Transcript Document

National Audit of Sexual
Healthcare for People with
HIV Infection
National Audit Group
British Association for Sexual Health & HIV
National Audit Group
Case notes audit
Final results
05 March 2007
National Audit Group
Participation 17 of 17 UK Regions*; 122 Trusts; 126
GUMed clinics; 9 Infectious Diseases
clinics
Number of
3210 (regional range 1-21%) – see chart
cases
3 London Regions 1175 (37%)
Age
<20 years: 20 (0.6%, 0-3%)
20-29 years: 352 (11%, 6-19%)
30-45 years: 2013 (63%, 50-72%)
>45 years: 825 (26%, 20-39%, )
*Note: South East & South West Thames is “South Thames”
Essex data included in “North Thames”.
Infectious Diseases Clinics aggregated as “Infectious Diseases”
National Audit Group
No
rth
So Th
ut am
h
e
Th s =
W
6
a
es
t M me 65
id s =
la
5
In
nd 10
fe
s
ct
=
io
us Tre 339
n
D
ise t =
2
No ase 05
rth s =
20
W
e
Yo
st 4
=
rk
sh 17
ire 9
An =1
7
M
er glia 2
se
ys =16
id
9
e
=
O
So xfo 129
rd
ut
h
=1
W
es 23
t
W
es =11
s
9
Sc ex
=
ot
la 119
nd
=1
W
al 05
No No es
rth
rth =74
er
er
n
n
I re
=
la 68
nd
=3
0
Number of cases (N=3210)
% Cases
25
20
15
10
5
0
National Audit Group
National Audit Group
or
th
er
n
Ir
M
er el a
n
se
ys d =
30
i
S c de
ot =1
2
la
nd 9
=1
W
0
N
or ale 5
th
s
W =7
es 4
An t = 1
So
7
g
ut lia 9
h
=
W 16
In
es 9
fe
ct
t=
N
io
o
us
rth 11
Di
er 9
n
se
as =6
es 8
W
W
es es =20
t M se
4
x
So i d
=
ut lan 119
d
h
Th s =
am 33
Y o es 9
N
or rksh =51
th
0
i
Th re =
am 17
es 2
Tr =66
en
5
t
O
xf =20
or
d 5
=1
23
N
% Cases
100
Gender (N=3210)
80
Not specified 5 (0.2%, range 0-2.9%)
% Male
% Female
60
40
20
0
Overall Male = 2020 (63%, range 51-80%);
Female = 1185 (37%, range 20-49%);
Pregnant women: 66 (5.6%, range 0-17%)
National Audit Group
Risk factors for HIV infection
MSM
Hetero – high prevalence areas
1263 (39%, range 21-61%)
1234 (38%, range 17-58%)
Hetero
IDU
Not known
Other
Blood
MTC
827 (26%, range 12-45% )
84 (3%, range 0-11% )
56 (2%, range 0-8%)
34 (1%, range 0-4%)
28 (1%, range 0-2%)
7 (0.2%, range 0-1%)
National Audit Group
Ethnic group White: 1716 (54%, 32-90%)
Number of
centres
previously
attended
Black: 1263 (39%, range 7-64%)
Asian/Asian British: 81 (2%, range 0-4%)
Not recorded: 93 (3%, range 0-24%)
Chinese/Other: 31 (1%, range 0-3%)
Mixed: 26 (0.8%, range 0-3.4%)
None: 1862 (58%, range 42-80%)
One: 804 (25%, range 15-38%)
Two: 136 (4%, range 0-12%)
Three: 20 (0.6%, 0-2.9%)
More than three: 4 (0.1%, 0-1.9%)
More than one (precise no. not known): 181
(6%, 0-13%)
Not known/not answered: 203 (6%, 0-17%)
National Audit Group
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 HIVrelated care in the UK during 2005
• NAG Audit: 3 210/47 517  7%
National Audit Group
National Audit Group
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
National Audit Group
In
f
=1
2
es
de
W
al
se
ys
i
9
W
=7
es
4
se
us
x
Di
=1
se
19
as
es
=2
An
04
gl
