Provision Of Sexual Health Services Research Articles

Sexual and Reproductive Health Care Services in the Pediatric Setting.

Pediatricians are an important source of health care for adolescents and young adults and can play a significant role in addressing their patients' sexual and reproductive health needs, including preventing unintended pregnancies and sexually transmitted infections (STIs), including HIV, and promoting healthy relationships. STIs, HIV, and unintended pregnancy are all preventable health outcomes with potentially serious permanent sequelae; the highest rates of STIs, HIV, and unintended pregnancy are reported among adolescents and young adults. Office visits present opportunities to provide comprehensive education and health care services to adolescents and young adults to prevent STIs, HIV, and unintended pregnancies. The American Academy of Pediatrics, other professional medical organizations, and the government have guidelines and recommendations regarding the provision of sexual and reproductive health information and services. However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services. The purpose of this clinical report is to assist pediatricians to operationalize the provision of various aspects of sexual and reproductive health care into their practices and to provide guidance on overcoming barriers to providing this care routinely while maximizing opportunities for confidential health services delivery in their offices.

A facility location model for analysis of current and future demand for sexual health services.

In this paper we address the clinic location selection problem for a fully integrated Sexual Health Service across Hampshire. The service provides outpatient services for Genito-Urinary Medicine, contraceptive and reproductive health, sexual health promotion and a sexual assault referral centre. We aim to assist the planning of sexual health service provision in Hampshire by conducting a location analysis using both current and predicted patient need. We identify the number of clinic locations required and their optimal geographic location that minimise patient travel time. To maximise the chances of uptake of results we validate the developed simple algorithm with an exact method as well as three well-known, but complex meta-heuristics. The analysis was conducted using car travel and public transport times. Two scenarios were considered: current clinic locations only; and anywhere within Hampshire. The results show that the clinic locations could be reduced from 28 to 20 and still keep 90% of all patient journeys by public transport (e.g. by bus or train) to a clinic within 30 minutes. The number of clinics could be further reduced to 8 if the travel time is based on car travel times within 15 minutes. Results from our simple solution method compared favourably to the exact solution as well as the complex meta-heuristics.

Pharmacists’ attitudes regarding provision of sexual and reproductive health services

ObjectivesThe primary objective was to assess attitudes from Ohio pharmacists about contraceptive authority. Secondary objectives included determining pharmacists’ perceptions of benefits, barriers, and preparedness for offering such services and examining attitudes about and experiences with other reproductive health topics to inform future research. MethodsAn anonymous 26-question Institutional Review Board–approved electronic survey was developed and distributed via Qualtrics to a random sample of 500 licensed pharmacists in Ohio. Two months were allotted for survey completion. A link to free Accreditation Council for Pharmacy Education–approved continuing pharmacy education (CPE) through Ohio Northern University was offered as an incentive for completing the survey. ResultsOne hundred thirty-eight pharmacists completed the survey (62% female). Fifty-eight percent worked in community pharmacy and 34% in health-system pharmacy. The majority indicated that oral and transdermal contraceptive methods should be pharmacist-initiated (57% and 54%, respectively) through a collaborative practice agreement or statewide protocol. More pharmacists supported provision of hormonal contraception through a collaborative practice agreement rather than a statewide protocol. Increased access to care and convenience for patients were identified most frequently as potential benefits. Time constraints, concerns of increased liability, and other barriers for initiating such services were identified by pharmacists. Pharmacists most frequently listed clinical guidelines, CPE, and patient education materials as tools needed to successfully initiate contraceptive therapy regimens. Pharmacists responding to the survey were also proponents of increasing involvement in other aspects of sexual and reproductive health, such as expedited partner therapy (64%) and human papilloma virus vaccination (67%). Respondents indicated a potential lack of experience or training in topics such as expedited partner therapy and intimate partner violence. ConclusionPharmacists surveyed showed interest in providing sexual and reproductive health services, including pharmacist-provided prescription contraceptive products and preventive health services. Further studies are needed to evaluate pharmacists’ roles in other sexual and reproductive health services.

P231 Understanding sexual practices, attitudes and sexual health service provision in the over 50s

IntroductionSince 2011 STI incidence has increased in the over-50 population in the UK.Higher divorce rates, lack of awareness, poor service provision and low pregnancy risk have all been suggested as...

