CDAT &

Sexual Health

Pamela Jones &

Alison Collins

Clinical Nurse Specialists

Integrated Contraception and Sexual Health Services

Strategic context

NICE, 2007 = targeting key groups at risk of STIs including those that undertake behaviours that increase the risk

National Treatment Agency for Substance Misuse (2007) = substance misuse services ensure sexual health assessment & access to safer sex advice enabled for service users with strong links to local SHS.

One Wales & Designed for Life for Wales (WAG 2007 & 2005) = increasing community based service provision

The project1st in Wales to identify a regular, designated,

specialist sexual health resource to work with CDAT

Funded by The Queen’s Nursing Institute for 1 year

Aim: reduce inequalities in access to sexual health services & increase uptake of sexual healthcare for clients who access substance misuse services

Objective: Every client has the opportunity to receive a sexual health assessment, advice, testing, treatment &/or referral as required.

• Specific aim 1: increase opportunistic advice, screening, treatment and referral on sexual health issues for people attending substance misuse clinic.

• Specific aim 2: improve access to cervical cytology screening.

• Specific aim 3: raise awareness of potential risks in relation to sexual health in this client group.

Specific Aims

• Provide a drop in nurse led clinic once a week within existing CDAT services

• Set up a one stop shop approach to sexual health provision

• Develop and support a multiagency approach to service provision

• Identify & support clients who need onward referral to specialist services

Objectives

Implementation • CNS working alongside CDAT during clinic sessions offering specific sexual health interventions not normally available in this setting

•Sessions to run alongside CDAT clinics providing an appointment and walk in service for service users.

•A small steering group made up of key stakeholders will oversee the project to ensure it is on target to meet its objectives.

• Merthyr Tydfil x1 per month

• Church Village (Nr. Pontypridd) x1 per month

• Rhondda Valley x1 per month

• Aberdare x1 per month

Venues

following detailed sexual health assessment:

health promotion & harm minimisation messages

STI testing

provision of barrier and other methods of contraception

contact tracing

cervical cytology

referral to specialist services if indicated.

Service provision

Possible benefits •improving accessibility & availability = individual & public health improvement with positive impact on the wider community.

•speedier access = timely advice, contraception and/or treatment reducing the levels of sexually transmitted infection and unplanned pregnancy.

•greater choice & control for clients in managing their sexual health

•identify wider health issues for clients and their partners/families improve their health and wellbeing in generic terms as well as gaining access to other services as indicated.• •developed in partnership between sexual health and community drug and alcohol services = the value of joint working & learning

Sessions commenced• June Church Village + Rhondda• July Merthyr + Aberdare

Sessions Held to End August 2008• Aberdare 2• Merthyr 2• Church Village 2• Rhondda 2

• Total sessions possible 14 • Total sessions held 8

Project Statistics

• Aberdare 2

• Merthyr 3

• Church Village 0

• Rhondda 2

Attendances to Date

•Complex needs of client group

•Reluctance of clients accessing service

•High DNA rate

•Communication between staff sets

•Cover for annual Leave/sickness

•Contacting clients with positive results

•Providing appropriate chaperones

Project Challenges

• Limited availability of service provision in each area (1 per Month)

• Sustainability

Project Challenges

• Leaflets and posters in CDAT clinics

• Outreach workers

• Mainstream services

Advertising project

• Female Aged 22• 1 Child• Methadone programme• Attended for Opportunistic STI screening• Also had opportunistic cervical cytology

Results1. Positive chlamydia

Attended mainstream services for treatment2. Abnormal cytology

Referred to colposcopy with support-DNAStaff in contact to arrange supported appointed

Case Study 1

• Male aged 30• Methadone programme• Attended for information and advice• Refused screening via swab but accepted urine for Chlamydia

Results

1. Positive chlamydia2. Attended mainstream service for treatment with partner3. Both treated4. Advised of need for full screening

Case Study 2

Conclusion • Slow to start

• Identifies the complexity of client cases

• Client satisfaction/results

• Evidence of integrated team working

• Some improved communication needed

• Need to address Annual leave/sickness• • Respond to changes in demand as the project becomes

established to meet need most appropriately

Thank You

Any Questions?