ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

Why is gonorrhoea so common in MSM when chlamydia and warts are not?

There must be something different in the way it is transmitted.

Sex without kissing increases with age.

Kissing only partners is much more common in gay men compared with heterosexual men.

Gay men may have many kissing partners in a club in a night.

Because urethral gonorrhoea becomes symptomatic quickly it gets treated, meaning at any point in time, the prevalence of gonorrhoea in the gay community is urethral in < 1%, rectal in 9% MSM and pharyngeal in 11%.

This translates into incidence rates of 3% urethral, 9% rectal and 44% pharyngeal.

 

Kissing and oral sex is important. The penis is irrelevant. It is just a poor bystander!

Posted by on in Public Health and Prevention

Day 2 had so many interesting topics. The use of Information Technology to improve sexual health care, by Dr Christopher Fairley was interesting. It is true that all people have access to internet and most of them use internet as their first source of information. Websites can be use to educate people, make online appointments and ask queries. It makes things so much quicker and easier.

Everybody is busy these days and do not like waiting for hrs. CASI is a very good system which is being used in some clinics to answer sexual history by the patient itself. this has proved to be quicker, avoids awkward questioning by the clinicians and more honest answers are given this way. It is also beneficial for the clinicians if they know some sexual behaviors and risks prior to seeing the patient.

SMS results and SMS reminders are being favoured by patients and clinics. SMS results within 90 minutes or even in 24 hrs makes it so easier and quicker. SMS are also used for vaccination reminders and TOC reminders and have proven to be very successful. It saves time and is quick for both parties. The number of patients have increased in the last 10 yrs from 15000  to 50000, due to using IT appropriately . Websites like "let them know" and "Dramadownunder" have been very successful in contact tracing.

Take home message of " Set up a good database and it will save you for life" was food for thought.

 

 

Day 1/ Monday 14/11/2016 - Highlights from day 1:

Today was full of diversity in Sexual Health Field.

It was amazing to see so many people come together to listen to each of the incredible presenters and discuss, debate and learn.

My main contributions today where through regular 'tweets' on my Twitter account.

Please check them out at Twitter @paulafe2

 

 

 

Posted by on in Public Health and Prevention

Plenary 2 Tuesday 15/11/2016

GOLLOW LECTURE :Rebecca Guy Assoc Professor Kirby Institute:surveillance,evaluation and research program

Presented new technologies for STI  Prevention

Re thinking Sexual Health 

And how can we use new technologies for disease prevention

Specifically Information technology

To embrace what people are using therefore currency

In a world open 24 hours

 

Primary and secondary prevention:STI testing and diagnoses

What technology has been evaluated

PROBLEM: STI Testing;time consuming/registration 

Solution electronic client self register:self appoint

Outcome evaluation significant benefit re time saved

Problem of awkward conversations 

Solved by computer assisted survey instrument (CASI) 

Linked with management system

Evaluated as efficient, acceptable,

Problem of STI test with clinic capacity

Solution Xpress clinic

Evaluated 

All leading back to reflection and constant need to improve efficiency of practice and improved outcomes for clinic and client

GP still low STI  testing rates despite 80% young people go to GP

Latest findings suggest poorly targeted

ACCEPT survey:

150 GP clinics

73.4% of chlamydia presentations asympto clients attending for non sexual health issues /missed opportunistic test

.? COMPUTER PROMPTS 

Evaluated and helpful 30% increase testing

Need comprehensive screening eg previously rectal swabs not done MSM

User friendly software

Low Syphilis   testing in increasing STI rates

Solution:opt out/opt in syphilis test in HIV management

Simple cheap study in 2007 by DR Melanie Bissessor and MSM with HIV

Simple sticker on file requesting syphilis check

Pre 21%

Post 85% :such simple cheap intervention.

Study 2

Syphilis testing same day as HIV VLautomatic,could deselect:

Colaboration required clinics, labs under Burnett Istitute

ACCESS checks how tracking

Generally need to increase testing rates

Problem of treatment delays especially Remote areas

Discussed SMS reminders recall possibilities

TTANGO (test treat and go);Colaboration 12 Health Services

Key message is the mean time to treatment

With POCT 4/7

Lab test 19/7

And partners to be treated

Use of "Let them know"websiteMSHC, evaluated/acceptable:SMS

BUT people not returning TOC, reinfection and dangers PID etc

Discused other clinical strategies and efficiency eg: REACT RCT:

Not suitable for test kits mailed to address parents,partners

Other technologies not comprehensively evaluated

WA online educational resources parents and adolescents

Poor condom use reported: Adolescents report "no condoms it just happened"

The new world of online websites to meet and connect and how to tap into that population group to encourage testing

The difficulty of behavioural interventions

Technology must help research ,rapid info to inform  progress

data.kirby.unsw.edu.co JUST released

TAKE HOME MESSAGE

Why not all Health Services using IT/online technologies 

Is the future online Sexual Health Services.......

Need to all look at improved, efficient, acceptable and cost effective ways of increasing comprehensive STI I testing

 

Christopher Fairley  MSHC presented

The use of nformation technology to improve Sexual Health care in a following session

Which complimented Rebeccas presentation

Great comment; Health care is most important fight against STI

STI easier to control than treatment

Sexual Health does not deal with "noble organs" does not attract the $

need to be more efficient....like the Banks....

Need IT in clinical services

CAS:I :all staff  and clients love it

Use of SMS

Websites like Let them know

STI Atlas

Whats PREP

DATA OPENS EYES

CLINICIANS NEED TIO UNDERSTAND DATA

NEED A DATA BASE

 

Sexual Health Conference Day 2  Gollow Lecture IT and sexual health

Notes: 

Young people are very engaged with new technology. 

  • It's available 24/7
  • Offers privacy
  • It can be interactive
  • Is able to offer sexual content.
  • For me it's highly valuable for education

New self check in stations have proven to increase efficiency with faster interactions, data being more accurate as well as allowing more patients to be seen.

Other interventions include medical software prompt systems which have proven to increase opportunisitc testing of STI's such as Chalmydia.

Computer system grouping of tests and guidance has also increased syphilis testing in HIV positive clients and checking for missed tests such as rectal swabs for Gonorrhoea / Chlamydia in MSM.

SMS recall systems have increased testing regularity and recall for test for cure.

Resources:

http://amaze.org
http://data.kirby.unsw.edu.au

 

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