224 results found
Bruton P, Rai T, Kall M, et al., Experience of primary care for people with HIV: a mixed-method analysis, British Journal of General Practice, ISSN: 0960-1643
BackgroundAdvances in treatment have transformed HIV into a long-term condition (LTC), presenting freshchallenges for health services, HIV specialists and general practitioners (GPs).AimTo explore the experience of people living with HIV (PLHIV) regarding using their GPs.Design and settingA mixed-method analysis using data from two sources: a nationally-representative survey of PLHIVand a qualitative study with London-based PLHIV.MethodsUnivariate logistic regression for quantitative data and Framework analysis for qualitative data.ResultsThe survey had 4,422 participants; the qualitative study included 52 participants. In both studies, GPregistration and HIV status disclosure were high. Similar to general population trends, recent GP usewas associated with poor self-rated health status, co-morbidities, older age and lower socioeconomic status. Two-thirds reported a good experience with GPs; a lower proportion feltcomfortable asking HIV-related questions. Actual or perceived HIV stigma were consistentlyassociated with poor satisfaction. In the interviews, participants with additional LTCs valuedsensitive and consistent support from GPs. Some anticipated, and sometimes experienced, problems relating to HIV status, GPs’ limited experience and time to manage their complex needs. Sometimesthey took their own initiatives to facilitate coordination and communication. For PLHIV, a ‘good’ GPoffered continuity and took time to know and accept them without judgement.ConclusionWe suggest clarification of roles and provision of relevant support to build confidence in GPs andprimary care staff to care for PLHIV. As PLHIV population ages, there is a strong need to developtrusting patient/GP relationships and HIV-friendly GP practices.
Papageorgiou V, Jones K, Mindham R, et al., ‘Do I really want to do this for the rest of my life?’: a qualitative exploration of participant and study staff perspectives from the Therapy withdrawal in Recovered Dilated cardiomyopathy - Heart Failure (TRED-HF) study, Chronic Living Conference 2020
Ensor S, Davies B, Rai T, et al., 2019, The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in Sub-Saharan Africa; a mixed methods systematic review, Journal of the International AIDS Society, Vol: 22, Pages: 40-53, ISSN: 1758-2652
IntroductionUNAIDS has recommended that in 14 countries across sub‐Saharan Africa (SSA), 90% of men aged 10 to 29 years should be circumcised by 2021 to help reduce transmission of HIV. To achieve this target demand creation programmes have been widely implemented to increase demand for Voluntary Medical Male Circumcision (VMMC). This review explores the effectiveness of demand creation interventions and factors affecting programme implementation.MethodsWe completed a mixed methods systematic review searching Medline, Embase, Global health, psycINFO and CINAHL databases in August 2018 with no time restrictions. Demand creation interventions conducted in SSA were categorized and quantitative data about VMMC uptake was used to compare relative and absolute effectiveness of interventions. Qualitative data were summarized into themes relevant to the delivery and impact of programmes.Results and discussionEighteen of the 904 titles were included in the review. Effective interventions were identified in each demand creation category: financial incentives, counselling or education, involvement of influencers and novel information delivery. Of the 11 randomized controlled trials (RCTs), the greatest absolute impact on VMMC prevalence was seen with a complex intervention including VMMC promotion training for religious leaders (compared to control: 23% (95% CI 22.8 to 23.8) absolute increase; odds ratio (OR) 3.2 (1.4 to 7.3)). Financial incentives generally produced the largest relative effects with men up to seven‐times more likely to undergo VMMC in the intervention arm compared to control (adjusted OR 7.1 (95% CI 2.4 to 20.8), 7.1% (3.7 to 10.5) absolute increase). Qualitative findings suggest that interventions are more impactful when they are judged appropriate and acceptable by the target population; delivered by people with relevant personal experience; and addressing broader social and cultural influences through partnership with and education of community leaders.Con
Ward H, Garnett GP, Mayer KH, et al., 2019, Maximizing the impact of HIV prevention technologies in sub‐Saharan Africa, Journal of the International AIDS Society, Vol: 22, ISSN: 1758-2652
Ensor S, Davies B, Rai T, et al., The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in Sub-Saharan Africa; a mixed methods systematic review, AIDS Impact 2019
