scholarly journals What can be learnt from a qualitative evaluation of implementing a rapid sexual health testing, diagnosis and treatment service?

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e050109
Author(s):  
Ava Lorenc ◽  
Emer Brangan ◽  
Joanna M Kesten ◽  
Paddy J Horner ◽  
Michael Clarke ◽  
...  
Keyword(s):  
Sexual Health ◽  
Patient Care ◽  
Health Centre ◽  
Specific Treatment ◽  
Qualitative Evaluation ◽  
Diagnosis And Treatment ◽  
Normalisation Process Theory ◽  
Treatment Service ◽  
Transmitted Infection ◽  
Positive Impacts

ObjectivesTo investigate experiences of implementing a new rapid sexual health testing, diagnosis and treatment service.DesignA 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.SettingA sexual health centre in Bristol, UK.Participants26 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.ResultsImplementation 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.ConclusionsThe 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.

Fuckbuddy partnerships among men who have sex with men – a marker of sexually transmitted infection risk

2017 ◽  
Vol 29 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Vincent J Cornelisse ◽  
Christopher K Fairley ◽  
Tiffany Phillips ◽  
Sandra Walker ◽  
Eric PF Chow
Keyword(s):  
Sexual Health ◽  
Health Centre ◽  
Romantic Attachment ◽  
Sexual Partners ◽  
Health Clinic ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Hiv Prevention Strategies ◽  
Sex With Men ◽  
Exposure Prophylaxis

‘Fuckbuddies’ are a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment. We surveyed 989 men who have sex with men (MSM) at the Melbourne Sexual Health Centre, Australia, with the aim of determining the frequency of ‘fuckbuddy’ partnerships among sexual health clinic attendees and assessing their sexual risk. The majority (60%) of 1139 regular partnerships were described as ‘fuckbuddies’. Most MSM (63%) with a ‘fuckbuddy’ had multiple ‘fuckbuddies’. MSM with ‘fuckbuddies’ were more likely to also have casual sexual partners (odds ratio [OR] 5.7; 95% confidence interval 3.6–8.9) and had more casual sexual partners (median of 4 versus 1, p < 0.001) and more rectal chlamydia (12.4% versus 5.7%; adjusted OR 2.3; p < 0.05) than MSM without ‘fuckbuddies’, and this risk persisted after adjusting for total numbers of sexual partners. Our findings suggest that patients with ‘fuckbuddies’ are at particular risk of sexually transmitted infections. We argue that clinicians should specifically ask about ‘fuckbuddy’ partnerships as part of their risk assessment during patient interviews, as these patients may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP).

Demand for sexual health services during the Olympic Games: both sides of the Sherman effect

2003 ◽  
Vol 14 (5) ◽  
pp. 307-308 ◽  
Author(s):  
Anna M McNulty ◽  
Richard Rohrsheim ◽  
Basil Donovan
Keyword(s):  
Sexual Health ◽  
Olympic Games ◽  
Health Centre ◽  
Care Utilization ◽  
Chi Square ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Centre Database ◽  
The Impact ◽  
The Olympic Games

To determine the impact of the Olympic Games the Sydney Sexual Health Centre database was accessed for demographic, health care utilization, and morbidity variables for two periods of interest: 15-29 September 2000 (the 'Olympic period'), and 1-30 September 1999 ('1999 comparison period'). Differences were tested by chi-square statistics and by calculation of odds ratios (ORs) using SPSS. During the Olympic period twice as many of the new patients had arrived in Australia that year (35% c.f. 18%: OR 2.46, 95% CI 1.49-4.05, P=0.0002). Per attendance the proportion with symptoms or a known sexually transmitted infection (STI) contact was higher during the Games (29% c.f. 16% OR 1.67, 95% CI 1.1.27-2.21, P=0.0002) and there was a marginally higher yield of bacterial STIs (6% c.f. 3%: OR 1.83, 95% CI 1.06-3.13 P=0.03). The normal clinic population was replaced by an increased proportion of symptomatic patients who were recent arrivals in Australia.

scholarly journals Sexually transmitted infection diagnoses and access to a sexual health service before and after the national lockdown for COVID-19 in Melbourne, Australia

2020 ◽  
Author(s):  
Eric P F Chow ◽  
Jane S Hocking ◽  
Jason J Ong ◽  
Tiffany R Phillips ◽  
Christopher K Fairey
Keyword(s):  
Health Service ◽  
Sexual Health ◽  
Sexually Transmitted Infection ◽  
Health Centre ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Sexual Health Service ◽  
Before And After ◽  
Clinical Conditions ◽  
The Impact

