Vickie Knight

Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men

Objectives To evaluate the impact of a short message service (SMS) reminder system on HIV/sexually transmitted infection (STI) re-testing rates among men who have sex with men (MSM). Methods The SMS reminder programme started in late 2008 at a large Australian sexual health clinic. SMS reminders were recommended 3–6 monthly for MSM considered high-risk based on self-reported sexual behaviour. The evaluation compared HIV negative MSM who had a HIV/STI test between 1 January and 31 August 2010 and received a SMS reminder (SMS group) with those tested in the same time period (comparison group) and pre-SMS period (pre-SMS group, 1 January 2008 and 31 August 2008) who did not receive the SMS. HIV/STI re-testing rates were measured within 9 months for each group. Baseline characteristics were compared between study groups and multivariate logistic regression used to assess the association between SMS and re-testing and control for any imbalances in the study groups. Results There were 714 HIV negative MSM in the SMS group, 1084 in the comparison group and 1753 in the pre-SMS group. In the SMS group, 64% were re-tested within 9 months compared to 30% in the comparison group (p<0.001) and 31% in the pre-SMS group (p<0.001). After adjusting for baseline differences, re-testing was 4.4 times more likely (95% CI 3.5 to 5.5) in the SMS group than the comparison group and 3.1 times more likely (95% CI 2.5 to 3.8) than the pre-SMS group. Conclusion SMS reminders increased HIV/STI re-testing among HIV negative MSM. SMS offers a cheap, efficient system to increase HIV/STI re-testing in a busy clinical setting.

SMS reminders improve re-screening in women and heterosexual men with chlamydia infection at Sydney Sexual Health Centre: a before-and-after study

Background In 2009, Sydney Sexual Health Centre implemented a short message service (SMS) reminder system to improve re-screening after chlamydia infection. SMS reminders were sent at 3 months recommending the patient make an appointment for a re-screen. Methods Using a before-and-after study, the authors compared the proportion re-screened within 1–4 months of chlamydia infection in women and heterosexual men who were sent an SMS in January to December 2009 (intervention period) with a 18-month period before the SMS was introduced (before period). The authors used a χ2 test and multivariate regression. Visitors and sex workers were excluded. Results In the intervention period, 141 of 343 (41%) patients were diagnosed with chlamydia and sent the SMS reminder. In the before period, 338 patients were diagnosed as having chlamydia and none received a reminder. The following baseline characteristics were significantly different between those sent the SMS in the intervention period and the before period: new patients (82% vs 72%, p=0.02), aged <25 years (51% vs 33% p<0.01), three or more sexual partners in the last 3 months (31% vs 27%, p<0.01) and anogenital symptoms (52% vs 38%, p<0.01). The proportion re-screened 1–4 months after chlamydia infection was significantly higher in people sent the SMS (30%) than the before period (21%), p=0.04, and after adjusting for baseline differences, the OR was 1.57 (95% CI 1.01 to 2.46). Conclusions SMS reminders increased re-screening in patients diagnosed as having chlamydia at a sexual health clinic. The clinic now plans to introduce electronic prompts to maximise the uptake of the initiative and consider strategies to further increase re-screening.

Nurse-led sexual health care: international perspectives.

Nurses as first-line care providers for the treatment of sexually transmitted infections are a relatively new concept in the United Kingdom (UK). However, for over 25 years, services in other countries have been empowering nurses to work as autonomous practitioners, capable of dealing with patients presenting with a range of sexual health conditions and issues without necessarily seeking the advice or input of a doctor. This paper will present the observations of nurse-led services in Amsterdam, Seattle and Sydney. It will discuss how service providers in the UK can learn from the experiences of international colleagues and will argue why trained and experienced genitourinary medicine nurses need to advance their role and be better integrated as first-line care providers.

