John McSorley

The utility of short message service (SMS) texts to remind patients at higher risk of STIs and HIV to reattend for testing: a controlled before and after study

Background Patients attending for sexually transmitted infection (STI)/HIV testing may be at continuing risk of infection and advised to return for retesting at a later date. Objectives To measure the impact of short message service (SMS) text reminders on the reattendance rates of patients who require repeat STI testing. Methods Reattendance rates were measured for two groups of higher risk patients: those listed for routine SMS text reminders in 2012 and a control group of patients from 2011 with the same risk profile who had not received any active recall. Reattendance was counted if it was within 4 months of the end of the episode of care. Results Reattendance rates were not statistically different between the text group 32% (89/274) and the control group 35% (92/266). Reattendance also was not statistically different between the text and control groups respectively in patients with the following risks: recent chlamydia 43/121 (36%) versus 41/123 (33%), recent gonorrhoea 4/21 (19%) versus 7/21 (33%), recent emergency contraception 27/60 (45%) versus 25/56 (45%) and other risks 7/27 (26%) versus 9/26 (35%). High rates of STIs were found in patients who reattended in both the text group (13/90, 14%) and control group (15/91, 17%) and at even higher rates at reattendance if the reason for recall was chlamydia infection at the initial visit: 9/43 (21%) in the text group and 10/41 (24%) in the control group. Conclusions SMS texts sent as reminders to patients at higher risk of STIs and HIV did not increase the reattendance rate, when compared with standard advice, in this service which already has a high reattendance rate. STI rates were high in those patients who reattended.

Using short message service text reminders to reduce 'did not attend' rates in sexual health and HIV appointment clinics.

‘Did not attend’ and cancellation rates were compared for two 12-month periods before (2009) and after (2012/2013) the introduction of routine short message service text reminders being sent to patients who have pre-booked appointments. After the introduction of short message service text appointment reminders, the overall ‘did not attend’ rates fell by 4% from 28% to 24% (p < 0.005) and by 10% from 28% to 18% (p < 0.05) for male sexual health appointments. There was no significant change in the HIV clinic ‘did not attend’ rates. In the same periods, the cancellation rates increased 4% overall (from 62% to 66%) and by 17% (from 55% to 72%) for female sexual health clinics (p < 0.005). These results suggest that routine text reminders increase clinic attendance rates by reminding patients to attend and prompting them to cancel if they cannot come.

A prospective study of the effectiveness of electronic patient records in rapid-cycle assessment of treatment and partner notification outcomes for patients with genital chlamydia and gonorrhoea infection

Objective To assess the effectiveness of electronic patient records (EPRs) in facilitating multiple, rapid measurements of treatment and partner notification (PN) outcomes for chlamydia and gonorrhoea. Methods In two sexual health clinics, the proportion of patients with chlamydia and gonorrhoea who had been treated within 4 weeks of diagnosis was measured, and also the proportion where at least one of their partners had been treated. These outcomes were measured monthly for 6 months, and changes in recording practice were instituted when necessary. Results It took 8 h to capture and analyse the data for 89 patients in month 1. The health advisers subsequently entered data into searchable fields to facilitate better data capture. As a result, by month 6 it took only 1.5 h to measure these outcomes using an electronic search. It had previously taken 2 days to perform the same analysis using paper records. In month 1, successful treatment was recorded in 26/27 (96%) patients with gonorrhoea and 57/61 (93%) with chlamydia, and there was successful PN for gonorrhoea and chlamydia patients in 19/27 (70%) and 39/61 (64%). By month 6, the recorded outcomes were 30/31 (97%) and 81/86 (94%), respectively, for successful treatment and 28/31 (90%) and 74/86 (86%) for successful PN, respectively. Conclusions Frequent rapid clinical outcome monitoring is easily attained using EPRs as long as the data are entered into searchable fields. Treatment and PN success for chlamydia and gonorrhoea with this method are well above national targets, which may be attributable to both the use of EPRs and better data capture.

British HIV Association Guidelines on the Use of Vaccines in HIV-Positive Adults 2015