P232 Somewhere over the rainbow: establishing acceptable locations for sti screening and support for MSM

IntroductionOver the Rainbow is a community based LGBT support service and level 3 GUM clinic in Bournemouth, currently under threat due to funding cuts. In May 2016, a patient consultation was undertaken to explore alternative options for service provision.MethodsA survey was distributed online and in clinic to capture views on the provision of local sexual health services for MSM.Results96 people responded to the survey after visiting the service for STI screening (60%) or one to one support (40%). 40% of these would not be happy attending a mainstream GUM or CASH clinic, or GP for STI screening. 34% would not be happy to access STI screening on-line. One third would be unwilling to attend alternative agencies for counselling or support.80% of the 86 online respondents had attended Over the Rainbow in the past. Responses indicated that even fewer (44-56%) would be happy to attend a mainstream GUM or CASH clinic or GP for STI screening, with a similar proportion reluctant to attend other community settings.Comments highlighted that service users valued a dedicated LGBT service, in the heart of the gay community. It was described as a safe haven.DiscussionFuture service design and provision must consider community need. Patients expressed a preference for LGBT specific community based services, able to accommodate their sexual health needs within a holistic framework. Many value a face-to-face consultation rather than accessing STI screening on-line.

Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults' perceptions of this initiative.

BackgroundOpportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013–2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines.AimTo determine young adults’ opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice.Design and settingQualitative interviews were conducted in a general practice setting in England between March and June 2013.MethodThirty interviews were conducted with nine male and 21 female patients aged 16–24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework.ResultsParticipants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation.ConclusionGeneral practice staff should facilitate patients’ preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way.

Social Accountability for Adolescent Sexual and Reproductive Health

Adolescent population of Nepal is facing health and social problems related to sexual, reproductive, behavioral and traditional social practices. Adolescent pregnancy, child marriage, unwanted pregnancies, Chhaupadhi (restrictions during menstruation and delivery), sexual- gender based violence, unsafe abortion, HIV/AIDS, drug addiction and suicide are major problems which have severe consequences in the lives of adolescents in Nepal. Addressing such daunting problems that adolescents are facing today needs holistic approach, going beyond health. Wider community support, civic engagement and social mobilizations are required to tackle the ASRH problems. Community Based Institutions (CBIs), Community Leaders and citizens have obligations to respond to the problems related with service delivery and ending harmful practice as a social accountability for protection, fulfill and upholding the rights of adolescents. In this context, the objective of this study is assess awareness and engagement capacity of citizens for addressing adolescent sexual and reproductive health problems as a social accountability in Baitadi District of Nepal. Descriptive and analytical research design were used to assess the level of awareness and empowerment from the citizen’ perspectives. A total of 337 respondents affiliated with the five different types of community based institutions (CBIs) were interviewed using structured questionnaire for data collection and data analysis was done by using SPSS version 16.0. The preliminary results of the study reveals that majority of citizens were aware and informed about SRH problems of adolescents, citizens perceived that child-marriage (15%) is the main issue of adolescents in the community followed by Gender Based Violence (13.4%) and adolescent pregnancy (12.7%) among others. The study reveals that citizens belonging to rural areas have more citizen, actions on preventing child marriage; awareness level was higher among citizens from Non-Dalit communities than in Dalit communities. Further, 59.9 percent citizens feel confident to talk about sexual-reproductive health services related concerns in the meeting whereas 32.6 percent citizens perceived that they are hesitant to speak on SRH issues. Similarly, nearly half of the citizens perceived that they were not capable of deciding freely to talk about SRH related issues in the meeting. Only 61.1 percent citizens feel confident to claim for access to quality health service as their fundamental rights from public health facilities. The study concluded that majority of citizens affiliated with Community Based Institutions were aware about characteristics and Sexual and Reproductive Health issues of adolescent population at their communities. However, still a sizeable citizen felt less confident to use their individual agency to decide freely, speaking up against existing traditional norms and shown less confident in claiming Sexual and Reproductive health service as rights. The study revealed that citizen’s accountability capacity is inadequate for tackling adolescent sexual and reproductive health service provision and social behavior change at the community level and therefore this calls for the dire needs to build the capacity of vanguard citizens to contribute to improving adolescents sexual and reproductive health status.Himalayan Journal of Sociology & Anthropology - Vol. VII (2016), page: 13-39