The C-project: use of self-collection kits to screen for Chlamydia trachomatis in young people in a community-based health promotion project

BACKGROUND The present study aimed to ascertain the acceptability to at-risk young people of self-collected urine samples as a means of testing for Chlamydia trachomatis (chlamydia); to determine the effectiveness of drop-off and outreach collection methods as a means of detecting and treating chlamydia; and to determine the rate of positive chlamydia tests in a sample of the target group. METHODS Participants requested postal testing kits from the project website, the NSW Sexual Health Infoline or at an outreach event and either returned urine samples at selected drop-off locations or directly to the researchers during active outreach events. RESULTS A total of 413 kits were requested - 196 (47.5%) via email, 204 (49.4%) during outreach events and nine (2.2%) via the NSW Sexual Health Infoline. A total of 195 samples (47.2% of ordered kits) were returned. Participants were less likely to return samples if they had been requested by email (odds ratio = 9.6; 95% confidence interval: 6.0-15.0) or via telephone (odds ratio = 22.0; 95% confidence interval: 2.7-181.0) compared with directly obtaining a kit at an outreach event. The number of specimens positive for chlamydia in the targeted age range was 4, giving a 3.1% positive rate (95% confidence interval: 1.0-8.0). CONCLUSIONS This study identified that free testing kits and online communication worked well as a means of engaging young people and raising awareness of sexual health. However, the requirement to drop-off urine samples at selected locations was not well accepted.

Chlamydia trachomatis infection among antenatal women in remote far west New South Wales, Australia

BACKGROUND A prospective, cross-sectional study was undertaken of pregnant women attending antenatal services in the remote far west of New South Wales, Australia, between October 2004 and May 2006. Of 420 eligible women, 218 (52%) participated in the study. Six women (2.7%; 95% CI: 1.0-5.9) tested positive for Chlamydia trachomatis. The prevalence among pregnant, Indigenous women (n = 44) was 9.1% (95% CI: 2.5-21.7). Infection was significantly associated with Indigenous status (P = 0.003) and self-perceived risk for chlamydia (P = 0.05). Pregnant Indigenous women in remote areas may be at higher risk for chlamydia and targeted screening of this group should be considered.

Triage in a public outpatient sexual health clinic

BACKGROUND The increasing prevalence of sexually transmissible infections in Australia, coupled with a NSW Health Department requirement to target services to those most in need, has led many services to investigate patient triage as a way of better using scarce resources. In October 1997, a Triage Nurse position was trialled that aimed to facilitate the optimal flow of patients through the Sydney Sexual Health Centre (SSHC) clinic in an efficient and patient-focussed manner. A pre and post implementation time-flow study was conducted to analyse the effect. A staff survey was also completed to ascertain staff acceptance of the Nurse Triage system. METHODS A time-flow data survey tool was developed and placed in the medical record of every person attending the SSHC in one month in 1997 and again in 1999. The staff survey was an 11-item likert scale questionnaire administered to all centre staff. Data were analysed and average visit and waiting times were generated. RESULTS When comparing 1997 with 1999 data, the main results of note were that the length of consultation had been stable or decreased, the average wait time had remained stable or decreased and the wait time in the medical and nursing unbooked clinic had decreased. The average wait time for the unbooked clinic had decreased from approximately 24 minutes in 1997 to approximately 12 minutes in 1999. CONCLUSIONS Since the introduction of Nurse Triage, the average overall waiting times for those who attend without an appointment has halved and the wait to see a doctor and a nurse has decreased. The majority of staff felt that the triage process had improved patient flow.

Text message reminders do not improve hepatitis B vaccination rates in an Australian sexual health setting

OBJECTIVE To evaluate the impact of text message reminders (short messaging service (SMS)) on hepatitis B virus (HBV) vaccination completion among high risk sexual health center attendees. MATERIALS AND METHODS In September 2008, Sydney Sexual Health Centre implemented an SMS reminder system. The authors assessed the impact of the reminder system on HBV vaccination rates among patients who initiated a course. The authors used a chi-square test and multivariate logistic regression to determine if SMS reminders were associated with second and third dose vaccine completion, compared with patients prior to the intervention. RESULTS Of patients sent SMS reminders in 2009 (SMS group), 54% (130/241) received 2 doses and 24% (58/241) received 3 doses, compared to 56% (258/463) (P = 0.65) and 30% (141/463) (P = 0.07) in the pre-SMS group (2007), respectively. Findings did not change after adjusting for baseline characteristics significantly different between study groups. There were no significant differences in completion rates among people who injected drugs, HIV-negative gay and bisexual men (GBM), and HIV-positive GBM. Among sex workers, travelers, and people who reported sex overseas, second and third dose completion rates were significantly lower in the SMS group compared to the pre-SMS group. In the SMS group, 18% of those who only had one dose attended the clinic within 1-18 months and 30% of those who had 2 doses attended in 6-18 months, but vaccination was missed. DISCUSSION SMS reminders did not increase second or third vaccine dose completion in this population. CONCLUSION Clinician prompts to reduce missed opportunities and multiple recall interventions may be needed to increase HBV vaccination completion in this high risk population.