These guidelines provide updated, GRADE-based recommendations on the use of vaccines in HIVpositive adults. Several factors have made the updating of HIV-specific vaccination guidelines important: effective antiretroviral therapy (ART) has substantially modified the natural history of HIV infection, vaccination practices are evolving, and a large number of novel vaccines are becoming available in clinical care. The update contains important new guidance regarding the use of new vaccines against human papillomavirus (HPV), shingles (herpes zoster), and pneumococcus. Further key updates are related to the use of hepatitis B, meningococcus, and pertussis vaccines. Compared with HIV-negative individuals, HIV-positive adults often have an increased risk of infection or experience more severe morbidity following exposure to vaccine-preventable diseases, and therefore a lower threshold for extending indications and offering vaccination may be appropriate relative to the general population. Improved health and prognosis mean that HIV-positive adults are also increasingly likely to engage in travel or occupations that carry a risk of exposure to infectious agents, and these otherwise healthy individuals should not be denied protection or engagement with such activities if evidence indicates vaccination is safe and immunogenic. Immune responses to vaccination are often sub-optimal in HIV-positive patients, and while these improve with ART, they often remain lower and decline more rapidly than in HIV-negative individuals. However, many of these vaccines still afford protection and for some vaccines it is possible to improve immunogenicity by offering modified vaccine schedules, with higher or more frequent doses, without compromising safety. Non-replicating vaccines (e.g., whole inactivated, polysaccharide, conjugated, and subunit vaccines, or virus-like particles) can be used safely in HIV-positive persons, whereas replicating (live) vaccines have traditionally been contraindicated. However, ART-induced Immunorestoration reduces the risk of adverse events, in many cases shifting the risk-benefit ratio in favour of vaccination, whereby the risk of disease with natural infection becomes greater than the risk of live vaccine-related adverse events. Important examples of replicating vaccines that can be used in HIV-positive persons with good immunity include those for measles, mumps and rubella (MMR), varicella-zoster virus (VZV), and yellow fever. For vaccinated individuals, the importance of infection avoidance and infection control should continue to be emphasised. It is envisaged that the HIV specialist should provide overall guidance on vaccine use and enlist the help of primary care physicians for vaccine administration. Education of health care providers and good communication are key requirements to ensure successful implementation of this guidance. Despite evidence that HIV-positive persons benefit from vaccination, there are persisting perceptions about disease incidence and burden, and vaccine effectiveness and safety, which affect vaccination practices among health professionals caring for HIV-positive patients. It is hoped that this guidance will help overcoming such barriers.

‘It's all in the message’: the utility of personalised short message service (SMS) texts to remind patients at higher risk of STIs and HIV to reattend for testing—a repeat before and after study

Background Patients at increased risk of sexually transmitted infections (STIs)/HIV acquisition are advised to reattend for retesting. A previous study showed that ‘generic’ text reminders did not improve reattendance. Aim To assess if a personalised text message with increased contact information would increase reattendance rates of at-risk patients. Methods Patients who are at risk of future STIs, defined by having a current acute STI, attending for emergency contraception, commercial sex workers (CSWs) or men who have sex with men (MSM), were sent a text reminder to reattend for retesting 6 weeks after initial visit. Reattendance rates were measured for September to December 2012 (control group who received a generic text message) and February to May 2014 (intervention ‘personalised message’ group who received a text message containing their first name and ways to contact the clinic). Reattendance was counted within 4 months of the end of the initial episode of care. Results The reattendance rate was significantly higher for the intervention group: 149/266 (56%) than the control group: 90/273 (33%) (p=0.0001) and was also significantly higher in the intervention group than the control group in patients with the following risks: recent chlamydia (64/123 (52%) vs 43/121 (36%)) (p=0.03), recent gonorrhoea (41/64 (64%) vs 4/21 (19%)) (p=0.0003) and MSM (26/45 (58%) vs 3/18 (16%)) (p=0.006). New STI rates in the reattending intervention group and controls were 26/ 149 (17%) and 13/90 (14%) (n.s), respectively. Conclusions Sending a personalised text message with increased contact information as a reminder for retesting increased reattendance rates by 23% in patients who are at higher risk of STIs.

Retrospective study of the effect of enhanced systematic sexually transmitted infection screening, facilitated by the use of electronic patient records, in an HIV‐infected cohort

The aim of the study was to assess the impact of electronic checklists in enhancing sexually transmitted infection (STI) screening in routine HIV care.

The effect of electronic patient records on hepatitis B vaccination completion rates at a genitourinary medicine clinic

The study was conducted to assess whether the introduction of an electronic patient records-based system affected hepatitis B vaccination completion rates and post-vaccination return rates, when compared to a paper-based system. Data were gathered for three groups of patients: those commencing vaccination (a) when paper records were in use (paper records group), (b) after electronic patient records were introduced (basic electronic patient records group) and (c) after electronic patient records were enhanced with recall (enhanced electronic patient records group). Compared to the paper records group, the third dose completion rates for patients managed using electronic patient records did not differ significantly: 74/119 (62.2%) paper vs. 58/98 (59.2%) basic electronic patient records, p = 0.652 and 89/130 (68.5%) enhanced electronic patient records, p = 0.298. On sub-group analysis, completion rates in patients of black ethnicity in the enhanced electronic patient records group were significantly higher than those in the paper records group: 16/19 (84.2%) enhanced electronic patient records vs. 11/23 (47.8%) paper, p = 0.014. Patients in the enhanced electronic patient records group were more likely than those in the paper records group to attend for measurement of hepatitis B surface antibody levels: 61/130 (46.9%) vs. 39/119 (32.8%), p = 0.023.

