3Cs & HIV programme

Report
1
3Cs & HIV Programme
Chlamydia, Contraception, Condoms & HIV
A programme to support basic sexual health provision in general practice
3Cs & HIV programme
Supporting sexual health provision in general practice
• The 3Cs & HIV programme is designed to support general practices deliver:
– A basic sexual health offer (‘3Cs’) during any routine consultation with
young adults (15 – 24 year olds):
• A chlamydia screen
• Signposting or provision of contraception advice
• Free condoms
– HIV testing in adults (≥ 16 years) in line with current clinical guidelines:
• Awareness of indicator conditions where HIV testing should be considered
• In high prevalence areas, routine offer of HIV test to all new practice
registrants
• The 3Cs & HIV programme is specifically designed meet the needs of, and to fit
alongside work already being undertaken by, GP teams.
General practice
An important role in sexual health promotion
• At least 60% of young adults visit their GP every year - and want the option of
accessing sexual health services1,2
• Most people become sexually active between 16-19 years old:3,4,5
– Sexual activity can be opportunistic, unplanned and linked with alcohol
and drugs
– STI rates and under 18 conceptions are indicators of ongoing health
inequality
– 70% of young adults who have had a chlamydia test are more likely to test
again in future, and 68% are more likely to recommend testing to friends
• The 3Cs & HIV programme will help young adults access sexual health advice
and services to avoid negative health outcomes that may impact their future
life chances
1.Salisbury et al. British Journal of General Practice. 2006; 56:99-103; 2. Hogan et al. BMC. Public Health 2010, 10:616; 3. DH. Improving Access to Sexual Health
Services for Young People.2007 ; 4. DfES. Teenage Pregnancy Next Steps. 2006; 5. HPA Web Survey of Young Adults (2012)
3Cs & HIV programme
Why include HIV testing?
HIV in the UK, 2011:1
• Estimated 96,000 people living with HIV – 24% (22,600) are unaware of their
infection
• Estimated prevalence of 1.5 per 1,000 population – higher among MSM and
black Africans
• 47% of HIV cases diagnosed late (CD4<350) in 2011
Why focus on reducing late HIV diagnoses?
• Public health impact – treatment can prevent onward transmission2 - indicator
within Public Health Outcome Framework
• Individual prognosis - early diagnosis can lead to near-normal life expectancy3
• Cost - expanded HIV testing shown to be cost effective4-5 and increased costs
of a late versus early diagnosis (x2-3 times) which persist longer term7,8
1. HPA HIV in the UK 2012 report; 2. Cohen et al NEJM 2011 3. Nakagawa et al AIDS 2012; 4. Paltiel et al N Engl J Med 2006; 5. Yazadanpanah et al Plos
One 2011; 6. MMWR 2006; 7. Krentz et al HIV Med 2008; 8. Beck et al Plos One 2011
HIV testing: an opportunity in general practice
• 76% of people diagnosed with HIV had been seen in health
services in previous year – of which, 76% in general practice1
• Department of Health pilot projects investigated expanded
HIV testing in general medical services:2
– Feasible
– Cost-effective
– Acceptable to patients
1.
2.
Burns et al AIDS 2008
HPA Time to Test for HIV Report 2011
3Cs &HIV programme
Anticipated results
• The 3Cs & HIV programme adapts an intervention trialled by the HPA to
increase chlamydia testing in general practice
• In this randomised controlled trial, surgeries that fully engaged with the
intervention significantly improved screening rates and chlamydia detection1
• These results provide a realistic measure of the take up and efficacy of the 3Cs
& HIV intervention if commissioned in General Practice
• The 3Cs & HIV programme is designed to strengthen sexual health work
already funded and underway in your area, and support delivery of Public
Health Outcomes Framework indicators
1.McNulty C. In press
3Cs & HIV programme
Outline of delivery
The 3Cs & HIV programme is designed to fit into current general practice
activity, and support surgeries engage young adults in an evidence-based
sexual health intervention
The NCSP will offer 1,500 surgeries across England the opportunity to
participate in 2013/14:
• Local areas sign up to participate and identify a local 3Cs & HIV trainer
• NCSP ‘train the trainers’ and provide all 3Cs & HIV programme materials
• 3Cs trainers engage local practices in participating
• Local 3Cs & HIV practices deliver offer to young adults on ongoing basis
• 3Cs & HIV practice data collected and evaluated across 2013/14
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An evidence-based programme
Employing the Theory of Planned Behaviour
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The Theory of Planned Behaviour
Personal
Attitudes
Subjective
Norms
Perceived
Barriers
Intention
to Screen
Behaviour:
sexual health
offer for all
young adults
External Barriers
Chlamydia screen offer forgotten,
surgery premises’ barriers etc.