Young sexual minority women's use of the internet and other digital technologies for sexual health information seeking

We know little about the online sexual health information seeking practices and needs specific to young sexual minority women. This is problematic as young sexual minority women report heightened negative sexual health outcomes in contrast to their heterosexual peers, which could be partially addressed through being able to access effective, relevant online sexual health information sources. This exploratory qualitative study employed a series of focus groups to understand more about what types of online resources young sexual minority women access, their motivations for using those resources, and what types of sexual health information they need. The focus group data were analyzed from a thematic analysis approach. Results indicate that participants used a wide range of online resources, such as apps, websites, blogs, and YouTube. The type of resource accessed often depended upon the information needed. Participants reported preferring online resources due to experiences or expectations of heteronormativity from their sexual health service providers, convenience and accessibility, the capacity to remain anonymous, and the lack of relevant sexual health information offline. These findings help begin to fill the gap on knowledge of young sexual minority women's sexual health information seeking practices, which can be used for the development of effective online sexual health information resources targeting young sexual minority women.

Sexual health service providers' perceptions of transgender youth in England.

Transgender youth often face difficulties when accessing sexual health services. However, few studies investigate health service providers' perceptions of transgender youth, and fewer focus on sexual health. To fill this gap, our study draws on social representations theory to examine sexual health service providers' perceptions of transgender youth and how this influences the provision of health services for this marginalised population in England. A thematic analysis of 20 semi-structured interviews with service providers, conducted between March and June 2014, resulted in five main themes centred on: binary representations of transgender; transgender as homosexuality; uncertain bodies; unstable mental states; and too young to know. Of the service providers interviewed, many understood transgender within a male/female binary, and perceived being transgender to be synonymous with being gay. There was confusion among service providers regarding transgender youths' sexual organs, and most of those interviewed saw transgender youth as mentally unstable and confused. Finally, many service providers perceived that transgender youth are too young to know that they are transgender and make decisions about their body. Some of these representations were potentially stigmatising and many conflicted with transgender youths' representations of themselves. Training by transgender people is recommended to help address these misunderstandings.

Are Adolescents and Youth Programs Missing The Real Targets? Analysis of Socio-Cultural Factors Influencing Use of Sexual Reproductive Health Services by Young People in Swaziland

Background: Access to reproductive health services by youth has received minimal attention given that Sexual Reproductive Health (SRH) service provision for many years has been tailored to meet the needs of the adult population. The youth have therefore been neglected partly due to cultural sensitivity that dictates what, when and how SRH information and services should be transmitted to them. The current study therefore sought to unveil and explore sociocultural factors influencing youth utilization of SRH services provided in health facilities. Methods: A mixed method approach was used to gain a comprehensive view of factors influencing utilization of adolescent sexual reproductive health (ASRH) services. Data were collected quantitatively by using semi-structured questionnaires and qualitatively through individual in-depth interviews and Focus Group Discussions (FDGs) among a total of 927 youth aged 15-24 years (222 out of school youth and 705 in-school youth). The study sample also comprised of 68 gate keepers who included: teachers, religious authorities, parents/guardians, traditional authorities and health professionals. Results: The study exposed factors underlying utilization of SRH services among Swazi youth. Such factors included the family, peers, religious and community values and norms. Youth who perceived their families, communities and peers to be liberating towards uptake of SRH services were more likely to utilize those services compared to youth who perceived the opposite. Conclusion: The results persuade optimistic youth programs determined to increase uptake of SRH services among youth to incorporate parental and community programs instead of exclusively focusing on youth in all interventions designed to propel protective sexual behaviour among youth at all service delivery levels. Recommendations: Parental, community, traditional and religious leadership involvement in the development and execution of youth program interventions should be prioritized.

