Transcript SSHA Conference 2014 - Society of Sexual Health Advisers

Express Sexual Health:
maintaining quality of care for new
HIV diagnoses alongside new
technology
SSHA Conference 2014
Elizabeth Kershaw
Senior Health Adviser, 56 Dean Street
56 Dean Street
• One of three sexual health clinics run by
Chelsea and Westminster NHS Foundation
Trust, based in Soho
• Full range of staff and sexual health services
Dean Street Express
• New walk in clinic for asymptomatic sexual health
screening
• Latest technology to process samples and deliver
swift results within 6 hours
Patient attendances Feb. – Sept.
Month
Feb.
Mar.
Apr.
May
June
Jul.
Aug.
Sept.
(20th)
56 Dean
St
3948
4259
4039
4358
4419
4792
4129
2980
Dean
Street
Express
2966
4171
4120
4764
4899
5795
5974
4085
Total
6914 8430
8159
9122
9318
10587 10103 7065
Attendances Feb – Sept. 2014
Male
- new patients
Female
- new patients
56 Dean Street
Dean Street Express
76%
78%
13%
24%
29%
33%
22%
57%
Patient flow at DSE
•
•
•
•
Up to 330 patients in a 12 hour day
Up to 220 patients on a Saturday 6 hour day
Infinity test cycle 90 minutes
Infinity machine capacity 620 samples per day
Preliminary results
10
8
6
Dean St Express
4
56 Dean St
2
56 Dean St
0
Dean St Express
from test to
results
From test to
treatment
Preliminary patient details
• 72% of men attending are MSM
• 94% of women attending are heterosexuals
Role of health adviser at DSE
• DSE a largely automated service, incl. results
management
• Each patient sees staff member for serology
• Risk assessment questions as standard
• HAs available to provide advice and support to
staff and for patient referrals
• HAs manage new HIV diagnoses in the clinic
and through recall after serology
Managing an HIV reactive result at DSE
•
•
•
•
HIV INSTI POCT reactive at DSE
Determine test set running by nurse/HCA
Health Adviser on call via 56DS
HA attends to confirm results, discuss with
patient, take first HIV bloods and provide
support and information
HIV results
Clinic
Jan
Feb.
Mar.
Apr.
May
June
July
Aug.
Sept
YTD
56 DS
34
15
40
18
20
23
27
26
203
DSE
-
15
23
11
34
28
19
22
152
Total
34
30
63
29
54
51
46
48
355
Follow up
• All patients see health adviser at diagnosis
and are offered an HA appointment one week
post diagnosis
• All patients offered first medical appointment
at 56 DS, usually available within 2/52 post
result
Patient ethnicity in new HIV diagnoses
140
120
100
80
60
40
20
0
56 Dean St
Dean St Express
Age range in new HIV diagnoses
80
70
60
50
56 Dean Street
40
Dean St Express
30
20
10
0
<20
21-29
30-39
40-49
>50
Gender of new HIV diagnoses
165
200
147
150
female
100
male
50
4
0
male
5
female
56 Dean Street
DSE
Risks and testing history
• 9% of newly diagnoses were testing for the
first time
• 23% reported >10 sexual contacts in last 3/12
• 68% reported UPAI within last 3/12
• 32% reported drug use within last 3/12
Partners
• Where partners subsequently tested, 33%
tested positive
• In cases where there had been unprotected
sex in the last 72 hours, 75% of partners
started on PEP
Challenges
•
•
•
•
Managing the flow of patients
Language diversity
Patient expectations from express screen
Clinic environment
Thanks to the 56 Dean St Health
Advisers
•
•
•
•
Daniel Dennehy
Jen Fearnley
Chris McCormack
Gaynor Lawrenson