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THE BIG SCREEN

THE BIG SCREEN. Ruth Hall Chlamydia Screening Programme Brighton & Hove City, Eastbourne Downs, Mid-Sussex, Sussex Downs & Weald PCTs. Chlamydia Trachomatis. Commonest sexually transmitted infection in England & Wales 90,000 new cases diagnosed in 2003

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THE BIG SCREEN

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  1. THE BIG SCREEN Ruth Hall Chlamydia Screening Programme Brighton & Hove City, Eastbourne Downs, Mid-Sussex, Sussex Downs & Weald PCTs

  2. Chlamydia Trachomatis • Commonest sexually transmitted infection in England & Wales • 90,000 new cases diagnosed in 2003 • < 70% of cases are asymptomatic – large numbers remain undiagnosed • Largest single factor in PID, ectopic pregnancy and infertility • Bacterial infection - easily cured by antibiotics

  3. Diagnoses of genital chlamydial infection in GUM clinics by sex & age group, UK: 1995-2002 Males Females

  4. Background • CMO Expert Advisory Group 1998 • acknowledged seriousness • 1999/2000 screening pilots – Portsmouth / Wirral • reported 2001/2 • high level acceptance • >95% positive cases treated • Increased availability of non-invasive, more sensitive tests

  5. Background • Department of Health funding for National Roll-out of Programme • 2002 – Ten Phase 1 sites announced • 2004 – Sixteen Phase 2 sites announced • Brighton consortium won Phase 2 funding

  6. How many will we screen? • Target population 92,800 (age 16-24 years) • Estimate 75,000 will be sexually active (NATSAL) • Screen 30,000 per annum

  7. Opportunistic screening • Sporadic screening: • 6th form colleges • Schools • Youth clubs • Freshers’ events • Sports events • Lewes prison • Clubs • Pubs • Beaches • Continuous sites: • Gynaecology • Termination pregnancy • Family planning • GU Medicine • Selected GP surgeries • University • Youth clinics

  8. How does it work? • Any patients under 25 offered the test • Posters and information booklets • Specific chlamydia request forms • largely self completed by patients • three data items to be completed by clinic staff • No examination necessary • Urine sample for men • Self-taken lower vaginal swab for women • Programme training and manual for site staff

  9. Patient Management • Estimate ~ 10% positive (14-17% in some sites) • Contact via preferred method and invite to attend • primary screening site • central chlamydia office • “chlamydia clinics” • Treatment • stat dose of azithromycin 1g direct observation • offer full screen at GU clinic if symptomatic • sexual abstinence for 7 days • Trace contacts

  10. Direct advantages • Reduce the local prevalence of chlamydia • Improve access to sexual health services (rural areas, disadvantaged groups, homeless) • Detailed epidemiological data for the Department of Health from outside GUM clinic settings • Decreased reproductive morbidity (ectopic pregnancy, infertility) • Reduced consultations relating to chronic pelvic pain

  11. Indirect advantages • Improved awareness of sexual health & safer sex issues • Greater knowledge amongst health care professionals • Increased opportunities to discuss sexual health promotion / condom use • Enhanced links between health, youth, education & non-NHS services

  12. Local Programme Stages • Stage 1 Design & Implement • Stage 2 Evaluate Trial • Stage 3 Monitor & Report • Stage 4 Secure Future Funding

  13. Programme Plan

  14. Scope • Sexually active <25s • Brighton & Hove, Eastbourne Downs, Mid-Sussex and Sussex Downs & Weald PCTs • Phase II of Department of Health National Chlamydia Screening Programme Roll-out • DH funding for 2 years • £510k set-up and year 1 • £515k year 2

  15. Sites to Date • Brighton & Hove City - 10 • Eastbourne Downs - 3 • Sussex Downs & Weald - 1 • Mid-Sussex - 2 • Presentations made to 8 further sites

  16. Sites to Date • Hospital Clinics - 3 • GP Surgeries - 7 • Family Planning - 2 • Youth Centres - 2 • Student Advice Centres - 2

  17. Tests to Date • August (from 17th) - 23 • September - 145 • October - 168 • November (to 17th) - 90

  18. Results to Date

  19. Questions?

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