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BASHH 2012 UK Re-Audit of Asymptomatic Screening

BASHH 2012 UK Re-Audit of Asymptomatic Screening. Dr Hugo McClean. BASHH 2012 Audit standards. Sexually Transmitted Infections: UK National Screening and Testing Guidelines August 2006 http://www.bashh.org/guidelines Recommended Tests for Asymptomatic Patients

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BASHH 2012 UK Re-Audit of Asymptomatic Screening

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  1. BASHH 2012 UK Re-Audit of Asymptomatic Screening Dr Hugo McClean

  2. BASHH 2012 Audit standards • Sexually Transmitted Infections: UK National Screening and Testing Guidelines August 2006 http://www.bashh.org/guidelines • Recommended Tests for AsymptomaticPatients • This presentation builds upon the recommendations from the 2009 audit

  3. BASHH 2012 Audit- presentation scheme • Standards • Methods • Results • Key messages • Recommendations for improvement

  4. Conclusions 2009 Audit • High overall rates of testing with BASHH CEG first line recommended tests for chlamydia, syphilis and HIV • High overall rates of testing for gonorrhoea in women when NAATs included • Important number of cases having N. gonorrhoeae NAATs, including urine GC NAATs (45% MSM) • Urethral microscopy ~ 20% men • Cervical microscopy ~ 10% • Most MSM tested for HepB (80%) • Predominance of hepatitis C testing in MSM

  5. Suggested Areas for Practice Improvement/Interventions 2009 Audit • Increased documentation of discussion about oral and anal sex, as recommended in the BASHH recommendations on sexual history taking to identify which anatomical sites need to be sampled for infection • Regional strategies should be considered to balance nucleic acid amplification testing for gonorrhoea with culture testing to monitor antibiotic sensitivity • Increased screening for hepatitis B in MSM is needed in some regions. • Increased screening for HIV is needed in some regions, particularly for women

  6. Standards

  7. Asymptomatic heterosexual men * Urethral culture only for gonorrhoea: 1194 (58%, 2-98%) ** Recommended if urethral specimen not available

  8. Asymptomatic MSM * Urethral culture only for gonorrhoea ** Recommended if urethral specimen not available

  9. Asymptomatic women * recommended if urethral specimen not available

  10. Case definition • No symptoms offered on presentation (either on a triage form, or similar form, or on direct questioning by a healthcare worker) • Seen during a first meeting in a new or re-book episode

  11. Data collection- 1 • Audit interval: • Clinic policies: on day of audit • Cases seen 1 October to 31 December 2011 • Data collection • Launched 7 Jan 2012 • Closed 15 April 2012 • Participation: • Level 3 services: BASHH NAG Regional Chairs network • BASHH website, emails, BASHH Newsletter

  12. Data collection- 2 • Data submitted using an online form • Clinic policy data • Case note data: • Up to consecutive 40 cases* *RCP Local Clinical Audit: handbook for physicians: http://old.rcplondon.ac.uk/clinical-standards/ceeu/Documents/Local-clinical-audit-handbook-for-physicians-August-2010.pdf

  13. Results • Case, clinic, regional and national level data • National aggregate composed of regional-level data • Percentage of clinics in each BASHH Region meeting performance levels • Overall national performance

  14. Questions asked • Recording of oral sex: occurrence, non-occurrence, patient declined to answer, documented not asked, no record, not applicable • Receptive anal sex: same as for oral sex • Offer of HIV testing: offered & done, offered & declined, not offered, not applicable • Tests for hepatitis B, or immune or chronic infection or not appliacable • Tests for gonorrhoea

  15. Gender and sexual preference • Total 6669 cases • Women: 3321 (50%) • Men: 3348 (50%) • Het men: 3020 (90%) • MSM: 328 (10%)

  16. Number (%) of clinics participating, by Region

  17. Documentation about oral sex

  18. Documentation about receptive oral sex- women 2009: 45% (8-65%) Percentage of cases having a record made about occurrence or non-occurrence of receptive oral sex

