Abstract
BackgroundHospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration.MethodsThe study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM) attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254), and quality rating.ResultsPre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals). Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good.ConclusionsThe HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.
Highlights
Hospital HIV care and public sexual health care services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment to larger numbers of HIV patients
This study aimed to close the gap in sexual health care by implementing and evaluating a policy change regarding the combination of public health care and hospital care in an innovative, integrated STI /HIV care structure serving male and female HIV patients in the Netherlands
This process resulted a list of current practical barriers for sexual health care provision to HIV patients and included a lack of HIV patient attendance to public health care settings, in spite of their comprehensive sexual health care services
Summary
Hospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. HIV-infected persons are considered to have unmet needs with respect to sexual health care, i.e. counselling about safe sex, relationships, reproductive health and pregnancy, and testing and treatment for sexually transmitted infections (STIs) [2,3,4,5,6]. Specific recommendations regarding testing at multiple anatomic sites or repeated testing are lacking These testing approaches are essential STI control strategies that are often included in standard operating procedures at public health STI clinics [12]. Sexual health care entails extensive counselling, partner notification, and treatment, services that are a part of the regular care offered at public health sexual health care centres [12]
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