Rosey Cummings

Australian men who have sex with men prefer rapid oral HIV testing over conventional blood testing for HIV

This study examined the views of 172 community-based Australian men who have sex with men (MSM) on the acceptability and potential uptake of rapid oral testing for HIV in clinic and home-based settings. Men were asked to complete a questionnaire that sought their views on rapid testing for HIV. When asked about which HIV test they would prefer in a clinic setting, 64% indicated a preference for rapid oral HIV testing and 74% indicated that if rapid oral HIV testing was available at a clinic they would test for HIV more frequently. If rapid oral HIV testing was available for home testing, 63% of men indicated it would be likely they would test themselves for HIV and 61% indicated they would test more frequently. Overall, MSM expressed a preference for rapid oral HIV testing and would test more frequently if testing was available for clinic or home use in Australia.

Evaluation of Electronic Medical Record (EMR) at Large Urban Primary Care Sexual Health Centre

Objective Despite substantial investment in Electronic Medical Record (EMR) systems there has been little research to evaluate them. Our aim was to evaluate changes in efficiency and quality of services after the introduction of a purpose built EMR system, and to assess its acceptability by the doctors, nurses and patients using it. Methods We compared a nine month period before and after the introduction of an EMR system in a large sexual health service, audited a sample of records in both periods and undertook anonymous surveys of both staff and patients. Results There were 9,752 doctor consultations (in 5,512 consulting hours) in the Paper Medical Record (PMR) period and 9,145 doctor consultations (in 5,176 consulting hours in the EMR period eligible for inclusion in the analysis. There were 5% more consultations per hour seen by doctors in the EMR period compared to the PMR period (rate ratio = 1.05; 95% confidence interval, 1.02, 1.08) after adjusting for type of consultation. The qualitative evaluation of 300 records for each period showed no difference in quality (P>0.17). A survey of clinicians demonstrated that doctors and nurses preferred the EMR system (P<0.01) and a patient survey in each period showed no difference in satisfaction of their care (97% for PMR, 95% for EMR, P = 0.61). Conclusion The introduction of an integrated EMR improved efficiency while maintaining the quality of the patient record. The EMR was popular with staff and was not associated with a decline in patient satisfaction in the clinical care provided.

A plea for more research on access to sexual health services

Access to sexual health services, by those at highest risk of sexually transmitted infections (STI) is critical to effective STI control. Access to services is determined by the systems that clinics use to prioritize clients. However, despite there being thousands of sexual health services world wide, only three published studies in the last 25 years have specifically assessed changes in the process of access to STI clinics in which a control period was used. These studies indicate that appointments booked in advance provide the least access for higher risk clients, whereas both triage systems and systems with a significant proportion of same day appointments improve access. It is likely, however, that many services have changed their practices and evaluation of these changes could provide valuable data to improve the efficiency and hence improve STI control.

Introduction of a sexual health practice nurse is associated with increased STI testing of men who have sex with men in primary care

BackgroundThe study objective was to investigate the effect of the introduction of a sexual health practice nurse on HIV and STI testing in a general practice that specialized in gay men’s health.MethodsThis observational study compared the proportion of gay and other men who have sex with men (MSM) tested for HIV, syphilis, chlamydia (urethral and anal) and gonorrhoea (anal), or all of the above (defined as a complete set of tests at a single visit), two years before and one year after the nurse was introduced (Clinic A). Clinic B, a general practice which also specialized in gay men’s health, but with no sexual health nurse, was used as a control.ResultsIn Clinic A, amongst HIV negative MSM the proportion of men who had a complete set of HIV and STI tests increased from 41% to 47% (p < 0.01) after the nurse was introduced. Amongst HIV positive MSM attending clinic A there was an increase in the proportion of men who had a complete set of tests after the nurse was introduced from 27% to 43% (p < 0.001). In Clinic B there was no significant increase in testing in the proportion of either HIV negative or HIV positive men who had a complete set of tests over the same time periods.ConclusionsThe introduction of the sexual health practice nurse resulted in significant increases in episodes of complete STI testing among MSM. The effect was most pronounced among HIV positive MSM.

Use of computerized medical records to determine the feasibility of testing for chlamydia without patients seeing a practitioner.

The proportion of clinically important diagnoses in a low-risk, asymptomatic population who use a computer-assisted self-interview (CASI) to assess risk was needed to determine optimal health service delivery. Medical records were retrospectively analysed between July 2008 and June 2009 for risk characteristics and diagnoses. A total of 7733 new patients completed a CASI, of whom 1060 were asymptomatic heterosexuals. From this low-risk group, 26 diagnoses were made on the day of presentation, including 22 cases of genital warts (2.08% [95% confidence interval (CI) 1.22–2.93]), three cases of genital herpes (0.28% [95% CI 0.055–0.82]) and one case of unintended pregnancy (0.094% [95% CI 0.0061–0.52]). Additionally, there were 54 cases of chlamydia detected (5.09% [95% CI 3.77–6.42]). As chlamydia is effectively diagnosed and managed from self-collected samples, patient review is not always required. This study provides evidence for an express testing service for chlamydia to streamline the screening of low-risk, asymptomatic heterosexual patients as identified by CASI without the need to for a traditional face-to-face consultation.

