Victorian HIV Service STI Project How simple is to ordering a blood test?? Brian Price Business and Community Services Man...
Outpatient Clinic <ul><li>Funded through BBV Program DHS for 2 year STI testing project.  To implement STI testing in Outp...
Barriers and Challenges general STI testing <ul><li>Technology & Data Systems </li></ul><ul><li>No system to automate rout...
Barriers and Challenges general STI testing <ul><li>Technology & Data Systems </li></ul><ul><li>Systems to automate blood ...
Data 29% 420 Unknown 28% 417 Not targeted for screening (seeing Psychiatry, D&A, Oncology, Female, heterosexual male) 0.5%...
Syphilis Screening 39 (9.9%) 393 (48.8%) 805 Jan – June 2009 58 (10.1%) 575 (61.0%) 943 2008-2009 54 (9.2%) 590 (63.2%) 93...
Gonorrhoea Screening 5 5 189 (29%) 235  805 Jan – June 2009 9 10 283 (30%) 433  943 2008-2009 2 2 239 442  933 2007-2008 7...
Chlamydia Screening 18 (8.7%) 23 (5.8%) 208 (26%) 399 805 Jan – June 2009 25 (8.1%) 31 (4.4%) 310 (33%) 697 943 2008-2009 ...
Summary <ul><li>Effectively 6 months of screening has occurred </li></ul><ul><li>Starting to see an increase in people scr...
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Victorian HIV Service STI Project

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Victorian HIV Service STI Project: How simple is to ordering a blood test? Presentation given by Brian Price at the AFAO National Syphilis Forum, 23 October 2009.

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  • Hospitals are providing HIV care to patients and need to be implementing syphilis screening. There are many barriers to this. Systems and technology and size of services
  • Victorian HIV Service STI Project

    1. 1. Victorian HIV Service STI Project How simple is to ordering a blood test?? Brian Price Business and Community Services Manager & Prof Jenny Hoy Head HIV Service
    2. 2. Outpatient Clinic <ul><li>Funded through BBV Program DHS for 2 year STI testing project. To implement STI testing in Outpatient setting. </li></ul><ul><li>350 HIV attendances per month; 4100 in 08/09 </li></ul><ul><li>805 individuals have > 1 CD4 and viral load </li></ul><ul><li>Not all MSM or reporting being sexually active </li></ul><ul><li>Some patients attend for primary care some have shared care with a S100 GP. </li></ul><ul><li>Model: Nursing led initial and annual assessment and offering sexual health screening </li></ul>
    3. 3. Barriers and Challenges general STI testing <ul><li>Technology & Data Systems </li></ul><ul><li>No system to automate routing blood tests such as medical director </li></ul><ul><li>Data system to be able to assess compliance/denominator. Upgraded HIV specific database which now allows flagging and recently implemented STI alert (other Melb based hospitals don’t have this). No funding to do this. </li></ul><ul><li>Patient Specific </li></ul><ul><li>Patients decline testing </li></ul><ul><li>Patients time </li></ul><ul><li>Screen at GP (what does it actually mean in relation to full STI screen) </li></ul><ul><li>Self identification of risks. A number of HIV positive MSM attending our clinic would not identify as MSM and thus not identify a requirement for screening. </li></ul><ul><li>Staff specific </li></ul><ul><li>Time available. There is not the capacity for the nurse to screen everyone </li></ul><ul><li>Physical space to undertake screening </li></ul><ul><li>Doctors use of the HIV database is variable ie they may not use the electronic alert system for screening. </li></ul><ul><li>Other patient health priorities may often get in the way of undertaking a STI screen </li></ul><ul><li>Implementation of the model of care </li></ul>
    4. 4. Barriers and Challenges general STI testing <ul><li>Technology & Data Systems </li></ul><ul><li>Systems to automate blood test requests (with opt out)  </li></ul><ul><li>Data systems to flag testing and screening requirements  </li></ul><ul><li>Patient Specific </li></ul><ul><li>Consent  </li></ul><ul><li>Understanding in share care; who is doing what, and what tests have been done  </li></ul><ul><li>Self identification of risks.  </li></ul><ul><li>Staff specific </li></ul><ul><li>Doctors use of data systems where not integrated into medical notes.  </li></ul><ul><li>Other patient health priorities may often get in the way of undertaking a STI screen  </li></ul>IMPACT ON SYPHILLIS TESTING If we want screening then we need space, resources and time
    5. 5. Data 29% 420 Unknown 28% 417 Not targeted for screening (seeing Psychiatry, D&A, Oncology, Female, heterosexual male) 0.5% 8 Patient declines 42% 634 Risk assessed/screened (267) Recently screened (337) GP Screens (30) 100% 1479 (805people) Number of attendances at HIV Outpatient Clinics (Jan – July) Percentage Number
    6. 6. Syphilis Screening 39 (9.9%) 393 (48.8%) 805 Jan – June 2009 58 (10.1%) 575 (61.0%) 943 2008-2009 54 (9.2%) 590 (63.2%) 933 2007-2008 41 (9.3%) 441 (50.5%) 874 2006-2007 Patients with a new diagnosis Number of Patients tested Alfred ongoing care Pts Financial Year
    7. 7. Gonorrhoea Screening 5 5 189 (29%) 235 805 Jan – June 2009 9 10 283 (30%) 433 943 2008-2009 2 2 239 442 933 2007-2008 7 7 205 471 874 2006-2007 No. Patients with a new diagnosis Diagnosis Number of Patients tested Gonorrhoea Tests Alfred ongoing care Pts Financial Year
    8. 8. Chlamydia Screening 18 (8.7%) 23 (5.8%) 208 (26%) 399 805 Jan – June 2009 25 (8.1%) 31 (4.4%) 310 (33%) 697 943 2008-2009 17 (6.9%) 20 (3.9%) 246 511 933 2007-2008 10 (4.9%) 12 (2.2%) 204 531 874 2006-2007 Patients with a new diagnosis New Diagnosis Number of Patients tested Chlamydia Tests Alfred ongoing care Pts Financial Year
    9. 9. Summary <ul><li>Effectively 6 months of screening has occurred </li></ul><ul><li>Starting to see an increase in people screened. </li></ul><ul><li>Database will provide a better indication of frequency of testing recommended for individuals. </li></ul>  Stable Screens Positive Results STI  Double results of Gono 8-9% (9.8% of rectal swabs) Chlamydia  Low numbers Gonorrhoea  Alfred dx approx 30% cases seen amongst PLWHA in Vic Syphilis Screens
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