Siobhan Murphy

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.

Sexually transmitted disease rates before and after HIV testing

Summary: The aim of the study was to evaluate the effect of having an HIV-positive or negative test result on sexual risk behaviour before and after the test. Longitudinal retrospective case-note survey identifying new episodes of sexually transmitted disease (STD) infections in 114 subjects testing HIV positive and 114 matched negatives were examined at the Genitourinary Medicine Department, St Marys Hospital, Paddington, London. Across the whole sample in the year after HIV testing the number of cases of new STD infections was 40% of the number of cases in the year prior to HIV testing. There was no association between serostatus and incidence of STD infections before and after HIV testing. Of those testing negative, 5.3% were identified as having a new infection in the year after the HIV test, while amongst those testing positive there was a rate of new STDs of 2.6%. In conclusion, there was no evidence that having a negative test result increased the risk of acquisition of new STDs. Rates of new STD infections amongst seropositives in the year after HIV testing were low.

‘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.

Re: cervical screening in HIV-positive women in the East of England: recent CD4 as the predictive risk factor

Dear Editor, In this paper, Davies et al. suggest that the prevalence of abnormal smears in the HIV cohort in women with a CD4 cell count> 350 cells/mm (6.3%) is similar to the prevalence of abnormal smears in the general population (6.6%–7.2%). However, we feel that this conclusion is erroneous. The data for HIV-positive women were collected for 12 months. However, the national cervical screening programme recommends that women have smears every three years under the age of 50 and every five years to age 65. Therefore, the correct comparison would have been the prevalence of abnormal smears in the HIV cohort in any three-year period, assuming many were aged under 50. Whilst the accumulation of annual smears over a three-year period may give a higher three-year prevalence than single smears over the same three-year period (due to falsenegative results in the three-yearly smears), it is still likely that the prevalence of abnormalities in the HIV-cohort would have been much higher. An audit of the data for our cohort shows that the three-yearly prevalence (2013–2015) of abnormal smears is 18%. In our audit, there were 346 HIV infected women of which 65/346 (18.8%) had one or more abnormal smears. Only six of those (9%) with abnormal smears, had CD4 cell counts< 350 cells/ mm and six (9%) were not on antiretroviral therapy (ART). Only one woman with an abnormal smear had both a CD4 cell count< 350 cells/mm and was not on ART. There was no significant difference between smear result based upon age, CD4 cell count, ART use or viral load. In other words, the rate of abnormal smears seems to be three times higher than the national prevalence. Whilst these data do not prove that annual smears are more beneficial than three-yearly smears in HIV-positive women, they do not support a change from the current practice. We plan to publish more complete data at a later date. As the authors suggest, more research is required to try and ascertain if a change from yearly to twoor three-yearly smears would increase the risk of HIVpositive women developing cervical cancer.