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What will become of the KC60? In the October 2007 edition of this journal. Hughes et al (1) reported on the KC60 returns from genitourinary medicine (GUM) clinics for 2006. They comment in their conclusion that diagnoses made outside GUM are not included, which is clearly a major deficiency if we are using the KC60 as an epidemiological surveillance
Some community data does find a way in....
Some community data does find a way in. Lavelle et al (2), in their letter in the December 2007 edition gave an example of this – the National Chlamydia Screening Programme ( N.C.S.P.) in Liverpool offers concomitant Nucleic Acid Amplification Test (N.A.A.T). screening for
gonorrohoea but if treatment is required it is given by the local GUM service. It is still coded as B1 (uncomplicated gonorrohea) and has probably distorted upwards the returns for that clinic, in contrast to the national trend. The authors suggestion is a change in or addition to the
KC60 coding to separate out diagnoses made by community clinics.
Another problem with using the KC60 as a surrogate for full epidemiological monitoring is that GUM clinics routinely report partner diagnoses into the KC60 and, as partners are much more likely to be positive, this distorts upwards prevalence estimates based on this data.
The recently developed Enhanced Sexually Transmitted Infections Surveillance Scheme for Cheshire and Merseyside (3) is an example of what might replace the KC60. Like the KC60 it is based on data collected in GUM, but also collects geographical data (by postcode) and much more
extensive demographic detail. It enables geographical mapping for service planning (by primary care trust) and for comparison with deprivation indices. It can also easily be combined with data from community screening programmes to increase coverage, although with the caveat that double reporting would have to be avoided.
If the KC60 is to be modified rather than replaced then it may be possible to alter its categories to allow unconfounded analyses ( e.g. diagnosed in GUM self-referral / partner of known case/ diagnosed in community but GUM referral etc ). But isn`t it complicated enough already? (4)
1. Hughes G, Simms I, Leong G. Data from UK genitourinary medicine clinics, 2006 : a mixed picture. Sex Transm Inf 2007;83:433-435
2. Lavelle S, Mallinson H, Henning S, et al. Impact on gonorrhoea case reports through concomitant/ dual testing in a chlamydia screening population in Liverpool. Sex Trans Inf 2007; 83: 593-594
3. Hargreaves S, Cook P, Bellis M. Enhanced Surveillance of Sexually Transmitted Infections in Cheshire and Merseyside 2006.
4. Coyne K M, Cohen C, Mandalia S et al. KC60 Coding: room for improvement- a study into consistencies and inconsistencies in the use of
diagnosing codes. Int J STD AIDS 2007;18: 118-119