ia
=1
O
69
xf
o
N
rd
or
=1
th
23
W
es
t=
Yo
17
r
k
N
s
9
hi
or
re
th
=1
Th
72
So
am
ut
e
s
h
=6
Th
N
65
a
m
or
es
th
er
=5
n
W
10
I
r
es
el
a
tM
nd
id
=3
la
0
n
So
ds
ut
=3
h
39
W
es
t=
11
Tr
9
en
t=
N
20
or
5
th
er
Sc
n
=6
ot
la
8
nd
=1
05
ec
tio
M
er
Hepatitis virus testing ( N=3210)
%
% Hepatitis B
% Hepatitis C
% Hepatitis A
100
80
60
40
20
0
Overall: Hep A 59%, range 0-91%; Hep B 98%, range 95-100%;
Hep C 91%, range 79-100%
National Audit Group
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
National Audit Group
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
National Audit Group
Offer of hepatitis B & A vaccination – total cases
minus not appropriate cases
%
% Hep B vaccination
% Hep A vaccination
No
rth
er
n
I re
la
No nd
No rthe
rth rn
W
es
t
So
ut Ang
h
Th lia
am
e
No We s
rth sse
Th x
am
Sc es
ot
la
nd
W
es Wa
t M le
id s
M lan
er
d
se s
So ysi
ut de
h
In
W
fe
es
Y
ct
io ork t
us
sh
i
D
ise re
as
es
Tr
en
O t
xf
or
d
100
90
80
70
60
50
40
30
20
10
0
Overall: Hepatitis B 77%, range 47-96%; Hepatitis A 23%, range 2-64%
National Audit Group
4 week targets
– within* 4 weeks of HIV diagnosis
Seen at this centre only, n=1862 (58%)
Sex history documented %
STIs tests offered %
Safe sex documented %
% Cases
100
80
60
40
20
No
rth
er
n
I re
la
nd
=2
W
2
al
es
=3
Sc
7
ot
la
nd
=4
O
4
xfo
rd
=9
No
9
rth
er
n
=3
T
So
9
r
en
ut
t=
h
Th
11
am
0
es
=3
W
30
es
se
x
=7
5
An
g
lia
No
=7
rth
3
W
e
M
st
er
=9
se
7
No
y
sid
rth
e
Th
a m =90
W
es
es
tM
=3
id
99
lan
ds
Yo
=1
rk
67
sh
i
re
So
In
=1
fe
u
th
ct
06
iou
W
es
sD
t=
ise
63
as
es
=1
11
0
*Before or after HIV diagnosis
National Audit Group
I re
la
nd
=
W
al 22
es
=3
O
xf
or 7
d
So
=9
A
ut
n
9
h
g
Th lia
am =7
3
e
No s =
rth 33
er 0
n
=
Tr
en 39
M
er
t
se =1
1
y
No sid 0
rth e =
90
W
e
No W st =
rth ess 97
Th ex
am =7
Yo es 5
rk
=
sh 39
9
ir
Sc e =
W
10
es
ot
In
6
l
tM a
fe
n
ct
d
id
io
us lan =44
d
D
ise s =
1
a
So se 67
ut s =
h
11
W
es 1
t=
63
No
rth
er
n
STS within* 4 weeks of HIV diagnosis
Seen at this centre only, all risk groups n=1862 (58%)
% Cases
100
90
80
70
60
50
40
30
20
10
0
Overall: 87%, range 60-100%
*Before or after HIV diagnosis
National Audit Group
No
No rthe
rn
rth
=6
M We
8
er
st
se
=1
ys
79
i
d
Yo
e
=
rk
sh 129
In
ire
fe
S
ct
=1
co
io
72
t
us
la
n
D
ise d =
as 105
es
=2
W
04
So
al
es
ut
h
W =74
es
t=
11
Tr
9
en
t
W
No
es =20
5
se
rth
x
Th
=
am 11
es 9
No
An =66
rth
gl
5
ia
er
=1
So n Ir
69
e
ut
la
h
Th nd
am =3
es 0
=5
W
O
xf
es
10
t M ord
=1
id
la
nd 23
s
=3
39
STS in previous year
100
90
80
70
60
50
40
30
20
10
0
- all risk groups N=3210
% Cases
Overall: 54%, range 38-84%
National Audit Group
W
es
t=
17
W
Yo ale 9
s
rk
sh = 7
ire 4
No
=
rth 172
Sc ern
ot
la =68
In
n
fe
ct
W d=
io
us ess 105
e
D
ise x =
as 119
es
=2
T
0
M
r
er ent 4
se
=2
ys
id 05
e
No
An =12
9
rth
gl
i
a
Th
W
=
am 16
es
tM
es 9
No
id
=
rth lan 665
