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BASHH 2009 Asymptomatic Screening Audit in UK GUM Clinics

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Presentation on theme: "BASHH 2009 Asymptomatic Screening Audit in UK GUM Clinics"— Presentation transcript:

1 BASHH 2009 Asymptomatic Screening Audit in UK GUM Clinics
~ Case Notes Audit ~

2 BASHH 2009 Asymptomatic Screening Audit
Audit methods Results (selected) Limitations Conclusions Recommendations for practice change

3 Recommendations audited against
BASHH Clinical Effectiveness Group: Sexually Transmitted Infections: UK National Screening and Testing Guidelines August 2006* *http://www.bashh.org/guidelines

4 Asymptomatic case definition
No symptoms offered on presentation (either on a triage form, or similar form, or on direct questioning by a healthcare worker) New or re-book

5 Methods First 30 consecutive patients January to March 2009
Questionnaire designed by NAG, available at: Electronically data submission using Feedback Server software and downloaded for analysis using Microsoft Access and Excel. Data collated and aggregated by Clinics: regional aggregates Regions: national aggregate

6 Results …

7 Main messages HIV, syphilis, chlamydia – good testing performance against BASHH first line recommended tests Gonorrhoea: good testing performance only when culture plus NAATs included Throat and rectal gonorrhoea screening common practice for MSM Especially when sexual history documented

8 Contribution of cases, N= 4428
4428 cases from 157 clinics (~60% of all GU Medicine clinics) Regional contribution: 2-17%

9 Gender & sexual preference, N= 4428
Men: 2297 (52%, 43–59%) Heterosexual: 2078 (47%, 37–56%) MSM: 219 (5%, 2–8%) Women: 2131 (48%, 41–57%)

10 Results: specific infection screening in asymptomatic groups
HIV & syphilis screening …

11 HIV screening in asymptomatic groups
“All patients attending the GUM clinic should be offered an HIV test, according to the National Strategy for Sexual Health and HIV ” Testing uptake standard 60% Group Done n (%, regional range) MSM n= 219 207 (94%, %) Heterosexual men n=2078 1731 (83%, 70-96%) Women n=2131 1716 (81%, 66-98%)

12 HIV testing in women (n=2131)

13 HIV testing in MSM (n=219)

14 Syphilis screening* in asymptomatic groups
“Screening is recommended for all asymptomatic patients attending a UK GU clinic” Group Done n (%, regional range) MSM n= 219 212 (97%, %) Heterosexual men n=2078 1755 (84%, 70-96%) Women n=2131 1735 (81%, 69-98%) *Any test for syphilis: EIA, TPPA, VDRL/RPR,TPHA

15 Chlamydia screening …

16 Done n (%, regional range)
Chlamydial screening Group CEG Test of choice Done n (%, regional range) MSM n= 219 Urine NAAT or urethral NAAT 210 (96%, %) Het men n=2078 1991 (96%, %) Women n=2131 Cx NAAT, VV NAAT, or urine NAAT 1987 (93%, %) Urethral NAAT: het men 347 (17%, 0-69%), MSM 37 (17%, 0-60%), women 120 (7%, 0-32%) Women n=2131 Urine NAAT 233 (11%, 0-37%) VV NAAT 347 (16%, 0-40%)

17 Gonorrhoea screening …

18 Done n (%, regional range)
MSM, n= 219 CEG test of choice: culture for invasive sampling Tests for gonorrhoea Done n (%, regional range) Urethral culture only 119 (54%, 9-100%) Urethral culture or urine NAAT* 207 (94%, %) * Recommended if urethral specimen not available

19 Done n (%, regional range)
Heterosexual men, n=2078 CEG test of choice: culture for invasive sampling Tests for gonorrhoea Done n (%, regional range) Urethral culture only 1194 (58%, 2-98%) Urethral culture or urine NAAT* 1926 (93%, %) * Recommended if urethral specimen not available

20 Done n (%, regional range)
Women, n=2131 CEG test of choice: culture for invasive sampling Tests Done n (%, regional range) Cx culture 1393 (65%, 26-94%) + Cx NAAT, VV NAAT 1770 (83%, 53-99%) + Urine NAAT, urth NAAT, urth cult 1981 (93%, %)