How men with non-chlamydial, non-gonococcal urethritis are managed in Australasia

Summary: The aim of this study was to ascertain how sexual health physicians in Australia and New Zealand manage men with chlamydia-negative non-gonococcal urethritis (NGU), particularly in relation to the notification of their female sexual partners. In July 2006, a cross-section survey was sent out to all the members of the Australasian Chapter of Sexual Health Medicine. Seventy-three percent of sexual health physicians believed that female partners of men who present with chlamydia-negative NGU were at risk of adverse reproductive health outcomes. At least 62% usually initiated some form of partner notification of female partners of men with chlamydia-negative NGU. However, only 19% (21/111) of sexual health physicians routinely tested for, and only 65% sometimes tested for, pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in men presenting with NGU. These included Mycoplasma genitalium, herpes simplex virus, ureaplasma species, Trichomonas vaginalis and adenoviruses.

An evaluation of an express testing service for sexually transmissible infections in low-risk clients without complications

UNLABELLED Background One effective way of reducing the prevalence of sexually transmissible infections (STIs) in a population is ensuring easy access to clinical services and screening of populations at high risk of STIs, including HIV. We aimed to describe the features of clients using the express testing service (ETS) and the overall impact on the service. METHODS This retrospective cross-sectional study involved all clients attending the walk-in triage service at Melbourne Sexual Health Centre before the introduction of ETS in 2009 and after ETS (2011 and 2012). RESULTS There were 32?720 and 82?265 consultations before and after ETS respectively. The ETS saw 4387 (9%) of 55?648 consultations (excluding appointments and results), giving rise to a fall in the proportion of lower-risk clients having full consultations (from 53% to 50% of consultations; P<0.001). The consultations testing for HIV and chlamydia (Chlamydia trachomatis) were marginally higher (HIV: 48% v. 47%, P=0.017; chlamydia: 70% v. 68%, P=0.015) with ETS. Young (26 v. 27 years) females (38% v. 34%) utilised the ETS more (P<0.001). The time taken for consultation and the total time spent in the clinic was significantly decreased during the ETS period (from 25min to 6min for consultation time and from 59min to 29min for total clinic time; P<0.001). CONCLUSIONS The data suggest that fast-track services such as ETS are effective in increasing access for higher-risk individuals while streamlining screening of asymptomatic low-risk clients.

What female patients feel about the offer of a chaperone by a male sexual health practitioner.

The aim of this study was to determine the experience and views of female patients when they were offered a chaperone by a male sexual health practitioner for a genital examination. Between November 2007 and January 2008, an anonymous survey was administered to female patients seen by male practitioners at Melbourne Sexual Health Centre. None of the 79 (95% CI 0–5%) patients who were offered a chaperone and declined one reported that they were uncomfortable declining the offer. The qualitative analysis showed that some participants appreciated being offered the option of a chaperone even if they did not want one and that the professional attributes of the practitioner influenced their decision not to have a chaperone. Only 8% (95%CI 4–15%) felt uncomfortable when asked if they would like a chaperone. The results reassure that when a female patient declines the offer of a chaperone within a sexual health clinic, the male practitioner can feel confident that this is the expression of the patients wish.

HIV prevention during a sexual health consultation; a suggested quality audit

We therefore reviewed the medical records of clients attending MSHC who had tested HIV-negative and who subsequently tested HIV-positive at MSHC within 1 year of their last negative test. We reviewed all new HIV-positive cases over a 3-year period from 1January 2004. We extracted epidemiological data and clinical notes relating to risk, interventions and discussions held during consultations. Quantitative data was analysed using SPSS software (SPSS Inc, Chicago, IL, USA). Annotated records were examined and transcribed by two researchers (SP, RC), independently. A process of qualitative thematic analysis then occurred in order to generate common themes. All 20 clients who fulfilled the inclusion criteria were men who have sex with men (MSM) and had a mean age of 32 years. At their last HIV-negative consultation before testing HIVpositive, 16 reported inconsistent condom use for anal sex among 23median male partners (range 1 to 200) over the previous 12 months. Over half (13) clients had at least one documented sexually transmissible infection (chlamydia/ gonococcal/herpes simplex virus) diagnosed at the Centre in the year before HIV positive diagnosis. In the medical records of the HIV-negative consultations, qualitative themes generated relating to their risk of acquiring HIV included drug and alcohol use (n=1), depression (n=6), serodiscordant relationships (n=6) and history of sexual abuse (n=2). Post HIV diagnosis, the medical records indicated the same themes at higher rates and, in particular, drug and alcohol use during high-risk events (n=9). Depression was slightly higher (n=7), as was a history of sexual abuse (n=3). Despite reporting considerable levels of risk for HIV transmission at the last HIV-negative consultation, only seven records documented an offer of counselling and in only five of these cases were the clients referred for counselling or other services to assess risk. Two records indicated that referral to these services had been declined. We found that while these clients often reported unsafe sex, the full context of the sexual encounter was often not documented in the medical record at the time of the negative test but was documented later. Of particular note only one client had drug or alcohol use documented initially, but after the HIV diagnosis, nine had this documented. While we acknowledge medical records may not fully reflect the extent of discussions held during a consultation, these findings indicate that documentation needs to be improved in medical records and also that a more proactive process of referral for counselling should be implemented in the Centre. We are, therefore, implementing a quality improvement process to ensure enhanced documentation of contributing factors that predispose to unsafe sex and for the offer of referral to counselling services and the outcome of that offer. The recommendation is that HIV-negative MSM are asked questions relating to the context of high-risk events and that the offer of appropriate services be made if these co-contributors are acknowledged during sexual history taking. Wepropose that seroconversion to HIV among clients seen at a sexual health service could be used as an important quality marker that should be regularly audited. Given the current rises in HIV seen in Australia, fine-tuning services for MSM is one way of reducing future HIV cases. 1