national audit group national audit of sexual healthcare for people with hiv infection national...
TRANSCRIPT
National Audit Group
National Audit of Sexual Healthcare for
People with HIV Infection
National Audit GroupBritish Association for Sexual Health & HIV
National Audit Group
Case notes audit
Final results05 March
2007
National Audit Group
Participation
17 of 17 UK Regions*; 122 Trusts; 126 GUMed clinics; 9 Infectious Diseases clinics
Number of cases
3210 (regional range 1-21%) – see chart3 London Regions 1175 (37%)
Age <20 years: 20 (0.6%, 0-3%) 20-29 years: 352 (11%, 6-19%)30-45 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)
0
5
10
15
20
25
North T
ham
es =
665
South
Tha
mes
=51
0
Wes
t Midl
ands
=339
Trent
=20
5
Infe
ctio
us D
iseas
es =
204
North W
est =1
79
Yorks
hire
=17
2
Anglia
=16
9
Mer
seys
ide =
129
Oxfo
rd =
123
South
Wes
t =11
9
Wes
sex
=119
Scotla
nd =
105
Wale
s =74
Norther
n =68
Norther
n Ire
land
=30
% Cases
National Audit Group
National Audit Group
0
20
40
60
80
100
North
ern
Irela
nd =
30
Mer
seys
ide
=129
Scotla
nd =
105
Wal
es =
74
North
Wes
t =17
9
Anglia
=16
9
South
Wes
t =11
9
North
ern
=68
Infe
ctiou
s Dise
ases
=20
4
Wes
sex =
119
Wes
t Mid
lands
=33
9
South
Tha
mes
=51
0
Yorks
hire
=172
North
Tha
mes
=66
5
Trent
=20
5
Oxfor
d =12
3
% Cases
% Male % Female
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
MSM 1263 (39%, range 21-61%)
Hetero – high prevalence areas
1234 (38%, range 17-58%)
Hetero 827 (26%, range 12-45% )
IDU 84 (3%, range 0-11% )
Not known 56 (2%, range 0-8%)
Other 34 (1%, range 0-4%)
Blood 28 (1%, range 0-2%)
MTC 7 (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. 2006 HPA Nov 06
• A total of 47 517 individuals (all ages) living with diagnosed HIV accessed HIV-related care in the UK during 2005
• NAG Audit: 3 210/47 517 7%
National Audit Group
National Audit Group
Hepatitis virus testing•All HIV+ patients should be screened for HBV markers2004 BHIVA Guidelines: HIV and Chronic Hepatitis: Co-infection
with HIV and Hepatitis B Virus infection
•All HIV+ patients should be HCV tested2004 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 95-100%;
Hep C 91%, range 79-100%
0
20
40
60
80
100
Mer
seys
ide
=129
Wal
es =
74
Wes
sex =
119
Infe
ctiou
s Dise
ases
=20
4
Anglia
=16
9
Oxfor
d =12
3
North
Wes
t =17
9
Yorks
hire
=172
North
Tha
mes
=66
5
South
Tha
mes
=51
0
North
ern
Irela
nd =
30
Wes
t Mid
lands
=33
9
South
Wes
t =11
9
Trent
=20
5
North
ern
=68
Scotla
nd =
105
%% Hepatitis B % Hepatitis C % Hepatitis A
National Audit Group
Hepatitis B vaccination•All HBV non-immune patients at continuing risk
should be vaccinated2004 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 vaccinated2005 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).
