Uk national audit of chlamydial infection management
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UK National Audit of Chlamydial Infection Management. National Audit Group British Association for Sexual Health & HIV. Case notes audit Interim results. 20 February 2008. Case definition. Any one of the KC60 C4A, C4B, or ISD(D)5 C41A, C41B or C41R and seen in the audit interval

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UK National Audit of Chlamydial Infection Management

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UK National Audit of Chlamydial Infection Management

National Audit Group

British Association for Sexual Health & HIV


Case notes audit

Interim results

20 February 2008


Case definition

  • Any one of the KC60 C4A, C4B, or ISD(D)5 C41A, C41B or C41R and seen in the audit interval

  • GUM clinic or Sexual Reproductive Healthcare clinic

  • Audit interval: 2 January and 31 March 2007 inclusively

  • Sample number: first 30 patients seen in the audit interval (or all cases if less than 30 seen)

  • Data collected: 3 September 2007 to 31 October 2007


Demography


*Note: South East & South West Thames is “South Thames”

Essex data included in “North Thames”


Number of cases (N=5032)


Sample

*Health Protection Scotland: http://www.documents.hps.scot.nhs.uk/ewr/pdf2007/0720.pdf

† Health Protection Agency. Personal Communication


Reasons for testingMore than 1 reason possible


Presenting features: female cases (n=2474)


Presenting features: male cases (n=2546)


Test method - NAATs

Overall, 4679 (93%, regional range 100-69%) cases had NAAT testing documented from at least one of urinary, cervical, vulvovaginal, urethral or rectal sampling


Other chlamydial tests


Chlamydial tests in women

  • 2093 (85%) women had cervical or vaginal NAATs

  • of the remaining 381 not having cervical or vaginal NAATs

    • 134 (35%) had urine NAATs (of whom 52 (39%) had a genital examination performed)

    • 18 (5%) had urethral NAATS

    • 229 (60%) had no cervical, vulvovaginal, urinary or urethral NAATS


Chlamydial tests in men

  • 1723 (68%) men had urinary NAATS

  • Of the remaining 823 not having urinary NAATs

  • 699 (85%) had urethral tests

  • 124 (15%) had neither urinary nor urethral tests


Other tests for STIs: Syphilis


Other tests for STIs: HIV


Treatment: uncomplicated infxn.


Treatment: pregnant women

  • Twenty of 26 pregnant women were treated with azithromycin

  • ?suggests that most prescribers treating pregnant women consider that erythromycin is not an “adequate alternative” to azithromycin (the manufacturer’s advice stated by the British National Formulary

British National Formulary. [http://www.bnf.org/bnf/bnf/current/126828.htm]. (Accessed 09 February 2008)


Information-giving


Follow-up: modes of FU


Follow-up: time to FU


Partner notification


CEG standard for contact tracing

  • Auditable Outcome Measures

    • Partner notification recommendation: In 2004, a systematic review of UK GUM clinics’ work showed that a mean of 0.43 contacts per case of chlamydia were screened in large city clinics and 0.64 contacts per case of chlamydia were screened in other clinics

http://www.bashh.org/guidelines/2006/chlamydia_0706.pdf


Note: please look at the corresponding question in the Case notes questionnaire for this table


Conclusions: 1

  • Largest national audit to date (more clinics)

    • 187 (71%) of the 262 UK GUMed clinics plus 6 SRH clinics

  • Ethnic group not always recorded 8% (0-32%)

  • 83% aged 19 years or over

  • Relatively few MSM overall (3% all cases)

  • About ½ cases no symptoms

  • 1/3 attending for routine or asymptomatic screens,

    • ?implications for service provision/workloadreduction


Conclusions: 2

  • Main test used are NAATs

  • Main testing sites in women are cervical or vulval

  • 73% MSM tested for HIV, range 58-100%

  • Main treatment is azithromycin (54% cases), but a lot of doxycycline is also used (37% cases)

  • Most pregnant women treated with azithromycin

  • Lack of written information provided (only 50% cases overall)

  • More follow-up done by ‘phone or texting than in clinic

  • 25% cases no FU


Conclusions: 3

  • >90% of cases having PN had this provided by a HA or other suitably trained HCP

  • PN outcomes not documented for 25% cases provided with PN advice

  • 40% cases not documented as having treatment verified for contact(s), with wide range 0-51%

  • The national estimate of average number of contacts screened per index was 0.45, with regional performances between 0.29 to 0.73


… the end


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