One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups

May 2007

Implementing NICE guidance

NICE public health intervention guidance 3

What this presentation covers

• Background

• Recommendations

• Implementation advice

• Other NICE implementation resources

Changing practice

• NICE public health guidance is based on the best available evidence

• The Department of Health asks NHS organisations to work towards implementing public health guidance

• NHS compliance with developmental standards are monitored by the Healthcare Commission

Context for the guidance

• Sits alongside current guidance and initiatives for rapid testing for STIs

• Implement with infection-specific prevention and treatment guidelines and local protocols

• Forms one element in broader strategy to modernise sexual health services

National sexual health targets

• 50% reduction in under 18 conceptions by 2010

• patients contacting GUM clinics to be offered an appointment within 48 hours by 2008

• 25% reduction in new diagnoses of gonorrhoea and HIV infections by the end of 2007

• 15% of 15–24 year olds accepting chlamydia screening by end of March 2008

National STI rates - UK

Diagnosis of STIs in GUM clinics

1996 2005 2004–2005% change

1996–2005 %change

Chlamydia 35,840 109,958 5% 207%

Gonorrhoea 12,579 19,392 -13% 54%

HIV 2707 7450 -0.01% 175%

Local STI rates

Diagnosis of STIs in GUM clinics

[Insert year]

[Insert year]

[Insert year/ % change]

[Insert year/% change]

Chlamydia

Gonorrhoea

HIV

Under 18 conceptions in England

1998 2005

46.6

per 1000

15–17 year olds

41.1

per 1000

15–17 year olds

41,089 39,683

Local under 18 conception rates

1998 2005

…….

per 1000

15–17 year olds

……

per 1000

15–17 year olds

TOTAL TOTAL

What the guidance covers

• Identification of risk

• One to one structured advice

• Partner notification

• Commissioning

• Vulnerable young people under 18, including mothers and those who are pregnant

Determinants of risky sexual behaviour

• Individual factors – low self-esteem, lack of skills, lack of knowledge of the risks of unsafe sex

• External influences – peer pressure/attitudes and prejudices of society

• Service provision – accessibility of sexual health services and/or lack of resources such as condoms

Determinants of teenage pregnancy

• Behavioural factors include: - early onset of sexual activity - alcohol/substance misuse - already a teenage mother or had an abortion

• Social and cultural factors include: - low family educational aspirations, low education

attainment or no qualifications - living in care/daughter of a teenage mother - member of certain ethnic groups

Recommendation 1

Health professionals should:

• identify individuals at high risk of STIs

• have one to one discussions with them or arrange for these discussions to take place with an appropriately trained practitioner

Recommendation 2

Specially trained health professionals should have one to one structured discussions with people at high risk of STIs. They should:

• use behaviour change theories (see Conner & Norman 2005)

• address factors that help reduce risk-taking behaviour and improve self-efficacy and motivation

Behaviour change theories

•The health belief model

•Protection motivation theory

•Social cognitive theory

•Theory of reasoned action and planned behaviour

•The stages of change theory of health behaviour

Recommendation 3

Health professionals and partner notification specialists should:

• help patients with an STI to get their partners tested and treated (partner notification)

• provide patients and their partners with infection-specific information

• for chlamydia infection, consider providing a home sampling kit for partners

Recommendation 4

PCT commissioners should ensure:

• sexual health services meet local needs and are audited and monitored

• service providers have clearly defined roles in relation to STI prevention, testing and treatment, partner notification and follow-up

• staff are trained.

Recommendation 5

Health professionals should provide vulnerable young people aged under 18 with one to one advice and supporting information on:

• how to prevent and/or get tested for STIs

• how to prevent unwanted pregnancies

• other reproductive issues and concerns.

Recommendation 6

Midwives and health visitors should:

• regularly visit vulnerable young women aged under 18 who are pregnant or who are already mothers

• discuss with them: - how to prevent and/or get tested for STIs- how to prevent unwanted pregnancies- opportunities for returning to education, training and employment

Implementation advice

The key to successful implementation is:

• collaborative working to deliver integrated services that are easily accessible

• training to ensure the sexual health team meet the required competencies

Integrated services

Commissioners & service providers should work together to:

• develop services in a range of settings (including outreach)

• identify opportunities for joint commissioning (e.g. with other youth service providers)

• ensure clear care pathways using best practice guidelines for working with young people

• involve service users including young people to review and plan services

Training needs

Service providers may consider:

• a review of training needs and competencies

• updating training provision using accredited courses

• using trained staff and national guidelines to develop local protocols for assessing risk

Training needs

Commissioners may consider:

• a needs assessment and review of current services

• defining the role of NHS, community and voluntary sector service providers

• ensuring all providers have the necessary competencies and include training/CPD provision

Costs and Savings

•A reduction in the number of STIs, re-infections and conceptions will avoid activity costs such as testing and treating STIs

• Use the NICE costing tools to estimate the costs and savings at local level.

Access tools online

• Costing report and template

• Slide set

• Implementation advice

• Audit criteria

Available from www.nice.org.uk/PHI003

Access the guidance online

You can download the following documents from www.nice.org.uk/PHI003

• A quick reference guide

• The guidance itself, which includes the recommendations, details of how they were developed and evidence statements

• Supporting documents, including evidence reviews and an economic analysis