Sexual orientation and sexual health services utilization among women in the United States

Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011–2013 and 2013–2015 waves of the National Survey of Family Growth, which provide a national probability sample of U.S. women aged 15–44years (N=11,300), we used multivariable logistic regression to examine the associations between sexual behavior and sexual identity (modeled separately) and STI testing in the past year, Pap test use in the last 3years, lifetime HIV testing, and lifetime human papillomavirus (HPV) testing. Women with male and female lifetime sexual partners had higher adjusted odds of being tested for STIs ([odds ratio:] 1.61; [95% confidence interval:] 1.37–1.89), HIV (1.66; 1.29–2.14), and HPV (1.79; 1.41–2.25) and similar adjusted odds of obtaining a Pap test (0.98; 0.76–1.27) than women with only male lifetime sexual partners. Self-identified bisexual women had higher adjusted odds of obtaining an STI (1.43; 1.10–1.86) and HIV (1.69; 1.24–2.30) test but lower adjusted odds of obtaining a Pap test in the last 3years (0.66; 0.47–0.93) than heterosexual-identified women. Women with only female lifetime sexual partners had lower adjusted odds of receiving an STI (0.14; 0.07–0.28) and Pap (0.10; 0.03–0.27) test than women with only male lifetime sexual partners. Results comparing self-identified lesbian and heterosexual women were similar. Health care facilities should monitor and address sexual orientation disparities in women's sexual health care and ensure the provision of high-quality sexual health services to all women.

Provision of Adolescent-Friendly Sexual and Reproductive Health (SRH) Services Integrated into HIV Treatment and Care

Provision of Adolescent-Friendly Sexual and Reproductive Health (SRH) Services Integrated into HIV Treatment and Care

Social Workers’ Roles in Supporting the Sexual and Relational Health of Children with Disabilities

The purpose of this study was to understand social workers’ roles in meeting the sexual and relational health needs of children (aged 3–11) with disabilities. We conducted semi-structured interviews with 12 social workers from a range of practice settings. A phenomenological lens privileged the perspectives of social workers in their definitions of disability and sought to convey the meaning they assigned to their experiences of working with children in practice concerning matters related to sexual and relational health. Social workers enacted a broad definition of disability and often came to work with youth in contexts labeled as sexually problematic. In the provision of sexual health services, social workers embodied commonly adhered to roles including as practitioners, enablers, advocates, brokers, and managers. Services are needed that promote positive sexuality and relational health among children with disabilities. It is important that social workers be proactive advocates for the full inclusion of people with disabilities as equal sexual citizens.

Provision of positive sexual health services for young people: a realist evaluation

BackgroundEnglish and international policy calls for positive, comprehensive youth sexual health services (PCYSHS) that support young people to achieve sexual wellbeing. In practice, youth sexual health services are often oriented solely towards reducing unwanted conceptions and preventing sexually transmitted infections. This study aimed to develop theory and recommendations for practitioners to support delivery of PCYSHS. MethodsA realist evaluation was undertaken to uncover what works, for whom, and under what conditions, to deliver PCYSHS. We developed concepts and initial theories, in which we combined existing substantive theory with a logic model based on stakeholder's tacit knowledge, observational visits, and data that were relevant to underlying causal processes, extracted from academic and policy literature (27 sources). Academic sources were identified via a systematic search of four electronic databases. Search terms were “sexual health”, combined with “sex positive”, “young people”, “service”, and synonyms (“reproductive health”, “sexual subjectivity”, “sexual rights”, “holistic”, “integrated”, “reproductive rights”, “preventative”, “comprehensive”, “young”, “youth” “teen*”, “adolescen*”, “intervention*”, “framework*”, “paradigm*”, “programme*”, “model*”, “trial*”, “pilot*”) with no date restrictions. We selected papers relating to whole system transformation to PCYSHS in developed countries, written in English. Papers that considered only education settings, one-off interventions, or information resources were excluded. Papers were appraised by rigour and relevance in accordance with realist methodology guidelines. Evidence was then gathered from case studies of three services in England that had attempted implementation of PCYSHS. Data were derived via stakeholder interviews (n=24), social and print media (15), service specifications (5), and evaluation and consultation documentation (5). Analysis of these data (Nvivo, version 10) was directed at substantiating, refining, or refuting the initial theories. Ethics approval was given by Sheffield Hallam University Research Ethics Committee. Findings76 sources contributed to the development and testing of programme theories. The theories articulated how local buy-in to PCYSHS could be led by the following factors: clarity of both the concept and individual role; conviction in the approach to bring about positive change for young people; and coherence with local and national priorities. The theories suggested the mechanisms by which these factors work and showed the ways in which outcomes are contextually dependent. InterpretationThis study explains some of the challenges of translating the policy ambition of PCYSHS into practice. The realist inquiry found theoretical mechanisms that might affect delivery of PCYSHS and the contextual conditions that could hinder or enable them. These theories can help inform the development and evaluation of PCYSHS initiatives. FundingSheffield Hallam University Faculty PhD scholarship.

