DEVELOPMENT OF A SEXUALLY TRANSMITTED INFECTION ONLINE COURSE FOR PRACTICE NURSES Carolyn Murray Manager, GP sexual Health Services Project NSW STI Programs Unit

Background NSW Department of Health STI Strategy (2006 -2009) Support the capacity of General Practice in the management of STIs Improve access to information, training and resources Strengthen links between general practice and the public sexual health clinics In 2006 , NSW Department of health released the NSW STI Strategy, providing a state based framework for sexual health programs focussing on preventing and managing sexually Transmissible infections (STIs) A key role assigned to NSW STI Programs Unit was to strengthen the capacity of general practice to manage STIs within the primary care setting. Improve access to information, training and resources and strengthen links between general practice and the public sexual health clinics. This has led to a range of resources being developed including the development of a specific STI course and partnerships which I will refere to later. 2

Why STIs ? Chlamydia by year and age group Source: National Notifiable Diseases Surveillance System, courtesy NCHECR Annual surveillance report Chlamydia was the most frequently reported infection notified in Australia in 2007, with 51 867 newly diagnosed cases which is evidence by this graph we see a large increase in diagnoses from the year 200 - 2007 , mainly in the 15 -29 yr old age group. In NSW in the same period, Chlamydia has increased from three and a half thousand notifications in 2000 up to twelve and a half thousand in 2007. The rate of Chlamydia testing has increased over time and is likely to be partly responsible for the ongoing in crease in numbers of cases. However the key in working with general practice is to increase the detection of asymptomatic and undiagnosed infections. Sexually transmissible infections other than HIV Chlamydia was the most frequently reported infection notified in Australia in 2007, with 51 867 newly diagnosed cases. Among males, the population rate of reported diagnoses per 100 000 population more than doubled, from 46.7 in 1998 to 101.5 in 2002 and almost doubled again to 199.0 in 2007. Among females, the rate of chlamydia diagnoses doubled from 74.8 in 1998 to 146.3 in 2002, and then doubled again to 293.0 in 2007 (Figure 15). Increasing rates of diagnosis of chlamydia were reported in all States and Territories and were greatest in the 20 – 29 and 15 – 19 year age groups, which accounted for almost 80% of the annual number (Figure 16). From 2003 to 2007, the female to male sex ratio in the 15 – 19 year age group was 3.4:1 whereas in the 20 – 29 year age group it was 1.4:1. The rate of testing for chlamydial infection has increased over time and is likely to be partly responsible for the ongoing increase in numbers of cases. Age and sex specific patterns of diagnosis may also be influenced by differential testing rates.

Why General Practice ? Main provider of Sexual health* Access to the key priority populations *Grulich A et al, Sexually transmissible diseases and blood borne virus history in a representative sample of adults, Aust NZ J Public Health 2003;27(2):234-241 A study by Grulich et al found that General Practice is the main provider of sexual health primary care in NSW with 55% of Australians diagnosed with an STI or blood borne virus received treatment from general practice compared to 8% who received treatment from a publicly funded sexual health clinic. General Practice have access to the priority populations targeted for STIs including heterosexuals with recent partner change, young people (in the 16-25 yr old age group.) Grulich A et al, Sexually transmissible diseases and blood borne virus history in a representative sample of adults, Aust NZ J Public Health 2003;27(2):234-241   4

Why Practice Nurses ? Key skills and play a key role Trusted by patients Good listening skills Non judgemental Relate to patient on their level Maybe told personal information that the patient didn’t want to tell the GP Practice nurses self identified a range of skills that they already have that support their role in managing STIs and the barriers this may bring about these include Trusted by patients Good listening skills Non judgemental Relate to patient on their level May be told personal information that the patient didn’t want to tell the GP