ds
er
n
Ire =33
9
la
nd
O
=3
So xfo
rd 0
ut
So h W =1
23
ut
es
h
Th t =
am 11
es 9
=5
10
No
rth
STS within last 3 months –
% Cases
100
90
80
70
60
50
40
30
20
10
0
all cases, all risk groups
Overall: 31%, range 19-58%
National Audit Group
STS within last 3 months –
MSM compared to other risk groups
% Cases
100
90
80
70
60
50
40
30
20
10
0
W
es
rk t
sh
Sc ire
ot
la
nd
N
W
or
th ales
Th
am
In
fe
W es
ct
io
es
us
s
Di ex
se
as
N es
or
M the
er
r
se n
ys
id
e
W
T
es
t M ren
t
id
l
S o an
ut ds
h
W
es
t
So
An
ut
gl
h
N
Th i a
or
a
th
er me
s
n
Ire
la
n
O d
xf
or
d
All other risk groups
Yo
or
th
N
MSM
Overall: MSM, 43%, range 12-70%; other risk groups, 23%, range 11-50%
National Audit Group
STS within last 3 months –
Resident in an outbreak area compared to not resident in an
outbreak area
%
100
90
80
70
60
50
40
30
20
10
0
tla
t M nd
id
la
nd
N
s
or
th
W
es
t
W
al
So
es
In
ut
fe
ct
h
io
W
us
es
t
D
is
ea
N
or
se
th
Th s
So
am
ut
es
h
Th
N
or
am
th
es
er
n
Ire
la
nd
N
or
th
er
n
An
gl
ia
O
xf
or
d
Tr
e
Yo nt
rk
sh
ire
x
se
Sc
o
W
es
W
es
M
er
se
ys
id
e
Resident in an outbreak area
Not resident in an outbreak area
Overall: Outbreak area, 45%, range 14-100%;
Not an outbreak area, 25%, range 6-62%
National Audit Group
W
es
t
An =11
gl
9
ia
No
O
=
rth xfo 169
rd
er
n
=
Ire 12
3
la
nd
=3
W
0
al
e
No s =
7
rt
M
er her 4
se
n
=6
ys
No
id
8
rth e =
12
W
9
es
t
W
es =17
s
9
Sc ex =
No
o
1
rth tlan 19
d
So Tha =1
0
m
ut
es 5
h
Th
am =66
es 5
Tr =51
0
Yo ent
W
=2
rk
e
s
05
In
hi
st
fe
r
M
e
ct
id
=1
io
l
a
us
nd 72
D
ise s =3
as
3
es 9
=2
04
So
ut
h
6 months target
–
Sexual history documented last 6 months, all cases
% Cases
100
90
80
70
60
50
40
30
20
10
0
Overall: 34%, range 12-53%
National Audit Group
No
A
rth ng
lia
er
=1
n
I re
69
So
la
nd
ut
h
=3
W
0
es
Sc
t=
ot
11
la
nd 9
=1
W
05
M
a
er
l
se es =
y
No sid 74
rth e =
12
W
9
es
t=
17
Tr
9
e
nt
Yo
So rks =20
hi
ut
re 5
h
Th
=
am 172
es
N
No
or =51
0
rth the
r
Th
n
am =6
es 8
=6
O
xf
65
or
d
=1
W We
e
s
st
se 23
In
fe
M
x
ct
=1
i
d
io
us land 19
s
D
=3
ise
3
as
es 9
=2
04
–
Offer of tests for STIs documented last 6 months, all cases
6 months target
% Cases
100
90
80
70
60
50
40
30
20
10
0
Overall: 28%, range 14-47%
National Audit Group
T
No ren
t=
rth
87
W
es
t=
40
W
al
e
No s =
No
14
r
rth the
Th rn =
am
17
es
=
W
An 278
es
gl
tM
ia
id
=
la
nd 44
s
=1
Sc
14
ot
la
nd
=2
O
3
xf
or
Yo
d
=
rk
sh 59
So
ire
=6
So uth
9
W
ut
es
h
Th
t
am =3
es 3
=2
No We
0
rth sse 3
er
x
=
n
I re 3 4
M
In
la
er
fe
nd
se
ct
=
io
us ysid 6
e
D
=
ise
as 15
es
=6
0
Cervical cytology - documented result last 12 months
Denominator = total female cases minus not applicable cases
% Applicable cases
100
90
80
70
60
50
40
30
20
10
0
Overall: 73%, range 43-94%
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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
National Audit Group