Abstract Background We aimed to examine the impact of lockdown on sexually transmitted infection (STI) diagnoses and access to a public sexual health service in the COVID-19 pandemic in Melbourne, Australia. Methods The operating hours of Melbourne Sexual Health Centre (MSHC) remained the same during the lockdown. We examined the number of consultations and STI at MSHC between January and June 2020 and stratified the data into pre-lockdown (3-February to 22-March), lockdown (23-March to 10-May) and post-lockdown (11-May to 28-June) with seven weeks in each period. Incidence rate ratio (IRR) and its 95% confidence intervals (CI) were estimated using Poisson regression models. Results The total number of consultations dropped from 7,818 in pre-lockdown to 4,652 during lockdown (IRR=0.60;95%CI:0.57-0.62) but increased to 5,347 in the post-lockdown period (IRR=1.15;95%CI:1.11-1.20). There was a 68% reduction in asymptomatic screening during lockdown (IRR=0.32; 95%CI:0.30-0.35) but it gradually increased in the post-lockdown period (IRR=1.59;95%CI:1.46-1.74). STI with milder symptoms showed a marked reduction, including non-gonococcal urethritis (IRR=0.60;95%CI:0.51-0.72), and candidiasis (IRR=0.61;95%CI:0.49-0.76) during lockdown compared with pre-lockdown. STI with more marked symptoms did not change significantly, including pelvic inflammatory disease (IRR=0.95;95%CI:0.61-1.47) and infectious syphilis (IRR=1.14;95%CI:0.73-1.77). There was no significant change in STI diagnoses in post-lockdown compared to lockdown. Conclusions The public appeared to be prioritising their attendance for sexual health services based on the urgency of their clinical conditions. This suggests that the effectiveness of clinical services in detecting, treating and preventing onward transmission of important symptomatic conditions is being mainly preserved despite large falls in absolute numbers of attendees.

Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: a retrospective cross-sectional analysis

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 528 ◽  
Author(s):  
Robert Needleman ◽  
Eric P. F. Chow ◽  
Janet M. Towns ◽  
Vincent J. Cornelisse ◽  
Tim Z. T. Yang ◽  
...  
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Health Centre ◽  
Study Data ◽  
Sexual Risks ◽  
Transmitted Infection ◽  
Cross Sectional ◽  
Duration Of Symptoms ◽  
Demand Fluctuations ◽  
Exposure Prophylaxis

Background On 26 July 2016, Victoria began a large study of HIV pre-exposure prophylaxis, called PrEPX, that involved the creation of around 2600 appointments over 3 months across multiple sites in Melbourne, Australia. At this time, the Melbourne Sexual Health Centre (MSHC) appeared to have a larger demand on its services. The aim of the present study was to determine whether this apparent increase in demand was substantially different from other demand fluctuations. Methods: Patients presenting to the MSHC from 2014 to 2016 were reviewed. Demographic characteristics, sexual risks and sexually transmitted infection diagnoses were extracted from the clinical database. Results: There were 115522 walk-in presentations for care and a rise in presentations in the week following the launch of the PrEPX study, but at least six similar peaks occurred that year. The peak coinciding with the launch of PrEPX was only apparent for men who have sex with men. There was a substantial increase in the proportion of patients who could not be seen (i.e. triaged out), from 10% in the week before PrEPX to 22.2% in the second week after, but this was primarily due to staff absences. At the time of the PrEPX study, data were collected on the duration of symptoms for common conditions and found no significant (P&gt;0.29) change in the average duration of symptoms compared with that seen before the PrEPX launch. Conclusions: The increase in the number of medical consultations required for the PrEPX study did not result in excessive demand for public sexual health services.

scholarly journals Notification of STI test results by text messaging: Why do patients refuse? Cross-sectional study in a Parisian sexual health centre

2021 ◽  
pp. 095646242110485
Author(s):  
Jalal Charron ◽  
Pénélope Troude ◽  
Elise de La Rochebrochard ◽  
Christophe Segouin ◽  
Prescillia Piron
Keyword(s):  
Logistic Regression ◽  
Sexual Health ◽  
Text Messaging ◽  
Qualitative Content Analysis ◽  
Health Centre ◽  
Multivariate Logistic Regression Model ◽  
Transmitted Infection ◽  
Face To Face ◽  
Sti Testing ◽  
Sms Notification

Text messaging has been used to notify patients of results after sexually transmitted infection (STI) testing. This study aimed to characterise the population who refused notification of results by short message services (SMS) and to explore their reasons for refusing. From January to August 2018, 1180 patients coming for STI testing in a Parisian sexual health centre were offered SMS notification of their results, completed a self-administered questionnaire and were included in the study. Factors associated with refusal of SMS notification were explored using logistic regression models. Reasons for refusal were analysed following a qualitative content analysis methodology. In the study population, 7.3% [95% CI 5.8–8.8] of patients refused SMS notification. In the multivariate logistic regression model, male gender and older age were associated with refusal, as were non-French nationality, having forgone health care for economic reasons and being unemployed. Qualitative analysis showed that preferring face-to-face medical contact (32%) and anxiety about the test result (29%) were the main reasons given by patients for refusal. Socially disadvantaged patients may have more limited access to technology and be less at ease using it in a health context. Preference for face-to-face medical contact may reflect the need for human support in vulnerable populations.