21 Throat and rectal screening for gonorrhoea by culture

22 Asymptomatic MSM: rectal and throat gonorrhoea culture, n= 219
Site of test for gonorrhoea CEG Recommends Done n (%, regional range) Rectum 100%, if indicated by sexual history 153 (70%) Receptive anal sex documented n=141 119 (84%, %) Receptive anal sex not documented n= 78 34 (44%, 0-100%) Throat 175 (80%) Receptive oral sex documented n=156 134 (86%, %) Receptive oral sex not documented n= 63 41 (65%, 0-100%)

23 NAATs for gonorrhoea screening
Group Urine Done n (%, regional range) Urethra Cervical Rectal Throat Het men n=2078 751 (36%, 0-100%) 84 (4%, 0-16%) - MSM n=219 98 (45%, 0-100%) 37 (17%, 0-60%) 33 (15%, 0-44%) 20 9%, 0-30%) Women n=2131 209 (10%, 0-36%) (2%, 0-13%) 250 (12%, 0-44%) 5 (0.2%,0- 1.1%) (0.2%, 0-2.3%)

24 Urine NAATs for Gc in MSM

25 Conclusions and recommendations

26 Limitations- not known:
Patient, clinician or systems preferences influencing choice of Invasive/non-invasive sampling NAATs/culture Positive NAATs for gonorrhoea Culture confirmation Repeat testing with different NAAT target to avoid false positives

27 Main messages HIV, syphilis, chlamydia – good testing performance against BASHH first line recommended tests Gonorrhoea: good testing performance only when NAATs included Urine GC NAATs: often used, including 45% MSM Throat and rectal gonorrhoea screening common practice for MSM Especially when sexual history documented

28 Suggested Areas for Practice Improvement/Interventions- 1
Increased documentation of discussion about oral and anal sex Recommended in the BASHH Guideline on sexual history taking Identifies anatomical sites for sampling

29 Suggested Areas for Practice Improvement/Interventions- 2
Culture needed in every clinic? Regional strategies? … … balance NAATs with culture testing for gonorrhoea to monitor antibiotic sensitivity (Gonococcal Resistance to Antimicrobials Surveillance Programme)

30 Detailed data and PowerPoint presentation on: www. bashh
Detailed data and PowerPoint presentation on: Late 2010: DH-funded audit of BASHH STI Management Standards … the end

31 ACKNOWLEDGEMENTS The work done by all NHS staff who submitted data and supported the Audit is gratefully acknowledged. The work done by those running the pre-pilot and pilot phases is gratefully acknowledged. The work done by the Regional Chairs and staff in NHS Trusts/Clinics is gratefully acknowledged. Membership of National Audit Group, October 2008: Chris Carne (Chair), David Daniels (Vice-Chair), Hugo McClean (Hon Sec), Anatole Menon-Johansson (Director of Development), Raymond Maw (N.Ireland and BCCG chair), Ed Wilkins/Alison Rodger (BHIVA Representative), TC Harry (Anglia), Gail Crowe (Essex), Ravindra Gokhale (Merseyside), Ann Sullivan (N Thames), Eva Jungmann (N Thames), Sarup Tayal (Northern), Ashish Sukthankar (North-West), Adil Isaac (Oxford), Steve Baguley (Scotland), Arnold Fernandes (South-West), Cindy Sethi (SE Thames), Steven Estreich (SW Thames), Jyoti Dhar (Trent), Helen Bailey (Wales), Sarah McAndrew (Wales), Reena Mani (Wessex), Kaveh Manavi (West Midlands), Amy Tobin-Mammen (Yorkshire), Paul Bunting (Co-opted Member), Irene Vaughan (Co-opted Member), Mike Walzman (Co-opted Member),Nicola Low (Co-opted Member). The advice and support of Hilary Curtis in designing the on-line questionnaires and in collecting, processing and tabulating the audit data into a national aggregate and regional aggregates is gratefully acknowledged.


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