Sexually Transmitted Infections Foundation Course

1. Sexually Transmitted Infections Foundation Course

2. Note to Course Organisers: The Epidemiology slides are provided for use in conjunction with your local data. Local data could be obtained from your Local Authority or PCO or from your clinic returns and SOPHID data. The Sexual Health Balanced Scorecard provides a snapshot of sexual health at local level. Interactive maps and charts are found at http://www.apho.org.uk/sexualhealthbalancedscorecard This slide set is designed to be edited according to your own local audience and it is not expected that you show all the slides.

3. Epidemiology of STIs and HIV&Sexual Health Services in 2013

4. Learning Outcomes At the end of this session you should be able to: • Describe national and regional rates of common STIs • Demonstrate understanding of trends in STI and HIV infection rates in your local area • Identify sub-populations at greater risk of STIs/HIV

5. Number of new diagnoses of selected STIs, GUM clinics, England: 2002, 2010 and 2011 Routine GUM clinic returnshttp://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1215589015024

19. HIV tests among STI clinic attendees: England, 2009-2011

21. STIs & HIV • HIV is an STI – many of the risk factors for acquiring infection are the same • Some STIs increase risk of acquiring HIV • Some STIs increase shedding of HIV in infected individuals and therefore increase risk of transmitting HIV

22. Annual new HIV and AIDS diagnoses and deaths: United Kingdom, 1981-2011

23. New HIV diagnoses by exposure group: United Kingdom, 2002 – 20111

24. Number of people newly diagnosed and people living with diagnosed HIV infection: United Kingdom, 1980-2011

25. Estimated number of people living with (both diagnosed and undiagnosed) HIV infection in the United Kingdom: 2011

26. Prevalence rates of HIV: United Kingdom, 2010

27. Prevalence of diagnosed HIV infection by region of residence among population aged 15-59 years: United Kingdom, 2011 Less than 1 1-2 London >2

30. Summary Variety of risk factors for STI acquisition HIV /other STIs interact HIV and STI rates are increasing in UK National and regional rates of STIs vary Data from Health Protection Agency (Centre for Infections) 30

31. Sources of Data www.hpa.org.uk/HPAwebHome/ www.statistics.gov.uk www.isdscotland.org www.apho.org.uk/sexualhealthbalancedscorecard www.ons.gov.uk/ons/index.html

32. Section 2Sexual Health: Service Provision and Primary Care

33. Learning Outcomes At the end of this session you should be able to: • Describe recent changes in policy and specialist practice • List linked sexual health disorders • Describe clinical pathways and the potential for shared care • Recall the particular issues of confidentiality in the context of sexual health

34. STI - Service Objectives • Control of communicable diseases which have potentially serious effects upon • Physical well-being • Psychological well-being • STI control is essential to reduce HIV acquisition and transmission

35. Linked Sexual Health Pathologies Mental Health Anogenital Cancers Unintended pregnancies STIs HIV Neonatal Infections Subfertility

36. Establishment of “VD” Clinics • 1916 : Specialist clinics set up around the country : 113 by 1917 • Public Health (VD) Regulations 1916 • Voluntary attendance, no doctors referral needed • Confidentiality assured • Free treatment

37. Confidentiality The 1916 Regulation has been updated over the years: NHS (Venereal Diseases) Regulations 1974  Officers of all Health Authorities NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000  members or employees of Trusts After 2012 H&SC Legislation ???? NB: Applicable only to England

38. GUM Clinics today • National network of clinics • Most major cities, towns • Consultant-led service • Providers: Acute trust • Integration with HIV/AIDS inpatient services • May be linked to other acute services e.g. ID medicine, urology, dermatology, gynae Community care trust • Co-location / integration with other sexual health services Private/third sector

39. Principles of STI Management • Test before treatment • Screen for accompanying STIs • Simple treatment regimens • Follow-up after treatment • Partner notification • Non-judgemental patient support, counselling, education

40. Range of GUM Services

41. National Survey of Sexual Attitudes and LifestylesChanges: 1990-2000 • Earlier age first sexual intercourse • Increased number of lifetime partners • Decline in marriage, growth cohabitation • Increased risky behaviours • Partner change, unsafe sex • Greater changes in women and those living outside London

42. Recommended standards for sexual health services Standards for the management of sexually transmitted infections (STIs) Better prevention, better services, better sexual health - The national strategy for sexual health and HIV A Framework for Sexual Health Improvement in England Competencies for specialised STI services within primary care Recommended standards for NHS HIV services Azithromycin becomes OTC medicine National Chlamydia Screening Programme NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000 Effective Commissioning of Sexual Health and HIV Services GUM 48-hour Access: Getting to target and staying there a sexual health and HIV commissioning toolkit for Primary Care Trusts and local authorities Health and Social Care Act 2012 Primary Care Service Framework: Management of Sexual Health in Primary Care BEST PRACTICE GUIDANCE YOUNG PEOPLE UNDER 16 ON CONTRACEPTION, SEXUAL AND REPRODUCTIVE HEALTH

43. National Strategy for Sexual Health and HIV (2001) • Widened role for primary care • Closer working between Primary and Secondary care • Increased community role for sexual health advisers • Targeted chlamydia screening • Improved access to GUM services • Managed clinical networks for HIV and other services

47. Standard 7: Links to other services • All services managing STIs should ensure that they have formal links with the local specialist GUM service for advice, support and referral • Clear clinical care pathways should focus on ensuring appropriate clinical management for people accessing services and supporting professionals in the delivery of high quality care

48. Clinical Links Agreed clinical guidelines, joint teaching and training, shared management of long term conditions Agreed rapid track pathways for patients with unexpected complicated disease Clinical Governance Leadership role

49. A Framework for Sexual Health Improvement in England (2013) • Ambitions • reduce inequalities and improve sexual health outcomes • informed and responsible choices about sex and relationships • recognise that sexual ill-health affects all parts of our society • Need to address: • stigma, discrimination and prejudice • reducing STI rates using evidence-based interventions/initiatives • reducing unwanted pregnancies / access to full range of contraception options • support women with unwanted pregnancies to make informed decisions on options • tackle HIV through prevention and increased access to testing • promote integration, quality, value for money and innovation • Joined-up provision to enable seamless patient journeys • Best Practice in Commissioning • prioritising the prevention of poor sexual health • strong leadership and joined-up working • focusing on outcomes

50. Planning an Enhanced Service ? These essential documents are on the BASHH website…