Contraception and Sexual Health Update Dr DEBBIE Wisby November 6th 2015

Background Registered Nurse and Midwife. Sexual Health Nurse / Practice Nurse Worked in academia since 1998. Principal Lecturer Midwifery, Neonatal and Sexual Health / Lead Midwife for Education.

Hot Topics

Learning Outcomes Impact of change on sexual health service modernisation. To update knowledge on contraceptive methods /STI’s. Application to the latest statistics and evidence based guidelines.

Sexual Health Modernisation National Strategy Sexual Health and HIV (DH, 2001). A Framework for Sexual Health Improvement in England (DH, 2013) Public Health Outcomes Framework (DH, 2013) Commissioning and new ways of working. Service and role re-design as part of structural reform.

Public Health Outcome Framework Indicators S&RH Under 18 conceptions (Health Improvement) Chlamydia Diagnoses 15-24 years old (Health Protection) People presenting with HIV at a late stage of infection (Health Protection) Population vaccine coverage – HPV (Health Protection)

Perfect Storm Proposed £200 million cuts to public health budget announced by the Treasury. Large cuts in SRH services. Pressure on services Unacceptable delays Unsustainable pressure on primary care.

Contraceptive Care FSRH: 2015 Contraceptive care has been calculated to be one of the most cost effective healthcare investments. For every £1 spent on SRH care saves £11. Choice and access in contraception is at the heart of women’s health and plays a vital role in avoiding unplanned pregnancy.

State Of Maternity Services Report: RCM: 2015

State Of Maternity Services Report: RCM 2015

Contraceptive Methods FPA: 2015 No User Failure Contraception Injection Implant Intrauterine System (IUS) Intrauterine Device (IUD) Female sterilisation Male Sterilisation User Failure Contraceptive Vaginal Ring Contraceptive Patch Combined Oral Contraceptive Pill (COC) Progestogen-only Pill (POP) Male/Female condom Diaphragm/Cap Natural Family Planning

LARC: NICE (2005) “LARC is defined as contraceptive methods that require administration less than once per cycle per month”. Copper intrauterine devices Progestogen-only intrauterine systems Progestogen-only injectable contraceptives Progestogen-only subdermal implants

NHS Contraceptive Services: 2013/2014 Oral contraceptives – most common form of contraception for 47% women in all age groups. Male condom, 2nd most commonest method -18.2% The use of LARC methods have slowly increased and account for 31% of all women, compared to 18% in 2003/4. Implant most common LARC method – 12.9% of all methods. IU Devices – 9% over 35 years IU Systems – 17.5%

FSRH (CEU) Latest Guidance POP – March 2015 IU Contraception- April 2015, updated June 2015. Fertility Awareness – June 2015 Progestogen Only Injectable Contraception-December 2014, updated June 2015 Problematic Bleeding with hormonal contraception -July 2015. www.fsrh.org/

Sayana Press- Licence for Self Adminstration (FSRH:2015) LARC contraceptive depot injection (99% effective) Available in UK since 2013. Subcutaneous administration Administered every 13 weeks into upper anterior thigh or anterior abdomen. Licence extended to self administration at home.

Sayana Press Training in the technique and women must be supervised by appropriately trained HCP administering first dose. The study sites gave up to 3 injections to take home with a review at one year. Need easy access to HCP if problems arise. Written information given Pfizer offer a text service for reminders when injection is due. Systems in place for the provision and disposal of sharps.

www.sayanaanswers.co.uk

Ella One- Quick Starting FSRH: 2015 New data on quick starting hormonal contraception after use of ellaone (EC). Ulipristral acetate 30mg (UPA) A selective progesterone-receptor modulator. Effectiveness of progesterone-containing contraceptive method that is quick started might be reduced due to competition at the progesterone receptor site.

FSRH Statement September 2015

Abortion Statistics England and Wales: 2014 Total number of abortions was 184,571 0.4% less than in 2013. Abortion rate was highest for women age 22. 98% of abortions were funded by NHS 67% took place in the independent sector under NHS Contract, up from 64% in 2013. 92% carried out under 13 weeks gestation.

Abortion Statistics England and Wales: 2014 Medical abortions accounted for 51% of the total. First year, there has been more medical than surgical procedures. 3,099 abortions (2%) carried out under ground E (risk that child could be born handicapped). 37% of abortions in 2014 were to women who had already had one or more abortions.

STI Statistics

STI’s and Chlamydia Screening in England : 2014 In 2014, 440,000 diagnoses of STI’s made in England. Greatest impact in young heterosexuals under age 25 and MSM. Most common STI was chlamydia (206,774 diagnoses in 2014). Largest proportional increase was reported for syphilis (33%) and gonorrhoea (19%) MSM- 46% increase in syphilis, 32% gonorrhoea. High levels of condomless sex probably account for most of the rise, although better detection of gonorrhoea may have contributed.

HIV Statistics

HIV New Diagnoses, Treatment and Care in the UK: 2015 Report (October) A total of 6,151 people were newly diagnosed with HIV during 2014. 85,489 people seen for HIV care by the end of 2014. 1:6 now aged over 55 MSM- new diagnosis HIV positive - 3,360 in 2014 Decline in HIV diagnoses through heterosexual sex, largely due to a reduction in diagnoses among black African men and women. Major challenge in the UK is timely diagnosis in order to start lifesaving ART and prevent onward transmission of infection. 2 out of 5 in 2014, newly diagnosed with ‘late stage’ HIV. Late diagnosis is associated with a tenfold increased risk of death with one year of diagnosis. In 2014, 613 people with HIV died, most were late diagnosis. Urgent need to increase HIV testing opportunities in line with HIV testing guidelines (2008) http://www.bhiva.org/documents/guidelines/testing/glineshivtest08.pdf

Conclusion

Thank You For Listening

References DH (2001) Better Prevention, Better Services, Better Sexual Health, The National Strategy For Sexual Health & HIV, July 1st. London, HMSO. DH (2013) A Framework For Sexual Health Improvement in England, March, London. DH (2013) Improving outcomes and supporting transparency: Part1A: a public health outcomes framework for England, 2013-2016. DH (2014) Abortion Statistics, England and Wales:2014 www.dh.gov.uk June 2015 Health and Social Care Information Centre (2014) NHS Contraceptive Services, Community Contraceptive Clinics, Statistics for 2013/2014, October 30th 2014.

References FSRH (2015) CEU Statement on Self-Administration of Sayana Press, www.fsrh.org/ September. FSRH (2015) CEU Statement on Quickstarting and ellaone, www.fsrh.org/ September. FSRH (2015) Statements on cuts to Sexual & Reproductive Health Services, www.fsrh.org/ October. RCM (2015) A State of Maternity Services Report, London, RCM. PHE(2015) Health Protection Report,Vol.9, No.22. June 23rd. PHE(2015) HIV New Diagnoses, Treatment and Care in the UK, 2015 Report, October.