Theory of Planned Behaviour: supporting general practice
engage young adults in chlamydia screening
IDENTIFIED BARRIERS
INTERVENTION SOLUTION
“Low numbers of young adults
visit my practice”
Show surgery annual footfall for 15-24 yr olds
“Young adults don’t want to
talk about sexual health”
Discuss the evidence base showing young adults’
preference for sexual health services via their GP
Subjective
Norms
“My colleagues do not offer
sexual health care to young
adults”
Normalise the sexual health offer through:
• Appointing a sexual health champion per surgery
• Surgery posters promoting the initiative
• Invite cards given to young adults at Reception
Perceived
Barriers
“I lack knowledge about STIs,
HIV and pregnancy rates”
Practice staff offered training sessions and provided
with information resources
Personal
Attitudes
“I lack experience / confidence
engaging young adults in
sexual health matters”
Training videos show the offer being delivered
External barriers
Forgetting to make the offer
during a routine consultation
Risk that practice momentum
declines over time
Practice environment not
conducive to making the offer
The use of computer pop ups &
templates encouraged
GP practice receives three
contacts, including at least one
visit
GP practice receives regular
newsletter and information on the
practice’s results
Intervention can be tailored to suit
each surgery’s set up
South West of England Trial Results1
• Analysed 76 intervention and 81 control surgeries. Of the 76 surgeries offered
the intervention:
– 47 (63%) fully engaged (received three contacts with support worker)
– 16 (21%) partially engaged (received one or two contacts)
– 13 (17%) did not engage (refused all contacts)
• During the trial period:
– 2,907 vs. 2,379 screens in intervention and control surgeries, respectively
– 76% screening increase in intervention surgeries vs. controls (p<0.001)
– 40% increase in infections detected per surgery population (p=0.04)
• ‘Fully engaged’ intervention surgeries:
– Increased screening rates 2.33 times vs. controls (p<0.001)
– Increased chlamydia detection by 76% (p=0.005)
– Increased screening significantly for at least 9 months following the intervention
1.McNulty C. In press
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South West of England Trial Results1
Support
ends
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Start of
intervention
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3
4
Increase in screening
is sustained nine
months after support
ended in intervention
practices
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Impact sustained
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Intervention period
time
Control practices
Intervention practices
Non-selected NCSP practices in study area
Chlamydia screening rate per 100 15-24 year olds in study surgeries
January 2009 to January 2012, by month
1.McNulty C. In press
Once trained, 3Cs &
HIV surgeries can use
programme to
strengthen their
sexual health offer on
long-term basis
South West of England Trial:
Qualitative Results
• Feedback from qualitative interviews:
– Intervention was detailed and thorough
– Easy access to the support available
– Chlamydia support team went to the surgery to implement the intervention
– Chlamydia support team stayed in contact over a year
– Reward and recognition
“I think probably coming and actually explaining what it was and
giving us the support and phone support after and coming back
to the practice and checking how we were doing was helpful”
Practice Nurse
3Cs & HIV programme development:
Preliminary GP interviews
“I think doing all ‘three Cs’ would
be reasonable”
“We should be giving sexual
health advice alongside the
chlamydia testing, otherwise
we’re just testing not educating”
“It’s a population that needs a bit
of lateral thinking on how to
engage them”
“I think GU services and
contraception go hand in hand”
“It’s a good idea to make the link
between chlamydia, condoms
and contraception. It makes
sense to look at prevention at the
same time as cure”
“Really, I think it’s vital that
chlamydia testing is offered with
these other things as well”
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3Cs & HIV programme delivery
3Cs & HIV programme: Local area participation
• NCSP currently inviting expressions of interest from areas
• To participate, areas must identify someone currently working in sexual
health to become their 3Cs & HIV trainer
• The 3Cs & HIV trainer will deliver the programme locally: engaging local
practices, providing ongoing support and evaluating achievements
• The time required by 3Cs & HIV trainers will vary per area, depending on the
number of practices engaged, but estimated at 0.5 WTE if 30 practices
3Cs & HIV programme: NCSP role
The NCSP will provide the following to support local delivery of
the 3Cs & HIV programme:
•
•
•
•
•
•
‘Train the 3Cs & HIV trainer’ course
Two follow up contacts with each 3Cs & HIV trainer
3Cs & HIV resource pack for practices
Free condoms
Performance data, per practice
Project coordination and monitoring
3Cs & HIV programme:
Support and resources for practices
The programme is designed by GPs to fit general practice – and can
be tailored to each practice, building on their current skills and
services.
Each practice receives:
• An interactive training session
• Ongoing supportive follow up from their area trainer
• 3Cs & HIV practice resources to promote the programme
• 3Cs & HIV website – further information and resources
3Cs & HIV data collection
• The NCSP will evaluate the impact of the 3Cs & HIV programme
• Using local systems to collect data by practice on:
– Chlamydia testing and diagnoses
– Contraceptive prescribing data for 15-24 year olds
– HIV testing
– Registration / use of C-card and local condom programmes
• Aim: data available ~6 months after the end of each quarter
Timeline
• Jan – May 2013: expressions of interest & participant selection
• May – Jun 2013: NCSP training of 3Cs local area trainers
• End of May – Jul 2013: 3Cs & HIV trainers recruiting GP surgeries
• Jul 2013 onwards: 3Cs & HIV programme delivery roll out
What next?
• If you are interested in participating, please discuss with your NCSP sexual
health facilitator:
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–
–
–
–
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–
–
London
South East & Central
East of England
West Midlands
North West
Yorkshire, Humber & North East
East Midlands
South West
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
• We look forward to working with you.
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3Cs & HIV Programme
Chlamydia, Contraception, Condoms & HIV

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