  19. Documentation about receptive oral sex- het men Percentage of cases having a record made about occurrence or non-occurrence of receptive oral sex

  20. Documentation about receptive oral sex- MSM 2009: 81% (50-100%) Percentage of cases having a record made about occurrence or non-occurrence of receptive oral sex

  21. Documentation about anal sex

  22. Documentation about receptive anal sex- women Percentage of cases having a record made about occurrence or non-occurrence of receptive anal sex

  23. Documentation about receptive anal sex- MSM Percentage of cases having a record made about occurrence or non-occurrence of receptive anal sex

  24. Recording of occurrence of anal sex in heterosexual men- national data

  25. HIV testing uptake

  26. HIV testing uptake- eligible MSM Percentage of eligible MSM having an HIV test (‘not applicable’ excluded)

  27. HIV testing uptake- eligible women Percentage of eligible women having an HIV test (‘not applicable’ excluded)

  28. HIV testing uptake- eligible het men Percentage of eligible het men having an HIV test (‘not applicable’ excluded)

  29. Hepatitis B testing uptake

  30. Hepatitis B testing uptake- eligible MSM Percentage of eligible MSM having a test for hepatitis B (‘not applicable,’ ‘immune,’ ‘chronic infection ’ all excluded)

  31. Hepatitis B testing uptake- eligible women Percentage of eligible women having a test for hepatitis B (‘not applicable,’ ‘immune,’ ‘chronic infection ’ all excluded)

  32. Hepatitis B testing uptake- eligible het men Percentage of eligible men having a test for hepatitis B (‘not applicable,’ ‘immune,’ ‘chronic infection ’ all excluded)

  33. Gonorrhoea testing

  34. Gonorrhoea testing- MSM, any test done Percentage of MSM having any test done for gonorrhoea

  35. Gonorrhoea testing- women, any test done Percentage of women having any test done for gonorrhoea

  36. Gonorrhoea testing- het men, any test done 2009: 96% (89-100%) Percentage of het men having any test done for gonorrhoea

  37. Gonorrhoea testing- women, tests done (not oropharyngeal NAAT & culture)

  38. Gonorrhoea testing- women, tests done:oropharyngeal & rectal NAAT & culture

  39. 2009 Audit. Asymptomatic women: oropharyngeal & rectal gonorrhoea culture

  40. Gonorrhoea testing- MSM, tests done (not oropharyngeal NAAT & culture)

  41. Gonorrhoea testing- MSM, tests done:oropharyngeal & rectal NAAT & culture

  42. 2009 Audit. Asymptomatic MSM: oropharyngeal & rectal

  43. Gonorrhoea testing- het men, tests done

  44. Key points

  45. Recommendations for improvement • Review policies for gonorrhoea testing, particularly in women, and re-audit interventions aimed at improving uptake of testing • Consensus on sexual history taking questions, reflected in training • Consensus on anatomical site for NAAT testing, reflected in training

  46. Acknowledgements: BASHH Regional Audit Chairs & Members Chair Hugo McCleanVice Chair Chris CarneHon Sec Ann SullivanDirector of Development Anatole Menon-JohanssonBCCG Representative Phil KellBHIVA Representative Alison Rodger, Ed WilkinsScotland Daniel ClutterbuckWales Helen Baley, Sarah McAndrew, Carys KnapperNorthern Ireland Say QuahAnglia Raouf Moussa Cheshire & Mersey Ravindra Gokhale Essex Gail CroweNorth Thames Ann Sullivan, Alan SmithNorthern Sarup TayalNorth-West Ashish SukthankarOxford Gill WildmanSouth East Thames Cindy SethiSouth-West Zoe WarwickSouth-West Thames Steven EstreichTrent Jyoti DharWessex Neelam Radja, Leela SanmaniWest Midlands Sashi AcharyaYorkshire Amy Tobin-Mammen Co-opted Members David Daniels, Nicola Low, Lindsay Emmett Hilary Curtis for questionnaire design, collection, collation of data, user support and production of regional & national aggregates

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