Fast-track services for all? The preferences of Chinese-, Korean-, and Thai-speaking women attending a sexual health service.

Background Sydney Sexual Health Centre (SSHC) Xpress clinic has significantly reduced the length of stay and waiting time for clients at SSHC but is currently only available to clients who can read and understand a high level of English. This reduces access for culturally and linguistically diverse (CALD) clients. This study sought to determine the acceptability of 4 proposed components of an express clinic model among CALD clients: computer-assisted self-interview (CASI), self-collection of swabs/urine specimens, not having a physical examination, and consultation with a health promotion officer rather than with a clinician. Differences in acceptability based on language group, new or return client status, sex worker status, clinic visited status, and age were analyzed. Methods A cross-sectional, anonymous questionnaire was offered to all female Chinese, Thai, and Korean clients attending SSHC between March and November 2012. Multivariate regression and Pearson &khgr;2 statistical analyses were conducted using STATA 12 software. Results A total of 366 questionnaires were returned from 149 Thai, 145 Chinese, and 72 Korean participants. After multivariate analysis, the only predictor of willingness to use an express model of service provision was language group: overall, 67% Thai (odds ratio, 3.74: confidence interval [CI], 2.03–6.89; P < 0.01) and 64% Korean (odds ratio, 3.58; CI, 1.77–7.25, P < 0.01) said that they would use it compared with 35% Chinese. Age, history of sex work, new or returning clients, and general or language clinic attendance did not impact on choices. Within the preference for individual components of the model, more Thai women were happy with using a health promotion officer (43.2%) than Chinese (14.1%) or Korean (8.5%) (P < 0.001); no groups were happy with forfeiting a physical examination; Thai (48.6%) and Korean (40.9%) were happier with self-swabbing than Chinese women (23.9%, P < 0.001); and more Thai were happy to use a CASI (44.2%) than Chinese (12%) or Korean (11.1%; P < 0.001). Conclusions This research shows that the components of an express model used at SSHC are not favorable to our CALD client base. Despite a CALD express clinic having the potential to reduce waiting times, most clients did not favor reduced waiting time over being physically examined or using a CASI.

Australian sexual health nurses: variations in practice.

Objectives: The study aimed to describe the scope of practice of Australian Sexual Health Nurses in order to inform development of nationally consistent role functions. Method: Descriptive cross sectional survey of 201 sexual health nurses utilising an anonymous self-administered questionnaire with reply paid envelope which was sent to members of the Australian Sexual Health Nurses Association along with a letter which encouraged them to ask non member sexual health nurses to also complete a questionnaire. Major findings: Despite the fact that most Australian Sexual Health Nurses are employed in sexual health centres and family planning clinics, this study showed the scope of their practice to be extremely varied both in and between states/territories. Conclusion: The scope of practice of Australian sexual health nurses is varied. While questions remain as to the reasons for difference, the authors argue that the specialty needs to work toward a national model for basic sexual health nursing care. It is recommended that this model be based on knowledge of and rationales for variations in practice.

Clients’ preferred methods of obtaining sexually transmissable infection or HIV results from Sydney Sexual Health Centre

Given the documented benefits of using text messaging (short message service; SMS), the internet and email to deliver sexually transmissible infection (STI) test results, including high acceptability among clients, Sydney Sexual Health Centre (SSHC) aimed to identify which methods our clients preferred for receiving their results, using a cross-sectional survey. There was a preference for SMS (32%) for negative STI results, and for SMS (27%), phone call (27%) and in-person (26%) for negative HIV results. An in-person preference was shown for receiving positive STI results (40%) and positive HIV results (56%, P<0.001). While many clients would prefer to receive STI test results via text messages or phone call, many also still prefer a return visit, with this preference is dependent on the type and nature of the results. Our study suggests that, ideally, several options for obtaining results should be available.