M Tenant-Flowers

HIV testing in non-traditional settings--the HINTS study: a multi-centre observational study of feasibility and acceptability.

Background UK guidelines recommend routine HIV testing in healthcare settings if the local diagnosed HIV prevalence >2/1000 persons. This prospective study assessed the feasibility and acceptability, to patients and staff, of routinely offering HIV tests in four settings: Emergency Department, Acute Care Unit, Dermatology Outpatients and Primary Care. Modelling suggested the estimated prevalence of undiagnosed HIV infection in attendees would exceed 1/1000 persons. The prevalence identified prospectively was not a primary outcome. Methods Permanent staff completed questionnaires assessing attitudes towards routine HIV testing in their workplace before testing began. Subsequently, over a three-month period, patients aged 16–65 were offered an HIV test by study staff. Demographics, uptake, results, and departmental activity were collected. Subsets of patients completed questionnaires. Analyses were conducted to identify factors associated with test uptake. Findings Questionnaires were received from 144 staff. 96% supported the expansion of HIV testing, but only 54% stated that they would feel comfortable delivering testing themselves, with 72% identifying a need for training. Of 6194 patients offered a test, 4105 (66·8%) accepted (61·8–75·4% across sites). Eight individuals were diagnosed with HIV (0–10/1000 across sites) and all transferred to care. Younger people, and males, were more likely to accept an HIV test. No significant associations were found between uptake and ethnicity, or clinical site. Questionnaires were returned from 1003 patients. The offer of an HIV test was acceptable to 92%. Of respondents, individuals who had never tested for HIV before were more likely to accept a test, but no association was found between test uptake and sexual orientation. Conclusions HIV testing in these settings is acceptable, and operationally feasible. The strategy successfully identified, and transferred to care, HIV-positive individuals. However, if HIV testing is to be included as a routine part of patients’ care, additional staff training and infrastructural resources will be required.

UK National Guideline on the Management of Sexually Transmitted Infections and Related Conditions in Children and Young People (2009)

This guideline is appropriate for use in genitourinary (GU) medicine/sexually transmitted infections (STIs) clinics, and by other National Health Service (NHS) or other services providing sexual health advice, management or treatment to young people, e.g. sexual health clinics, young person’s clinics, contraceptive clinics, gynaecology/antenatal services, termination services, Sexual Assault Referral Centres (SARCs), paediatric services and general practice in the UK. The principles apply wherever young people are seen for sexual health care or where there are concerns about child sexual abuse (CSA) or where a STI has been detected. It includes recommendations on the assessment, examination, diagnostic tests, treatment regimens and prophylaxis for the effective management of children and young persons under 16 at risk of, or who have, an STI. It offers guidance on consent and confidentiality on children and young people presenting to health-care professionals working in sexual health services. It is also applicable to young people aged 16–18 who have learning difficulties or who are ‘vulnerable’. Some parts of the guidelines are relevant to all those providing sexual health services, but other parts are only relevant to Level 3 service providers. Prevention of STIs through health education and one-to-one interventions as recommended by the National Institute of Health and Clinical Excellence (NICE) is an integral part of sexual health care of young people but is outside the scope of the guidelines. Stakeholder involvement, rigour of development, levels of evidence and grading of recommendations are available online only in the full version of this guideline at http://ijsa.rsmjournals.com/cgi/content/full/21/4/229/DC1 This guideline is laid out in specific sections: Part 1: Introduction and discussion of issues concerning consent, confidentiality, child protection and basic principles of care. Part 2: The diagnosis and management of specific STIs and related conditions in the under 16s. Correspondence to: K Rogstad

Automatic oral fluid-based HIV testing in HIV screening programmes: automatic for the people.

UK guidelines recommend routine HIV testing in general clinical settings when the local HIV prevalence is > 0.2%. During pilot programmes evaluating the guidelines, we used laboratory‐based testing of oral fluid from patients accepting tests. Samples (n = 3721) were tested manually using the Bio‐Rad Genscreen Ultra HIV Ag‐Ab test (Bio‐Rad Laboratories Ltd, Hemel Hempstead, UK). This was a methodologically robust method, but handling of samples was labour intensive. We performed a validation study to ascertain whether automation of oral fluid HIV testing using the fourth‐generation HIV test on the Abbott Architect (Abbott Diagnostics, Maidenhead, UK) platform was possible.

Care of HIV-positive women aged 50 and over – can we do better?:

A sample of 123 HIV-positive women aged 50 years and over showed high rates of late diagnosis with CD4 count <350 (71%), significant co-morbidities (90%), high rates of premature menopause (6.8%) and early menopause (6.8%) and cervical cytological abnormalities (47%). Specific interventions to improve care in this group should include yearly cervical cytology, early counselling with regard to reproductive options, menopause management and screening for sexually transmitted infections (STIs).

Contraception and medical gynaecology for HIV-positive women in a one-stop clinic.

HIV-positive women may be reluctant to attend gynaecology or family planning clinics for fear of divulging their condition. Therefore, a referral clinic was opened within the HIV clinic. Retrospective case-note reviews of 197 new patients revealed 109 with a variety of medical gynaecology conditions (menorrhagia being the commonest) and 88 sought contraception. The full range of contraceptives was used, including Mirena for the treatment of menorrhagia as well as contraception and the combined pill adjusted for interaction with liver enzyme-inducing antiretroviral drugs. The acceptance of contraceptive advice and gynaecological evaluation by the patients has resulted in improved reproductive health services for these HIV-positive women. In centres with large cohorts of HIV-positive women, this type of one-stop specialist clinic will be very effective in providing high-quality reproductive health care and hence, this type of clinic is recommended for such centres.

HIV testing in non-traditional settings: feasibility and acceptability in an acute admissions unit

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Difficulties in accessing psychosexual services in London, UK

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Child sexual exploitation: a guide for obstetricians and gynaecologists

Child sexual exploitation (CSE) is a child protection issue and can affect any young person. Healthcare professionals play a key role in identifying both those who are victims of exploitation, and also those at risk. The General Medical Council considers that all doctors have a responsibility for child protection. Obstetricians and gynaecologists may come across victims of CSE in a range of clinical settings, but practitioners may not feel confident that they have sufficient training to recognise victims or potential victims or indeed what course of action to take if they do. This article provides training in both of these aspects by introducing Spotting the Signs (a questionnaire‐based tool to help detect CSE) and by highlighting appropriate referral pathways, including the vital role of joint working and information sharing.

A rare cause of lymphadenopathy – Rosai-Dorfman disease in a HIV-positive Ugandan woman

This case illustrates a rare cause of lymphadenopathy as a presenting feature of HIV and highlights the importance HIV testing in all patients who present with lymphadenopathy.