National Audit Group 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 Participation17 of 17 UK Regions*; 122 Trusts; 126 GUMed clinics; 9 Infectious Diseases clinics Number of cases 3210 (regional range 1-21%) – see chart 3 London Regions 1175 (37%) Age<20 years: 20 (0.6%, 0-3%) years: 352 (11%, 6-19%) 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 Number of cases (N=3210)

National Audit Group

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%)

National Audit Group Risk factors for HIV infection MSM1263 (39%, range 21-61%) Hetero – high prevalence areas 1234 (38%, range 17-58%) Hetero827 (26%, range 12-45% ) IDU84 (3%, range 0-11% ) Not known56 (2%, range 0-8%) Other34 (1%, range 0-4%) Blood28 (1%, range 0-2%) MTC7 (0.2%, range 0-1%)

National Audit Group Ethnic group White: 1716 (54%, 32-90%) 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%) Number of centres previously attended 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 HPA Nov 06 A total of individuals (all ages) living with diagnosed HIV accessed HIV- related care in the UK during 2005 NAG Audit: 3 210/  7%

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

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) BHIVA Immunisation Subcommittee. Immunisation Guidelines for HIV-infected Adults

National Audit Group 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%

National Audit Group 4 week targets – within* 4 weeks of HIV diagnosis Seen at this centre only, n=1862 (58%) *Before or after HIV diagnosis

National Audit Group STS within* 4 weeks of HIV diagnosis Seen at this centre only, all risk groups n=1862 (58%) Overall: 87%, range % *Before or after HIV diagnosis

National Audit Group STS in previous year - all risk groups N=3210 Overall: 54%, range 38-84%

National Audit Group STS within last 3 months – all cases, all risk groups Overall: 31%, range 19-58%

National Audit Group STS within last 3 months – MSM compared to other risk groups 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 Overall: Outbreak area, 45%, range %; Not an outbreak area, 25%, range 6-62%

National Audit Group 6 months target – Sexual history documented last 6 months, all cases Overall: 34%, range 12-53%

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

National Audit Group Cervical cytology - documented result last 12 months Denominator = total female cases minus not applicable cases Overall: 73%, range 43-94%

National Audit Group

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