Express Sexual Health: maintaining quality of care for new

HIV diagnoses alongside new technology

SSHA Conference 2014Elizabeth Kershaw

Senior Health Adviser, 56 Dean Street

56 Dean Street

• One of three sexual health clinics run by Chelsea and Westminster NHS Foundation Trust, based in Soho

• Full range of staff and sexual health services

Dean Street Express

• New walk in clinic for asymptomatic sexual health screening

• Latest technology to process samples and deliver swift results within 6 hours

Patient attendances Feb. – Sept.

Month Feb. Mar. Apr. May June Jul. Aug. Sept. (20th)

56 Dean St

3948 4259 4039 4358 4419 4792 4129 2980

Dean Street Express

2966 4171 4120 4764 4899 5795 5974 4085

Total 6914 8430 8159 9122 9318 10587 10103 7065

Attendances Feb – Sept. 201456 Dean Street Dean Street Express

Male 76% 78%

- new patients 13% 33%

Female 24% 22%

- new patients 29% 57%

Patient flow at DSE

• Up to 330 patients in a 12 hour day• Up to 220 patients on a Saturday 6 hour day• Infinity test cycle 90 minutes• Infinity machine capacity 620 samples per day

Preliminary results

from test to results From test to

treatment

0123456789

10

Dean St Express

56 Dean St

Dean St Express56 Dean St

Preliminary patient details

• 72% of men attending are MSM• 94% of women attending are heterosexuals

Role of health adviser at DSE

• DSE a largely automated service, incl. results management

• Each patient sees staff member for serology • Risk assessment questions as standard• HAs available to provide advice and support to

staff and for patient referrals• HAs manage new HIV diagnoses in the clinic

and through recall after serology

Managing an HIV reactive result at DSE

• HIV INSTI POCT reactive at DSE• Determine test set running by nurse/HCA• Health Adviser on call via 56DS• HA attends to confirm results, discuss with

patient, take first HIV bloods and provide support and information

HIV resultsClinic

Jan Feb. Mar. Apr. May June July Aug. Sept YTD

56 DS

34 15 40 18 20 23 27 26

203

DSE

- 15 23 11 34 28 19 22

152

Total 34 30 63 29 54 51 46 48

355

Follow up

• All patients see health adviser at diagnosis and are offered an HA appointment one week post diagnosis

• All patients offered first medical appointment at 56 DS, usually available within 2/52 post result

Patient ethnicity in new HIV diagnoses

White

British

White

other

White

total

Indian/P

akist

ani

Chinese

Africa

n

Caribbean

not stat

ed0

20

40

60

80

100

120

140

56 Dean StDean St Express

Age range in new HIV diagnoses

<20 21-29 30-39 40-49 >500

10

20

30

40

50

60

70

80

56 Dean StreetDean St Express

Gender of new HIV diagnoses

56 Dean StreetDSE

020406080

100120140160180

female

male45

165

147

femalemale

Risks and testing history

• 9% of newly diagnoses were testing for the first time

• 23% reported >10 sexual contacts in last 3/12• 68% reported UPAI within last 3/12• 32% reported drug use within last 3/12

Partners

• Where partners subsequently tested, 33% tested positive

• In cases where there had been unprotected sex in the last 72 hours, 75% of partners started on PEP

Challenges

• Managing the flow of patients• Language diversity• Patient expectations from express screen• Clinic environment

Thanks to the 56 Dean St Health Advisers

• Daniel Dennehy• Jen Fearnley• Chris McCormack• Gaynor Lawrenson