Papageorgiou V, Crittendon E, Davies B, et al., Impact of pre-exposure prophylaxis on the risk of bacterial sexually transmitted infections among cisgender women: systematic review, AIDS Impact 2019
Papageorgiou V, Wharton-Smith A, Campos-Matos I, et al., Patient data sharing for immigration enforcement purposes: a qualitative study of healthcare providers in England, Public Health England Annual Conference 2019
Pristera P, Bruton J, Cooke G, et al., Perspectives on transmission, treatment and elimination of hepatitis C in HIV-positive MSM in London: a qualitative study, AIDS IMPACT 2019
Ronn M, Mc Grath-Lone L, Davies B, et al., 2019, Evaluation of the performance of nucleic acid amplification tests (NAATs) in detection of chlamydia and gonorrhoea infection in vaginal specimens relative to patient infection status: a systematic review, BMJ Open, Vol: 9, ISSN: 2044-6055
OBJECTIVE: We aimed to assess the performance of NAATs using vaginal specimens in comparison to other urogenital specimens in their ability to detect chlamydia and gonorrhea infection in women.DESIGN: Systematic review.DATA SOURCES: EMBASE and Ovid MEDLINE databases through 3 October 2017.ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies that tested samples from the vagina and ≥1 other site (cervix and/or urine) with ≥2 NAATs for chlamydia and ≥2 NAATs or 1 NAAT and culture for gonorrhoea for each site.DATA EXTRACTION AND SYNTHESIS: We compared the performance of NAATs on specimens taken from the vagina to those from the cervix or urine in diagnosing chlamydia and gonorrhoea infection in women based on patient infection status (PIS). We analysed the performance using vaginal specimens compared to PIS. Performance is defined as the sensitivity of a NAAT using a specimen site and PIS status of the patient. We assessed risk of bias using modified QUADAS-2.RESULTS: Nine publications met the inclusion criteria (eight for chlamydia; six for gonorrhoea) and were narratively reviewed. Pooled summary estimates were not calculated due to the variable methodology and PIS definitions. Tests performed on vaginal specimens accomplished similar performance to cervical and urine specimens for chlamydia (range of performance estimates: vaginal 65-100%, cervical 59-97%, urine 57-100%) and gonorrhoea (vaginal 64-100%, cervical 85-100%, urine 67-94%). Vaginal specimens were estimated to have a performance >80% for chlamydia and gonorrhoea infections in all but one study.CONCLUSIONS: Performance of the NAATs for chlamydia and gonorrhea detection using vaginal specimens was similar to that of cervical and urine specimens relativeto PIS. As vaginal samples have a higher acceptability and lower cost, the study can support clinical testing guidelines by providing evidence that vaginal samples are a suitable alternative to traditional test sites.
Rai T, Bruton P, Day S, et al., 2018, From activism to secrecy: contemporary experiences of living with HIV in London in people diagnosed from 1986 to 2014, Health Expectations, Vol: 21, Pages: 1134-1141, ISSN: 1369-6513
Background:Successes in biomedicine have transformed HIV from a debilitating and frequently fatal infection to a chronic, manageable condition. Objective:To explore how the contemporary metanarrative of HIV as a chronic condition is understood by patients and how it varies depending on when they were diagnosed.Design:Qualitative interviews with fifty-two people living with HIV who were diagnosed during different phases in the history of the epidemic. Setting and participantsParticipants were recruited from two HIV clinics in London to include four “HIV generations”: generation 1 were those who had been diagnosed pre-1997 (pre-ART), generation 2 from 1997-2005 (complex ART), generation 3 from 2006-2012 (simpler ART) and generation 4 were diagnosed in the year before the study (2013-2014). Results: Participants in all HIV generations took their medication as prescribed, attended clinic appointments and were well-informed about their immunological biomarkers. While the pre-treatment generation had been engaged in community endeavours such as activism, public education and use of support groups, those more recently diagnosed had little experience of collective activities and their HIV was essentially a private matter, separate from their social identity. These strategies worked for some however those experiencing clinical or social problems related to HIV or wider issues often relied exclusively on their HIV clinic for wider support. Conclusion:The loss of public conversation around HIV, the imperative for patients to take on greater individual responsibility for HIV management and the streamlining of HIV services alongside reductions in ancillary support services may expose some people to suboptimal health outcomes.