Implementation of electronic patient records in a sexual health clinic

It is widely held that electronic patient records (EPR) will become the norm for recording all interactions between the patient and healthcare workers in the future in developed countries with sufficient information technology (IT) resource. With the rapid rise in attendance at UK sexual health clinics, there has been a commensurate rise in the number of case records generated creating problems in storage and efficient record management within each clinic. EPR has theoretical advantages in terms of enabling rapid access to clinical information, uniformity of data collection and flexibility of data use/audit. We therefore decided to implement EPR in this service and we describe our experience. The clinic provides services for both HIV and genitourinary medicine (GUM) patients. There are approximately 14 000 GUM attendances per annum, of which approximately 75% are new episodes of care for sexually transmitted infection (STIs) screening. The clinic is open access, largely walk-in, with a small number of bookable appointments. We serve an ethnically diverse, socially deprived, urban population in North West London. Having looked at the available options, we purchased the Blithe “Lilie” (Blithe Computer Systems, UK) patient management system ensuring that we had enough computers within the clinic for ready access by all staff …

O09 The impact of an HPV vaccination programme in young men who have sex with men (MSM) on clinical presentations with genital warts

Introduction We introduced a quadrivalent HPV (HPV4) vaccination programme in young MSM <27yrs attending our clinical services (Clinic 1 & 2) since 2012. We assess the impact on attendance with genital warts (GW) subsequent to vaccination in this population and an adjoining service (Clinic 3) not then offering vaccination. Methods We identified all MSM <27yrs receiving at least one dose HPV4 at Clinics 1 & 2, and all MSM <27yrs attending Clinic 3, between 2012 and 2017. Demographic and clinical data was extracted from electronic patient records. HPV DNA testing was not performed.Abstract O09 Table 1 Clinical Outcomes in HPV4 vaccinated and unvaccinated MSM under 27yrs Characteristic Clinic 1& 2 HPV programme No./Total (%) Clinic 3 No HPV programme No./Total (%) Probability value p = History of prior/current GW 75/757(9.9%) 27/180(9.6%) p = 0.06 Ever Re-attended 524/757(69%) 81/180(45%) p = 0.0001 Subsequent episode of GW: Re-attenders 11/524(2%) 22/81(27%) p = 0.0001 Subsequent episode of GW: All 11/757(1.5%) 22/180(12%) p = 0.0001 New cases of GW 3/757(0.4%) 4/180(2%) p = 0.0285 Results Current or prior history of GW was comparable in the 2 clinic populations. Re-attendance rates were lower in the clinic without active recall. Recurrent episodes of GW was higher 22/180 (12%) in the unvaccinated population than the vaccinated group 11/757 (1.5%). Incidence of new cases of GW, defined as a first clinical episode > 3 months since 1st vaccine, was significantly lower in the vaccinated population. Discussion We observed a significant reduction in subsequent episodes and potential new episodes of GW in an unselected population of MSM receiving HPV4 vaccine. Significant clinical benefit and saving can be expected from an HPV4 programme in MSM.

P240 What are the vaccination needs of msm in the current hepatitis a virus (hav) outbreak? a retrospective study of the hav immune status in first-attendance msm in a london gum clinic

Introduction Hepatitis A infection in MSM increased in incidence from late 2016 in the UK and has reached outbreak status. By February 2017, 42 confirmed or suspected cases had been reported in London. BASHH hepatitis guidelines recommend HAV vaccination of MSM in outbreak situations. Methods We looked at 100 consecutive MSM who attended our service for the first time in early 2016 to assess what the vaccination needs of MSM would be. Results Sixty seven of these MSM had a baseline HAV total antibody test of which 33 (49%) were HAV-Ab positive. A further 5/66 (8%) MSM gave a history of HAV vaccination but were antibody negative. 16/33 (48%) HAV-immune MSM gave a history of previous vaccination. 7/66 (11%) of the MSM who were immune, but non-vaccinated, came from HAV-endemic countries and presumed naturally immune. 49/98 (50%) who had baseline HBV antibody levels were HBV-immune of whom 14/49 (29%) were also HAV immune. Extrapolating from these data, our estimates for baseline vaccination requirements in new MSM were: 28% require monovalent HAV vaccine, 24% require monovalent HBV vaccine, 21% require bivalent HAV/HBV vaccine and 27% require no vaccine. Discussion If these data are representative of MSM in London, 49% (57% including those vaccinated but HAV-Ab –ve) are already HAV-immune. This has implications with regards to estimating the pool of non-immune MSM at-risk. It also enables us to estimate the types of vaccine required to meet the MSM’s needs in relation to HAV as well as HBV in the current outbreak