Outreach Partner Notification 5 years on Linda Lewis Senior Health Adviser Carlton Street Clinic 27 – 29 Carlton Street Blyth Northumberland NE24 2DT

About Northumberland –Over 2,000 square miles –Largest county in England –Diverse population

History December 2003 Commenced at Northumberland –Setting up GUM service working with lead nurse to develop GUM Service –GP Questionnaire re Sexual Health Strategy Identified over 8o% GP Practices were prepared to undertake sexual health screening but only 10% would undertake partner management. –Discussion with local laboratory re feasibility of sending copy reports to HA The beginning

2004 Commencement of Outreach Chlamydia Partner Notification Pathway –Overall aim:- to offer all patients within Northumberland who test positive for Chlamydia the same follow-up care and management as those who attend a GUM service, and therefore reduce the number of untreated infections in the sexually active population. Initially this was outreach only with HA contact via telephone / letter. Referring those who needed further screening etc to nearest GUM. From April 2004 offering HA service for all GUM clinical sessions both at base and outreach clinics

history 2004 –Collaboration with Clinical Governance in developing Leaflets Care pathway –Working with Secondary Care provider identification of link person training –Road shows in the 4 geographical areas Raising awareness of GUM service Raising awareness of STI’s Introducing Chlamydia Care Pathway –Mail shot to all primary and secondary service providers

2004 Lab reports received in accordance to previous provider service April Formal pathway commenced –All hospital reports acted upon –Majority of remaining reports not acted upon Unable to get permission from referrer over 45% of reports were not acted upon

process Positive Chlamydia lab result –Set recall date 1 month 2 weeks if pregnant If no referral contact referrer –Letter (review 1 month) –Telephone (review 2 days) – (review 2 days)

Depending on outcome Contact patient by chosen method –Telephone –letter Discussion to include –Treatment –Compliance –Partners (identifying sexual activity to ensure appropriate rx) –Safer sex –Offer further sti screen

2004 and 2005 lab reports

2004 and 2005 testing sites (male)

2004 and 2005 testing sites (female)

2004 reason for test female 25% re-infection

2005 reason for test 20% possibility of re-infection (10 patients not aware of diagnosis)

2004 Partner Notification Management difficult Lone HA Time constraints Problems contacting referrer Over 10% of patients did not know their diagnosis and of the remaining a further 15% were at risk of re-infection

2007and 2008 lab reports

2007 testing sites

2007 reason for test 4 not actioned

2008 testing sites

2008 reason for test

2007 Index Patient Management Male –GP 29 were initially treated by GP 3 were referred directly to GUM and treated 3 DNR to HA letter 1 attended GUM for retreatment –HMPY 3 were treated by HMPYI (no PN activated) However 13 GP’s DNR (unable to action further) and 2 moved out of area

2007 Index Patient Management Female –78 were not treated by initiating test site 24 WGH gynae 31 WGH antenatal 23 GP Treatment given –32 GP (hospital index patients) –37 GUM 4 index patients DNR and remainder moved

2007 Female PN outcome 3 retreated by GUM 2 retreated by initiating test GP 1 aware of diagnosis but not treated at time of contact 9 not aware of diagnosis

2008 IP female management 9 were not aware of diagnosis 9 were aware but not treated 12 needed retreatment by GUM 17 needed retreatment form GP

2008 IP male management 2 were not aware of diagnosis 1 needed retreatment by GUM

Female Partner management 154 IP gave partner details –2 x 3 –11 x2 –140 x 1 giving total of attended GUM 93 attended GP –4 were informed by HA –3 informed by IP –2 needed retreatment

Male partner management 21 patients identified 25 partners –4 attended GUM –18 attended GP –4 follow up undertaken by other gum –6 follow up undertaken by HMPYI

Thoughts Increasing number of GP screening and treating C4a what about other infections? more proactive screening prior to coil and other procedures Should we as Health Advisers be looking outside the “box” of GUM?