Course One day workshop Risk Assessment and sexual history taking Blood Borne Viruses Post Exposure Prophylaxis Sexually Transmissible Infections Chlamydia and Contact Tracing The pilot course ran as a 5 day workshop. A prerequisite for the course was to be currently working as a practice nurse and to complete a small amount of pre reading. The sessions included Risk Assessment and sexual history taking Blood Borne Viruses Post Exposure Prophylaxis Sexually Transmissible Infections Chlamydia and Contact Tracing

Aim To increase skills in: sexual history taking testing for uncomplicated STI contact tracing

Course Objectives Explain where to locate information on local STI epidemiology Describe the tests and/or clinical signs used to diagnose the most commons STIs and BBVs Provide examples where a Practice nurse may be involved in the primary care of a patient with HCV or HIV List the 7 steps to testing and managing Chlamydia Define the purpose and 2 methods of contact tracing Explain where to locate information on local STI epidemiology Describe the tests and/or clinical signs used to diagnose the most commons STIs and BBVs Provide examples where a Practice nurse may be involved in the primary care of a patient with HCV or HIV List the 7 steps to testing and managing Chlamydia Define the purpose and 2 methods of contact tracing

Pilots We ran 2 pilots one in Orange and one in Wagga Wagga Orange – 7 practice nurses Wagga Wagga – 9 practice nurses Both pilot courses were supported by their local divisions of general practice, which assisted in getting PN to the course, venue and catering. The courses were designed based on Sexual Health nurse training courses already available and tailored to the needs of practice nurses. 9

Evaluation Pre questionnaire Post questionnaire (3 months) 3 months post course questionnaire For evaluation we conducted PRE and POST questionnaires to gauge the level of knowledge as well as measuring if the Practice Nurses had increased the amount of Chlamydia testing in their practice since completing the course. Provided ongoing support via NSW Sexual Health Information line ( 1800 451 624) Describe the tests and/or clinical signs used to diagnose the most commons STIs and BBVs Provide examples where a Practice nurse may be involved in the primary care of a patient with HCV or HIV List the 7 steps to testing and managing Chlamydia Define the purpose and 2 methods of contact tracing

What did we learn ? Nurses already have a range of skills that support testing for STIs’ Good rapport with patients, non judgemental , trust, access and the ability to explain things to patients in everyday language Role plays provide practise in ways to “say it” and “introduce” STIs into a consultation. An online module would increase the access to course to more practice nurses After the two pilots the working group analyse the course content and structure against the online development criteria. Based on the practice nurse feedback and evaluations some of the information was removed. Eg: The majority of the HBV vaccination information was removed based on the fact that PN need to be accredited to give these immunisations and the up to date information is in the National Immunisation Schedule. Nurses already have a range of skills that support testing for STIs’ Good rapport with patients, non judgemental , trust, access and the ability to explain things to patients in everyday language The role plays providing ways to “say it” and “introduce” STIs into a consultation. were valuable in beginning to practise raising the issue with patients

Where to from here? APNA – Learning seat online development Available July 2009 We have engaged APNA to develop an online Sexual transmitted infections and BBV course. The course should be available in early July 2009

Until the course arrives there is a range of resources available form ASHM and NSW STIPU websites or from stand 23 www.ashm.org.au

www.stipu.nsw.gov.au

NEW online course Blood Borne Viruses & STIs for Practice Nurses STAND 23 NEW online course Blood Borne Viruses & STIs for Practice Nurses The course is aimed at Practice Nurses providing clinical services in primary care to patients who have, or are at risk of, BBVs & STIs. It outlines the public health aspects and clinical management of BBVs & STIs and it advocates a proactive approach to health care and evidence based practice. This course will provide an overview of the epidemiology, testing principles, pathogenesis, natural history and treatment of HIV, hepatitis B and C and common Sexually Transmissible Infections. This online course is FREE for NSW participants and available to other states and territories for a nominal fee COMING SOON @ the APNA website

Acknowledgements Liz Meadley –GPNSW Hiba Jebeile –ASHM Cherie Bennett –ASHM Donna Tilley- SSHC Belinda Caldwell – APNA Practice Nurses and GP Divisions -Orange and Wagga Wagga