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Health services and policy oral session 4—Screening
O5-S4.05 Introduction of a sexual health practice nurse increases STI testing among MSM in general practice
  1. M Y Chen1,
  2. A F Snow1,
  3. R Cummings1,
  4. L Owen2,
  5. C El-Hyak3,
  6. M E Hellard3,
  7. L Vodstrcil4,
  8. C K Fairley5,
  9. M Y Chen5
  1. 1Melbourne Sexual Health Centre, Melbourne, Australia
  2. 2Victorian AIDS Council, Gay Mens Health Centre, Australia
  3. 3Burnet Institute, Australia
  4. 4University of Melbourne, Australia
  5. 5Melbourne Sexual Health Centre, University of Melbourne, Australia

Abstract

Introduction Increased screening among MSM could improve STI control in this population; however published data on interventions that improve screening rates is limited. The aim of this study was to determine if introducing a sexual health practice nurse (SHPN) into a general practice clinic could increase HIV and STI testing among MSM who attend.

Methods In October 2008, Melbourne Sexual Health Centre introduced a SHPN into a Melbourne general practice with a high caseload of MSM. We undertook an observational study comparing the proportion and STI tests undertaken in the 9 months before (Period 1), and after the SHPN was introduced (Period 2). Consistent with Australian national STI testing guidelines for MSM, complete testing was defined as HIV and syphilis serology, urine test and anal swab for chlamydia, pharyngeal and rectal swabs for gonorrhoea, from the same man on the same date. MSM were stratified and analysed according to HIV status. The Qui-Square Test for Independence was used to compare the difference in proportions of tests. In the case of syphilis tests among HIV positive MSM the median number of tests was compared using the Mann–Whittney U Test.

Results Among HIV negative MSM, the propotion of MSM tested, increased from Period 1 to Period 2 as follows; HIV from 57.8% to 66.2%; syphilis from 59.9% to 76.6%; urethral chlamydia from 67.7% to 75.8%; pharyngeal gonorrhoea 62.5% to 69.9%; and rectal gonorrhoea/chlamydia from 58.5% to 69.5% (all p<0.001). The proportion of episodes of complete tesing, also increased from 41.1% to 51.9% (p<0.001). Among HIV positive MSM, the proportion of MSM tested, increased from Period 1 to Period 2 as follows; urethral chlamydia from 66.5% to 80.2%, pharyngeal gonorrhoea 58.7% to 77.2% and rectal gonorrhoea/chlamydia from 55.3% to 75.3%, (all p<0.001). Prior to Period 1, the clinic had a policy of testing HIV positive MSM for syphilis with each three monthly routine HIV monitoring blood tests. Therefore, the median number of syphilis tests was the same in both study periods (median 2, range 0 to 6, p=0.817). The proportion of episodes of complete tesing, also increased from 32.3% to 56.2% (p<0.001).

Conclusion The introduction of a SHPN into general practice significantly increased HIV and STI testing among MSM. The magnitude of the effect of this intervention may be greater in MSM high case load general practices where the culture of STI testing is less well established.

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