1. Senior Health Adviser, 56 Dean Street
Express Sexual Health: maintaining quality of care for new HIV diagnoses alongside new technology
SSHA Conference 2014
Elizabeth Kershaw
Senior Health Adviser, 56 Dean Street

2. 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

3. Dean Street Express
New walk in clinic for asymptomatic sexual health screening
Latest technology to process samples and deliver swift results within 6 hours
Touch screen check in and sexual history
Onsite GeneXpert Infinity machine for self taken gonorrhoea and chlamydia samples, processed in 90 minutes
Serology collected by courier every hour
Results texted to patients within 6 hours

5. 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

6. Attendances Feb – Sept. 2014 Male 76% 78% - new patients 13% 33%
56 Dean Street
Dean Street Express
Male
76%
78%
- new patients
13%
33%
Female
24%
22%
29%
57%

7. 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
Surge in patients after 12 noon Monday to a peak on Wednesday, reducing again until Saturday

8. Preliminary results
Results in 3.5 hours
Treatment in 47.9 hours

9. Preliminary patient details
72% of men attending are MSM
94% of women attending are heterosexuals

10. 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

11. 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

12. HIV results
Clinic
Jan
Feb.
Mar.
Apr.
May
June
July
Aug.
Sept
YTD
56 DS 34 15 40 18 20 23 27 26
203
DSE -  11 28 19 22
152
Total 30 63 29 54 51 46 48
355

13. 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

14. Patient ethnicity in new HIV diagnoses

15. Age range in new HIV diagnoses

16. Gender of new HIV diagnoses

17. 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

18. 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

19. Challenges Managing the flow of patients Language diversity
Patient expectations from express screen
Clinic environment

20. Thanks to the 56 Dean St Health Advisers
Daniel Dennehy
Jen Fearnley
Chris McCormack
Gaynor Lawrenson