1. 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV Train the Trainers Day [enter SHF area details]

2. Today’s agenda 11.00 – 11.30Introductions & background to 3Cs & HIV programme 11.30 – 12.303Cs intervention 12.30 – 1.00Lunch 1.00 – 2.00HIV intervention 2.00 – 3.00Trainer resource pack & logistics 3.00 – 3.15Break 4.00 – 4.30Monitoring & evaluation design (André Charlett) 4.30 – 5.00Q&A session 2 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

3. What is the 3Cs & HIV programme? National programme to support staff in general practice to deliver basic sexual health services in line with national policy and guidance The 3Cs & HIV programme is specifically designed meet the needs of, and to fit alongside work already being undertaken by, GP teams 3 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

4. The 3Cs & HIV programme is designed as a flexible intervention to support general practices to deliver: A basic sexual health offer (‘3Cs’) during any routine consultation with young adults (15 – 24 year olds): A chlamydia screen Signposting or provision of contraception advice Free condoms HIV testing in adults (≥ 16 years) in line with current clinical guidelines: Awareness of indicator conditions where HIV testing should be considered In high prevalence areas, routine offer of HIV test to all new practice registrants 4 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV What is the 3Cs & HIV programme?

5. Why chlamydia, contraception & condoms (3Cs)? All part of a basic sexual health offer – providing young adults with information and resources to avoid sexually transmitted infection and unplanned pregnancy - It makes sense to offer them together Supports existing practice in primary care – this is nothing new but it is important and it is not consistently offered Takes minimal time – this is all about permission to discuss and signposting 5 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

6. Why HIV testing? HIV in the UK, 2011: 1 - Estimated 96,000 people living with HIV – 24% unaware of their infection - Estimated prevalence of 1.5 per 1,000 – higher among MSM and black Africans - 47% of HIV cases diagnosed late (CD4<350) in 2011 Why focus on reducing late HIV diagnoses? - Public health impact – treatment can prevent onward transmission 2 - indicator within Public Health Outcome Framework - Individual prognosis - early diagnosis can lead to near-normal life expectancy 3 - Cost - expanded HIV testing shown to be cost effective 4-5 and increased costs of a late versus early diagnosis (x2-3 times) which persist longer term 7,8 6 1. HPA HIV in the UK 2012 report; 2. Cohen et al NEJM 2011 3. Nakagawa et al AIDS 2012; 4. Paltiel et al N Engl J Med 2006; 5. Yazadanpanah et al Plos One 2011; 6. MMWR 2006; 7. Krentz et al HIV Med 2008; 8. Beck et al Plos One 2011

7. Drawing on existing experience CIRT (Chlamydia Intervention Randomised Control Trial) Theory of planned behaviour Now working with three European partners funded via Leonardo HIV in primary care DH pilots (Lewisham, Brighton) Interviews with practice staff, young adults, other stakeholder Primary care led advisory group (details next slide) 7 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

8. 3Cs & HIV Advisory Group Dr. Sebastian Kalwij (chair) - GP Dr. Richard Ma – RCGP Jason Warriner – RCN Sexual Health Lead Suzie Clements – RCN, Practice Nurse lead Dr. Farhana Lockhat – GP (Wiltshire) Dr. Jane Wilkinson – GP (Cheshire) Dr. Farah Paruk – GP (Bedfordshire) Vicki Courage – Practice Nurse (Bedfordshire) Dr. Paula Baraister – Medical Advisor to the NCSP Kate Folkard – NCSP Programme Manager 8 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

9. Delivering the programme Trainers with existing skills and experience and a brief to work with GP selected to implement the programme 9 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

10. Practice Recruitment 10 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV All Practices in area offered opportunity to engage via letter/email Trainers recruited Collate list of interested practices and organise workshop dates Yes practice wants workshop “No thank you” response No Reply from practice Trainer follow up by phone to get response Collect practice chlamydia testing and footfall data for young people, to inform workshop Proceed with workshops

11. Materials Developed & Training Package CATTE/ 3Cs intervention presentation HIV intervention presentation Trainer Resource Pack Posters and invitation cards 3Cs & HIV offer demonstration videos 11 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

12. What will the general practices be offered? 3Cs training session HIV training session Posters, invitation cards, start-up supply of condoms Continual support from Trainer between sessions and follow up with third contact/visit Sustainable relationship with sexual health services and information in the local area 12 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

13. Evaluation Trainer-GP feedback forms Details are covered in the Trainer Resource Pack National NCSP monitoring Chlamydia testing activity dataset (CTAD) Practice specific data on: Contraceptive data for 15-24 year olds (this data is already collected in general practices as part of the QOF measurements) HIV testing and diagnosis for > 16 years old Audits GPs wish to undertake around sexual health 13 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

14. Support for Trainers Katy Town – NCSP training lead Katy.town@phe.gov.uk Nina Ockendon – CATTE project training lead Nina.Ockendon@phe.gov.uk Cliodna McNulty - CATTE project lead Further team contact details are on the www.STItraining.eu and NCSP websitewww.STItraining.eu 14 3Cs & HIV Programme Chlamydia, contraception, condoms and HIV

15. 3Cs & HIV Trainer Resource Pack Five sections: 1.Introduction 2.Recruitment 3.Practice information sheets 4.CATTE and HIV training resources 5.Policies & evidence

16. Trainer Resource Pack: 1. Introduction 163Cs & HIV Trainer Resource Pack 1.1 Background 1.2 Trainer implementation steps: Pre-training Training day Post-training 1.3 Website information 1.4 Frequently Asked Questions

17. Trainer Resource Pack: 2. Recruitment 173Cs & HIV Trainer Resource Pack 2.1 General practice recruitment template letter 2.2 General practice recruitment flow chart 2.3 Trainer tips for practice recruitment 2.4 Randomising practices

18. Trainer Resource Pack: 3. Practice information sheets 183Cs & HIV Trainer Resource Pack 3.1 Practice recruitment spreadsheet 3.2 General practice data tables

19. Trainer Resource Pack: 4. CATTE training session resources 4.1 3Cs training resources training day checklist training session registration sheet 3Cs training session evaluation form Post-training email (example) Condom distribution flow chart 19Presentation title - edit in Header and Footer

20. 203Cs & HIV Trainer Resource Pack 4.2 HIV training resources Example HIV scripts Clinical indicators diseases for adult HIV infection Example of patient pathway for HIV testing in primary care Template patient referral form Information for patients about HIV testing Information for patients about a positive HIV test result HIV training session evaluation form Trainer Resource Pack: 4. 3Cs & HIV training session resources

21. Trainer Resource Pack: 5. Policy & evidence 213Cs & HIV Trainer Resource Pack 5.1 Supporting references 5.2 NCSP core requirement quick reference sheets (6 th edition): Chlamydia screening roles and responsibilities Quick reference sheet for providers Quick reference sheet for commissioners 5.3 Recommended approaches to HIV testing in general practice