFINITELY ALL TREATE REGULAR PARTNERS AND ANYONE IN PAST MONTH BUT SOME WOULD NOT OFFER PROVIDER REFERRAL. MAY ALSO BE WORTH MENTIONING IF POSITIVE FOR ANOTHER STI THEN DOES NEED REVIEWED.	NO	NOUNLESS CURRENT PARTNER
Pelvic inflammatory disease / EPIDIDYMITIS	Use the look back intervals for chlamydial infection or gonorrhoea, if these are detected. If these infections are not detected, the look back interval is 6 months prior to the onset of symptoms or to the last sexual contact, whichever gives rise to the longer interval. WE HAD SOME DISCUSSION ABOUT WHETHER THIS IS STANDARD PRACTICE WE DEFINITELY ALL TREAT REGULAR PARTNERS AND ANYONE IN PAST MONTH HOWEVER IF NO STI IS FOUND IF YOU TREATE A PREVIOUS PARTNER THEN THEIR CONTACT WOULD NOT BE TREATED SO WHAT IS THE POINT… but some clinics WOULD NOT OFFER PROVIDER REFERRAL	YES	NOUNLESS CURRENT PARTNER
Phthirus pubis infestation	3 months prior to the onset of symptoms. NOT NECESSARY TO FOLLOW UPRemove? – PN not indicated	NO	NO
Scabies infestation	2 months prior to the onset of symptoms.Remove? – PN not indicated PN FOLLOW UP AND RESOLUTION NOT REQUIRED PROVIDER REFERRAL not OFFERED	NO	NO
Syphilis	Early syphilis:Primary syphilis: 3 months prior to the onset of symptoms Secondary syphilis: up to two years prior to the onset of symptoms Sexual contacts of index cases with early syphilis should have serological testing for syphilis at the first visit, and have this repeated six weeks and three months (12 WEEKS FOR CONSISTENCY) from the last sexual contact with the index case. IN THE HPA LEAFLET THERE IS A STATEMENT ON WHERE THERE IS A CHANCRE” IS THIS EVIDENCE BASED HOWEVER THIS SEEMS TO MAKE SENSE BE GOOD PRACTICE …. Consider epidemiological treatment of sexual contacts, particularly for high risk events. Latent and late syphilis: contact tracing (of sexual partners and children of female patients) should be done back to the date of the last negative syphilis serology, if available. Otherwise, it should extend back over the patient’s sexual lifetime as far as is feasible. Because of the possibility of congenital syphilis, consideration should also be given to the testing of mothers (of patients with late syphilis) who were born outside the UK in countries where sub-optimal antenatal care was a possibility	YES	YES
Trichomoniasis	Any partner(s) within the previous 4 weeks should be treated at the same time as the index case. Some clinics do not offer provider referral	NO	YES

Agreed Contact Actions Paragraph 1

SSHA feel it is important to add a comment that a “Not Traceable” outcome is agreed following a detailed and documented discussion with the index client.

Paragraph 2

Would recommend adding “No action is possible or no action is required because contact is already confirmed to be treated” and that all level 3 services (relevant to England and Wales) should offer provider notification service provided by a sexual health adviser or other professional trained in sexual health advising another good place to link to the SSHA competency pack.

Partner Notification Resolution Paragraph 1

May be worth while adding which infections including BBV’s we are talking about.

An end of this paragraph important to add that PN outcomes should be verified by a clinician where ever possible.

Proposed Auditable PN outcome measures Paragraph

Point 4. Would advise changing wording from proportion of contacts to the number of contacts per index case. SSHA would also like it considered that dropping the outcome to 0.4 from 0.6 may mean that services will not carry out PN as effectively as standard has lowered. If Standard 0.6 or 0.4 this should also apply to total numbers of partners attending whether verified by HCW or Index Patient but would be important to recommend underneath this outcome clinics detail how much of this was verified and non verified. Also you may wish to increase outcome figure if including all outcomes of verified and non.

SSHA would also recommend adding other auditable outcomes such as,

5. The number of provider referrals given per index case of an infection.

6. The number of provider referrals whose attendance at Level 1-3 sexual health service was documented as verified by a healthcare worker as a proportion of those provider referrals contacted.

Best Wishes

Martin Murchie

President of the Society of Sexual Health Advisers

SSHA National Sexual Health Adviser Competencies – Consultation

pmadden — Tue, 29 Nov 2011 21:03:27 +0000

SSHA National Professional Committee are asking for feedback on the newly developed SSHA National Sexual Health Adviser Competencies.

Consultation Period 1^st November 2011 to 31^st of January 2012

Please use the following headers when responding to the consultation on this document and ensure all comments are received by 31^st of January 2012:

DOWNLOAD SSHA Sexual Health Adviser Draft Competencies

State your name and area of interest/organisation.
Do you feel the aims and objectives of this document are sufficiently clear?
Do you feel this will be a useful tool in practice for both new entrants to the profession and experienced Sexual Health Advisers?
If you have comments on specific competencies or any part of the document, please reference the particular statement(s) to which you are responding. Example – page, paragraph number, line numbers
Are there any other areas that you feel it would be useful to include with regards expected competencies of Sexual Health Advisers or anything else in the framework? If so it would be useful to outline these specifically and where you feel they may sit in the document.
Please if applicable provide reference(s) to any evidence used to support your agreement or points for discussion.
Other comments.

Please forward all responses

By email to: martin.murchie@nhs.net

or post;

Martin Murchie

SSHA President

Sandyford

2-6 Sandyford Place

Glasgow, G3 7NB