TRAINING & SUPPORT

1. TOWARDS A LOCAL ENHANCED SERVICE FOR ASYMPTOMATIC SCREENING FOR SEXUALLY TRANSMITTED INFECTIONS: A PILOT STUDY Dr Elaine Gibbs GP University of Nottingham Health Service Cripps Health Centre University Park Nottingham BACKGROUND Nottingham has the highest level of sexually transmitted infections in the Trent Region, and one of the highest levels outside London. Chlamydia infection is a particular concern, with positive rates of 12% in women under 25 tested in 2006,1 and rates nearly doubling in the past five years.2 Despite this, most tests in primary care are being performed in women over this age, and rarely in men.3 Following the National Strategy for Sexual Health 2001,4 and Choosing Health 2004,5 Nottingham City PCT has been looking at the measures required to achieve the 48 hour access target for Genito-Urinary Medicine (GUM) clinics, as well as to increase the percentage of people aged 15-24 accepting screening for Chlamydia.6 Following discussions between Nottingham City PCT and the Nottingham GUM Clinic, a pilot study was set up to look at the feasibility of offering asymptomatic STI screening to under 25 year olds at the two University practices in Nottingham and the City Contraception and Sexual Health (CASH) clinic. The outcome of the pilot presented here mainly utilises the data from one of the three sites (Nottingham University Health Service). SET UP OF CLINICS The pilot commenced in February 2006. Clinics were advertised within the Health Centre only, and patients could self-refer. Four clinics were held each week, with 20 minute pre-booked appointments. Patients were provided with written information and counselled by the nurse prior to testing. Testing was offered for Chlamydia and Gonorrhoea, (from a self taken low vaginal swab or urine sample), and also for HIV and Syphilis serology. Chlamydia and Gonorrhoea tests were performed using Nucleic Acid Amplification (NAATS) testing. Patients were advised to contact the practice for their results 1-2 weeks after testing. Any patients with positive results were contacted by the nurse by telephone and invited to attend for treatment and contact tracing. Patients who failed to attend within 2 weeks were contacted again by telephone and letter. TRAINING & SUPPORT Training was provided by the local GUM department and consisted of 2 sessions of theoretical teaching, and a minimum of two clinical sessions in the GUM Clinic (including a session with a Health Advisor doing contact tracing). The service was designed to be nurse-led with GP support if necessary, using protocols developed by GUM and the Practice. GUM provided support through advice and fast-track access to their clinics. PROTOCOL 1. PROTOCOL 2. RESULTS TREATMENT & CONTACT TRACING Patients testing positive were contacted by telephone and invited to attend for treatment and contact tracing. Treatment for Chlamydia was 1g Azithromycin stat, administered by the nurse. Any patients testing positive for Gonorrhoea, Syphilis or HIV were fast-tracked to GUM for further testing. Contacts of Chlamydia positive cases were traced for the previous 6 month period. Complicated contact tracing was referred to GUM. RESULTS 199 patients attended for screening (133 female, 66 male) over a four month period. 26% were aged under 20 years. 94% accepted testing for Chlamydia and Gonorrhoea, and 90% for Syphilis and HIV. 7 patients tested positive for Chlamydia (3.5%). 6 of these were successfully treated and had contact tracing via the Health Centre. One patient was treated elsewhere. All other tests were negative apart from one equivocal gonorrhoea result (referred to GUM). PATIENT SATISFACTION QUESTIONNAIRE 89% of patients seen completed a satisfaction questionnaire. 96% of responders felt they had been able to make an appointment to suit them. 100% were happy with issues of confidentiality. 99% were happy with the length of the appointment, and had felt able to ask all the questions they wanted. Overall, 97% rated their clinic visit experience as good or very good. COMMENTS The clinic was well received by patients, and demand for appointments was high. Chlamydia rates were lower than anticipated, although the comparable pilot site serving students at the Nottingham Trent University had a positive rate of 8.9%. Practice nursing staff felt confident offering the service, including providing contact tracing, and were well supported by GUM. Although the option existed to advertise the service more widely, it appears that most patients were made aware by “word of mouth”. It is difficult to anticipate the level of demand if the Clinic was offered on a permanent basis, or more widely promoted. In order to offer the service more widely it was felt clinics could be run by a Health Care Assistant with appropriate training, and with shorter appointments. Following the successful completion of this pilot the PCT has now developed a Local Enhanced Service and is offering this to other interested GP Practices in Nottingham, as well as continuing in the pilot sites. REFERENCES 1. Nottingham Chlamydia Screening Project 2. Ghattaora R, Hooton D, Packham C, Subbarao-Sharma R, Robinson J. Greater Nottingham Sexual Health Needs Assessment. Nottingham 2005 3. Kufeji O, Slack R, Cassell J A, Pugh S, Hayward A Who is being tested for genital chlamydia in primary care? Sex Transm Infect 2003;79:234-236 4. Department of Health. The National Strategy for Sexual Health and HIV. London 2001 (http://www.dh.gov.uk) 5. Department of Health. Choosing Health: Making Healthy Choices Easier. Norwich 2004 (http://www.dh.gov.uk) 6. Nottingham City PCT Local Delivery Plan 2005-2008 (http://www.nottinghamcity-pct.nhs.uk)