scholarly journals Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Marta Blanco ◽  
Pablo Suárez-Sanchez ◽  
Belén García ◽  
Jesús Nzang ◽  
Policarpo Ncogo ◽  
...  
Keyword(s):  
Public Health ◽  
Treatment Guidelines ◽  
Health Workers ◽  
Health Centre ◽  
Regional Hospital ◽  
Malaria Treatment ◽  
Diagnosis And Treatment ◽  
Equatorial Guinea ◽  
Public Health Facilities ◽  
Health Centres

Abstract Background In 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea. Methods A cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge. Results Among the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres. Conclusions It is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.

Resistance-guided treatment of Mycoplasma genitalium infection at a UK sexual health centre

2021 ◽  
pp. 095646242098776
Author(s):  
Ruairi JH Conway ◽  
Seamus Cook ◽  
Cassandra Malone ◽  
Simon Bone ◽  
Mohammed Osman Hassan-Ibrahim ◽  
...  
Keyword(s):  
Single Dose ◽  
Confidence Interval ◽  
Sexual Health ◽  
Treatment Failure ◽  
Inflammatory Disease ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Macrolide Resistance ◽  
Fluoroquinolone Resistance ◽  
Treatment Failure Rate

We evaluated the ResistancePlus® MG assay in providing macrolide resistance-guided treatment (RGT) for Mycoplasma genitalium infection at a UK sexual health centre. M. genitalium–positive samples from men with urethritis and women with pelvic inflammatory disease (PID) were tested for macrolide resistance–mediating mutations (MRMMs). MRMM-positive infections were given moxifloxacin 400 mg; otherwise 2 g azithromycin (1 g single dose and then 500 mg OD) was given. Among 57  M. genitalium–positive patients (32 men and 25 women), MRMMs were detected in 41/57 (72% [95% confidence interval (95% CI) 58–83%). Thirty-two of 43 patients given RGT attended for test of cure. Treatment failure rate was significantly lower at 1/32 (3%) than 10/37 (27%) before RGT ( n = 37 [men = 23 and women = 17]; p = 0.008). Treatment failure was lower in male urethritis (0/15 vs. 7/21 p = 0.027) but not in female PID. There was a trend of a shorter time to negative test of cure (TOC) in male urethritis (55.1 [95% 43.7–66.4] vs. 85.1 [95% CI CI 64.1–106.0] days, p = 0.077) but not in female PID. Macrolide resistance is higher than previous UK reports and higher than expected. RGT reduces overall treatment failure and is particularly beneficial in M. genitalium urethritis. Fluoroquinolone resistance will continue to rise with increasing fluoroquinolone use, and RGT is critical to direct appropriate azithromycin use and prevent overuse of moxifloxacin.

scholarly journals Does online sexually transmitted infection screening compromise care? A service evaluation comparing the management of chlamydial infection diagnosed online and in clinic

2021 ◽  
Vol 32 (6) ◽  
pp. 528-532
Author(s):  
Nur Gasmelsid ◽  
Benjamin CB Moran ◽  
Tom Nadarzynski ◽  
Rajul Patel ◽  
Elizabeth Foley
Keyword(s):  
United Kingdom ◽  
Health Services ◽  
Sexual Health ◽  
Sexually Transmitted Infections ◽  
Sexually Transmitted Infection ◽  
Chlamydial Infection ◽  
Service Evaluation ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
The United Kingdom

Patient demand on sexual health services in the United Kingdom is so high that many services have introduced online screening to accommodate more patients. There are concerns that these services may not be accessible to all. This service evaluation was undertaken to determine whether online screening is accessible by those patients most at need by comparing the demographics and number of asymptomatic chlamydial infections detected online and in clinic. No difference was found in the age nor level of deprivation, demonstrating that online services are an accessible way to screen for sexually transmitted infections without overburdening established services.

Mycoplasma genitalium: test positivity in syndromic presentations and clinicians’ adherence with treatment guidelines at Sydney Sexual Health Centre

2021 ◽  
pp. 095646242110225
Author(s):  
Calvin Cheung ◽  
Christopher Bourne ◽  
Rick Varma
Keyword(s):  
Decision Making ◽  
Antimicrobial Resistance ◽  
Sexual Health ◽  
Treatment Guidelines ◽  
Health Centre ◽  
Diagnostic Testing ◽  
Mycoplasma Genitalium ◽  
Macrolide Resistance ◽  
Adherence To Treatment ◽  
Real World Data

Mycoplasma genitalium ( M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians’ adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive ( p = 0.30) or macrolide-resistant M.genitalium ( p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.

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