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National Audit of Sexual Healthcare for People with HIV Infection

National Audit of Sexual Healthcare for People with HIV Infection. National Audit Group British Association for Sexual Health & HIV. Case notes audit Final results. 05 March 2007. *Note: South East & South West Thames is “South Thames” Essex data included in “North Thames”.

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National Audit of Sexual Healthcare for People with HIV Infection

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  1. National Audit of Sexual Healthcare for People with HIV Infection National Audit Group British Association for Sexual Health & HIV

  2. Case notes audit Final results 05 March 2007

  3. *Note: South East & South West Thames is “South Thames” Essex data included in “North Thames”. Infectious Diseases Clinics aggregated as “Infectious Diseases”

  4. Number of cases (N=3210)

  5. Gender (N=3210) Overall Male = 2020 (63%, range 51-80%); Female = 1185 (37%, range 20-49%); Pregnant women: 66 (5.6%, range 0-17%) Not specified 5 (0.2%, range 0-2.9%)

  6. Risk factors for HIV infection

  7. Sample • A Complex Picture. HIV & other Sexually Transmitted Infections in the United Kingdom. 2006 HPA Nov 06 • A total of 47 517 individuals (all ages) living with diagnosed HIV accessed HIV-related care in the UK during 2005 • NAG Audit: 3 210/47 517  7%

  8. Hepatitis virus testing • All HIV+ patients should be screened for HBV markers • 2004 BHIVA Guidelines: HIV and Chronic Hepatitis: Co-infection with HIV and Hepatitis B Virus infection • All HIV+ patients should be HCV tested • 2004 BHIVA Guidelines: HIV and Chronic Hepatitis: Co-infection with HIV and Hepatitis C Virus infection • No specific recommendation for hepatitis A testing in non-co-infected patients … but see hepatitis A vaccination

  9. Hepatitis virus testing ( N=3210) Overall: Hep A 59%, range 0-91%; Hep B 98%, range 95-100%; Hep C 91%, range 79-100%

  10. Hepatitis B vaccination • All HBV non-immune patients at continuing risk should be vaccinated • 2004 BHIVA Guidelines: HIV and Chronic Hepatitis: Co-infection with HIV and Hepatitis B Virus infection • Post-vaccination HIV positive patients and other immunocomprised patients will still need to be monitored and given boosters when anti-HBs levels fall below 100 iu/l • 2005 CEG United Kingdom Guideline on the management of Viral Hepatitides

  11. Hepatitis A vaccination • Many outbreaks have been reported amongst homosexual men in large cities and therefore clinics in these areas should offer hepatitis A vaccination, particularly when increases rates of infection have been recognised locally • Intravenous drug users should also be vaccinated • 2005 CEG United Kingdom Guideline on the management of Viral Hepatitides • HAV vaccine is recommended for the pre-exposure prophylaxis of HIV-infected travellers to areas of high or intermediate endemicity of hepatitis A. It needs to be given as soon as possible and at least 2 weeks before travel (C, IV). • 2006 BHIVA Immunisation Subcommittee. Immunisation Guidelines for HIV-infected Adults

  12. Offer of hepatitis B & A vaccination – total cases minus not appropriate cases Overall: Hepatitis B 77%, range 47-96%; Hepatitis A 23%, range 2-64%

  13. 4 week targets– within* 4 weeks of HIV diagnosisSeen at this centre only, n=1862 (58%) *Before or after HIV diagnosis

  14. STS within* 4 weeks of HIV diagnosis Seen at this centre only, all risk groups n=1862 (58%) Overall: 87%, range 60-100% *Before or after HIV diagnosis

  15. STS in previous year - all risk groups N=3210 Overall: 54%, range 38-84%

  16. STS within last 3 months – all cases, all risk groups Overall: 31%, range 19-58%

  17. STS within last 3 months – MSM compared to other risk groups Overall: MSM, 43%, range 12-70%; other risk groups, 23%, range 11-50%

  18. STS within last 3 months – Resident in an outbreak area compared to not resident in an outbreak area Overall: Outbreak area, 45%, range 14-100%; Not an outbreak area, 25%, range 6-62%

  19. 6 months target– Sexual history documented last 6 months, all cases Overall: 34%, range 12-53%

  20. 6 months target– Offer of tests for STIs documented last 6 months, all cases Overall: 28%, range 14-47%

  21. Cervical cytology - documented result last 12 monthsDenominator = total female cases minus not applicable cases Overall: 73%, range 43-94%

  22. Conclusions • Variable performance in most areas of practice across Regions • Hepatitis B testing overall and regionally excellent • Interventions are needed to improve: • Hepatitis B vaccination • Testing for hepatitis C • Testing for syphilis and STIs • Aspects of sexual history taking and documentation • Safe sex work and documentation • Cervical cytology • Contraception

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