Sexual Health Update Community Pharmacy Sheffield Amy Buddery, Health Improvement Principal Public Health, Sheffield City Council amy.buddery@sheffield.gov.uk

Questions What does good sexual health look like? What role does/can Community Pharmacy have in improving sexual health? What barriers exist? 2/3 actions to take away

Sexual Health & Community Pharmacy A Framework for Sexual Health Improvement DH (2013) NPA – Healthy Living Pharmacies: taking a pro active approach to health & health improvement Important component of a well functioning sexual health system that support access, promotes choice and address inequalities

Contribution to Improving Sexual Health Support access and rapid access to specialist services Provide information and supports prevention Earlier diagnosis of STIs and access to treatment Protecting and safeguarding young people Providing support to those most at risk Supports wider determinants of sexual health Forms part of care pathways

Public Health Outcome Indicators Reduce the number of teenage conceptions (females aged 15-17 per 1,000) (23.6 per 1,000) Reduce the rate of late diagnosis of HIV (58%) Increase the chlamydia detection rate (people age 15-24 per 100,000) (1583 against a target of 2300)

Facts and Figures -STIs Overall 3838 new sexually transmitted infections (STIs) were diagnosed in residents of Sheffield, a rate of 680.8 per 100,000 residents (compared to 767.6 per 100,000 in England). In Sheffield, an estimated 6.1% of women and 8.1% of men presenting with a new STI at a specialist SHC during the 5 year period from 2010 to 2015 were re-infected with a new STI within 12 months. Sheffield has the 55th highest rate (out of 326 local authorities in England) for gonorrhoea, which is a marker of high levels of risky sexual activity. The rate of gonorrhoea diagnoses per 100,000 in this local authority was 64.2 (compared to 70.7 per 100,000 in England).

Facts and Figures There were 20 new late HIV diagnoses in Sheffield. The diagnosed HIV prevalence was 1.8 per 1,000 population aged 15-59 years (compared to 2.26 per 1,000 in England). In Sheffield, between 2013 and 2015, 57.5% (95% confidence interval [CI] 45.4-69.0) of HIV diagnoses were made at a late stage of infection (CD4 count <350 cells/mm³ within 3 months of diagnosis) compared to 40.3% (95% CI 39.5-41.1) in England. 58% of diagnoses of new STIs in Sheffield were in young people aged 15-24 years (compared to 45% in England).

Proportion of new STIs by age group and gender in Sheffield: 2015

Reproductive Health 2015 - 55% of 18-24 year olds prescribed user dependant oral contraceptives rather than long acting reversible methods 2015 – 1500 women in Sheffield were prescribed emergency hormonal contraception 13.4% - higher than the national average of 10%

Access to Emergency Hormonal Contraception (EHC) Community Pharmacy Scheme ≤ age 17 via PGD PGD for EHC in place at both University GP Practices Available at GP Practices Available at Sexual Health Service

EHC - levonorgestrel (Levonelle) PGD in place ≤ age 17 – looking to expand upper age limit to 24 years Self declaration of competence Under review –following Faculty of Sexual and Reproductive Health Guidance (March 2017) on use for patients with a BMI over 26 Being discussed at Formulary Sub Group and APG (21st Sept) Look out for amendments

EHC – ulipristal (EllaOne) PGD ≤ age 17 currently suspended due to changes to reclassification from a POM to a Pmed looking to expand upper age limit to 24 years Local guidance being drafted to include agreed use of Levonelle following APG mtg 21st Sept Look out for changes

Condoms & Chlamydia Increased availability of self testing kits for chlamydia/gonorrhoea order from Sexual Health Sheffield Service Condoms for EHC and NEX Pharmacies contact lorraine.gosnell@sheffield.gov.uk

Future Development of Provision Level 1 – condoms, EHC, self testing kits Level 2 – initiation and on going supply of oral contraceptives, injectable contraceptives, HIV testing Introduction of Pharmoutcomes

Questions What does good sexual health look like? What role does/can Community Pharmacy have in improving sexual health? What barriers exist? 2/3 actions to take away