2006 BHIVA Immunisation Subcommittee. Immunisation Guidelines for HIV-infected Adults
National Audit Group
0
10
20
30
40
50
60
70
80
90
100
Norther
n Ire
land
Norther
n
North W
est
Anglia
South
Tha
mes
Wes
sex
North T
ham
es
Scotla
nd
Wale
s
Wes
t Midl
ands
Mer
seys
ide
South
Wes
t
Yorks
hire
Infe
ctio
us D
iseas
es
Trent
Oxfo
rd
% Hep B vaccination % Hep A vaccination
%
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
0
20
40
60
80
100% Cases
Sex history documented % STIs tests offered % Safe sex documented %
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
0102030405060708090
100
Norther
n Ire
land
=22
Wale
s =37
Oxfo
rd =
99
Anglia
=73
South
Tha
mes
=33
0
Norther
n =39
Trent
=11
0
Mer
seys
ide =
90
North W
est =9
7
Wes
sex
=75
North T
ham
es =
399
Yorks
hire
=10
6
Scotla
nd =
44
Wes
t Midl
ands
=167
Infe
ctio
us D
iseas
es =
111
South
Wes
t =63
% Cases
STS within* 4 weeks of HIV diagnosis Seen at this centre only, all risk groups
n=1862 (58%)
Overall: 87%, range 60-100%
*Before or after HIV diagnosis
National Audit Group
0102030405060708090
100
Norther
n =68
North W
est =1
79
Mer
seys
ide =
129
Yorks
hire
=17
2
Scotla
nd =
105
Infe
ctio
us D
iseas
es =
204
Wale
s =74
South
Wes
t =11
9
Trent
=20
5
Wes
sex
=119
North T
ham
es =
665
Anglia
=16
9
Norther
n Ire
land
=30
South
Tha
mes
=51
0
Oxfo
rd =
123
Wes
t Midl
ands
=339
% Cases
STS in previous year - all risk groups N=3210
Overall: 54%, range 38-84%
National Audit Group
0102030405060708090
100
North W
est =1
79
Wale
s =74
Yorks
hire
=17
2
Norther
n =68
Scotla
nd =
105
Wes
sex
=119
Infe
ctio
us D
iseas
es =
204
Trent
=20
5
Mer
seys
ide =
129
Anglia
=16
9
North T
ham
es =
665
Wes
t Midl
ands
=339
Norther
n Ire
land
=30
Oxfo
rd =
123
South
Wes
t =11
9
South
Tha
mes
=51
0
% Cases
STS within last 3 months – all cases, all risk groups
Overall: 31%, range 19-58%
National Audit Group
0102030405060708090
100
North
Wes
t
Yorks
hire
Scotla
nd
Wal
es
North
Tha
mes
Wes
sex
Infe
ctiou
s Dise
ases
North
ern
Mer
seys
ide
Trent
Wes
t Mid
lands
South
Wes
t
Anglia
South
Tha
mes
North
ern
Irela
nd
Oxfor
d
MSM All other risk groups
% Cases
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 14-100%;
Not an outbreak area, 25%, range 6-62%
0
10
2030
40
50
60
7080
90
100
Mer
seys
ide
Wes
sex
Scotla
nd
Wes
t Mid
lands
North
Wes
t
Wale
s
South
Wes
t
Infec
tious
Dise
ases
North
Tham
es
South
Tha
mes
Northe
rn Ir
eland
Northe
rn
Anglia
Oxford
Trent
Yorks
hire
Resident in an outbreak areaNot resident in an outbreak area
%
National Audit Group
0102030405060708090
100
South
Wes
t =11
9
Anglia
=16
9
Oxfo
rd =
123
Norther
n Ire
land
=30
Wale
s =74
Norther
n =68
Mer
seys
ide =
129
North W
est =1
79
Wes
sex
=119
Scotla
nd =
105
North T
ham
es =
665
South
Tha
mes
=51
0
Trent
=20
5
Yorks
hire
=17
2
Wes
t Midl
ands
=339
Infe
ctio
us D
iseas
es =
204
% Cases
6 months target – Sexual history documented last 6 months, all
cases
Overall: 34%, range 12-53%
National Audit Group
0102030405060708090
100
Anglia
=16
9
Norther
n Ire
land
=30
South
Wes
t =11
9
Scotla
nd =
105
Wale
s =74
Mer
seys
ide =
129
North W
est =1
79
Trent
=20
5
Yorks
hire
=17
2
South
Tha
mes
=51
0
Norther
n =68
North T
ham
es =
665
Oxfo
rd =
123
Wes
sex
=119
Wes
t Midl
ands
=339
Infe
ctio
us D
iseas
es =
204
% Cases
6 months target – Offer of tests for STIs documented last 6 months, all
cases
Overall: 28%, range 14-47%
National Audit Group
0102030405060708090
100
Trent
=87
North W
est =4
0
Wale
s =14
Norther
n =17
North T
ham
es =
278
Anglia
=44
Wes
t Midl
ands
=114
Scotla
nd =
23
Oxfo
rd =
59
Yorks
hire
=69
South
Wes
t =33
South
Tha
mes
=20
3
Wes
sex
=34
Norther
n Ire
land
=6
Mer
seys
ide =
15
Infe
ctio
us D
iseas
es =
60
% Applicable cases
Cervical cytology - documented result last 12
months Denominator = total female cases minus not applicable cases
Overall: 73%, range 43-94%
National Audit Group
National Audit Group
National Audit Group
National Audit Group
National Audit Group
National Audit Group
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