P216 Community pharmacy-delivered chlamydia testing and management in the UK - a comprehensive review

Background/introduction Provision of sexual health services in community pharmacies is perceived to be a desirable strategy for increasing access to STI testing and care. Aim(s)/objectives To comprehensively review the literature on chlamydia services in community pharmacies in the UK Methods Eight electronic databases (Medline, AMED, BNI, CINAHL, EMBASE, HBE, HMC, PsychInfo) were searched by two researchers independently, until 4.3.16. Search terms were: (1) chlamydia, AND (2) pharmac*. Studies with qualitative or quantitative evidence on community pharmacy-based chlamydia care including screening, testing, treatment, partner notification and training were included. Results 8 studies, published 2007–2015, met inclusion criteria. They were disparate in terms of subjects: (4 focused on pharmacy staff, 2 on clients), methodology: (2 surveys, 1 qualitative, 1 mixed methods, 1 RCT, 2 cross-sectional and 1 cost-consequence study). Focus varied: treatment 7, screening/testing 5, partner notification 4, training 1, studies respectively. Main findings: pharmacists appear willing to offer chlamydia services if appropriately trained and supported. Barriers to offering opportunistic screening were highlighted. Two studies reported acceptability of screening/treatment but uptake by men in one study was very low (6%). The largest study (1131 people tested positive through pharmacy) reported 47% treated in pharmacy. Preliminary feasibility and acceptability of accelerated partner therapy and expedited partner therapy were shown (2 studies). Discussion/conclusion Despite considerable policy appetite and pharmacist support for pharmacy-delivered chlamydia care, very little robust evaluation of any element of chlamydia testing and/or management has occurred. Well implemented studies of clinical efficacy, assessing quality of care and cost-effectiveness are warranted.

P158 Evaluation of sexual health service use at baseline (2014) in South East London

Background/introduction Lambeth and Southwark have poor sexual health outcomes compared with the rest of England. We wished to evaluate an intervention to improve access to sexual health services through online STI testing and contraceptive provision. Aim(s)/objectives This study describes baseline service use in Lambeth and Southwark in 2014 prior to the introduction of online services. We present our methodology for evaluating service use across the boroughs. Methods We collated baseline demographic and clinical data from all sexual health service providers (genitourinary medicine and community sexual health clinics) in Lambeth/Southwark, South East London, for one calendar year (2014). Individual level clinic data were merged, together with Office for National Statistics (ONS) on index of multiple deprivation for area (LSOA) of residence. We summarise the main type of service used and define each attendance as possible to be provided “online” (basic STI test, repeat oral contraception) or requiring “offline” services (e.g. clinical exam, surgical intervention, symptoms, long-acting contraception). Results We collected over 127,000 attendance records for sexual health services in Lambeth and Southwark during 2014. All clinics reported consistent levels of activity during each quarter. Up to 40% of attendances could potentially be provided online based on clinic coding. Discussion/conclusion The low monthly variation in attendances suggests that current services are operating at capacity. Understanding current service use will enable evaluation of online services to assess whether providing online services 1) increases capacity, 2) reaches new population groups 3) improves access for high risk groups.

Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review.

BackgroundVoluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services.Methods and FindingsA systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males.ConclusionsVMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population.

Navigating conflicting laws in sexual and reproductive health service provision for teenagers.

BackgroundThe South African legal and policy framework for sexual and reproductive healthcare provision for teenagers is complex.ObjectiveThe article outlines the dilemmas emanating from the legal and policy framework, summarises issues with implementation of the legal and policy framework in practice, and summarises recent changes to the law.MethodsIn-depth analysis of the legal and policy framework. Training workshops with a purposive sample of nurses and other healthcare providers in the Western Cape.FindingsTensions between consent and confidentiality imposed by the Termination of Pregnancy Act, the Children’s Act, the National Health Act and the Criminal Law (Sexual Offences and Related Matters) Amendment Act render conflicting obligations on healthcare providers. Healthcare providers’ experiences with service provision in this context show that the conflicting roles they inhabit render their service provision to teenagers more challenging.ConclusionHealthcare providers need to learn about their legal obligations surrounding adolescent sexual and reproductive health services.

“You have to make a judgment call”. – Morals, judgments and the provision of quality sexual and reproductive health services for adolescents in South Africa

South Africa's legal framework on sexual and reproductive health (SRH) care for teenagers is complex. On the one hand, the law protects their right to make decisions regarding reproduction – e.g. giving girls of any age the right to terminate a pregnancy, and allowing adolescents to consent to receive contraception from age 12. On the other hand, the Sexual Offences Act sets the age of consent to sex at 16 years, and requires mandatory reporting of anyone younger. These contradictory obligations mean that nurses, doctors and counsellors are expected to provide care, and counsel teenagers about their choices, but also report and enforce the law. They must therefore make judgments about inherently moral issues: should teenagers be having sex, and what services should they receive? Based on in-depth interviews at 28 healthcare facilities conducted in 2012, and data from workshops on the ‘conflicting laws’ held in 2014, the paper uses the theoretical framework of street-level bureaucracy to understand barriers to nurses providing SRH care for teenagers in South Africa, and the implication that this has for adolescents' SRH. The paper argues that nurses' adaptation of the law is a response to significant structural constraints, moral discomfort, and poor understanding of the law – all taken against an ethical framework that emphasizes quality, responsive patient care. The result is uneven implementation that undermines SRH information, access to services, and ultimately increases risks for teens.

Service evaluation of a pilot to improve primary care sexual health services in England implemented using a stepped wedge design

BackgroundSexual health service provision in primary care is an essential component to universal provision of sexual and reproductive health services. However the offer of these services is not consistent. The 3Cs & HIV was a national pilot that combined educational workshops with posters, testing performance feedback, and continuous support from a specialist trainer. The aim was to improve awareness and skills of staff to increase rates of chlamydia screening in the population at highest risk (men and women aged 15–24 years) and to provide condoms with contraceptive information plus HIV testing according to national guidelines. MethodsThe pilot used a stepped wedge design over three phases from Aug 1, 2013, to Sept 30, 2014. Chlamydia testing and diagnosis rates in the control (pretraining) and intervention (post-training) periods were compared by use of a multivariable negative binomial regression model with general practice fitted as a random effect. Owing to the stepped wedge design, the number of months contributing to the control and intervention periods differed depending on which phase the general practice was allocated to and when the practice received training. Characteristics of general practices participating were included in the model. Practices were not paid for the intervention. The Research Governance Coordinator for Public Health England confirmed that no ethics approvals were needed for this study. FindingsThe 460 participating practices conducted 26 021 tests in the control period and 18 797 tests during the intervention period. Intention-to-treat analysis showed decreased median number of tests and diagnoses per month per practice after receiving training (2·68 tests before training [IQR 1·00–4·77] vs 2·67 after training [1·10–4·90]; 0·14 diagnoses before training [0–0·30] vs 0·13 after training [0–0·27]). Adjusted multivariable regression analysis showed no significant change in overall testing or diagnoses (incidence rate ratio [IRR] 1·01, 95% CI 0·96–1·07 and 0·98, 0·84–1·15, respectively). Testing increased significantly in 148 practices where payment was already in place before the intervention (IRR 2·12, 95% CI 1·41–3·18). InterpretationThis large national pilot found that educational support sessions to increase chlamydia screening in primary care were only effective in practices that already receive payment for chlamydia screening. 3Cs & HIV training might be a useful way to make better use of the resources already available. However this intervention will not increase national testing rates substantially. Although increases found in subgroups were statistically significant, they were still relatively small in magnitude. FundingThe 3Cs & HIV pilot was funded by Public Health England and was part of the Chlamydia Testing Training in Europe (CATTE) project. CATTE is part funded by a Leonardo Transfer of Innovation grant as part of European Union Lifelong Learning Programme.