Aghaizu A, Tosswill J, De Angelis D, et al., 2018, HIV incidence among sexual health clinic attendees in England: First estimates for black African heterosexuals using a biomarker, 2009-2013, PLoS ONE, Vol: 13, ISSN: 1932-6203
IntroductionThe HIV epidemic in England is largely concentrated among heterosexuals who are predominately black African and men who have sex with men (MSM). We present for the first time trends in annual HIV incidence for adults attending sexual health clinics, where 80% of all HIV diagnoses are made.MethodsWe identified newly diagnosed incident HIV using a recent infection testing algorithm (RITA) consisting of a biomarker (AxSYM assay, modified to determine antibody avidity), epidemiological and clinical information. We estimated HIV incidence using the WHO RITA formula for cross-sectional studies, with HIV testing data from sexual health clinics as the denominator.ResultsFrom 2009 to 2013, each year, between 9,700 and 26,000 black African heterosexuals (of between 161,000 and 231,000 heterosexuals overall) were included in analyses. For the same period, annually between 19,000 and 55,000 MSM were included. Estimates of HIV incidence among black Africans increased slightly (although non-significantly) from 0.15% (95% C.I.0.05%-0.26%) in 2009 to 0.19% (95% C.I.0.04%-0.34%) in 2013 and was 4-5-fold higher than among all heterosexuals among which it remained stable between 0.03% (95% C.I.0.02%-0.05%) and 0.05% (95% C.I.0.03%-0.07%) over the period. Among MSM incidence was highest and increased (non-significantly) from 1.24% (95%C.I 0.96–1.52%) to 1.46% (95% C.I 1.23%-1.70%) after a peak of 1.52% (95%C.I 1.30%-1.75%) in 2012.ConclusionThese are the first nationwide estimates for trends in HIV incidence among black African and heterosexual populations in England which show black Africans, alongside MSM, remain disproportionately at risk of infection. Although people attending sexual health clinics may not be representative of the general population, nearly half of black Africans and MSM had attended in the previous 5 years. Timely and accurate incidence estimates will be critical in monitoring the impact of the reconfiguration of sexual health services in England
Pufall EL, Kall M, Shahmanesh M, et al., 2018, Sexualized drug use ('chemsex') and high-risk sexual behaviours in HIV-positive men who have sex with men, HIV Medicine, Vol: 19, Pages: 261-270, ISSN: 1464-2662
OBJECTIVES: The incidence of sexually transmitted infections (STIs) and HIV infection remains high in gay, bisexual, and other men who have sex with men (MSM) in the UK, and sexualized drug use ("chemsex") and injecting drug use ("slamsex") may play a part in this. We aimed to characterize HIV-positive MSM engaging in chemsex/slamsex and to assess the associations with self-reported STI diagnoses and sexual behaviours. METHODS: Data from a 2014 survey of people attending HIV clinics in England and Wales were linked to clinical data from national HIV surveillance records and weighted to be nationally representative. Multivariable logistic regression assessed the associations of chemsex and slamsex with self-reported unprotected anal intercourse (UAI), serodiscordant UAI (sdUAI) (i.e. UAI with an HIV-negative or unknown HIV status partner), sdUAI with a detectable viral load (>50 HIV-1 RNA copies/mL), hepatitis C, and bacterial STIs. RESULTS: In the previous year, 29.5% of 392 sexually active participants engaged in chemsex, and 10.1% in slamsex. Chemsex was significantly associated with increased odds of UAI [adjusted odds ratio (AOR) 5.73; P < 0.001], sdUAI (AOR 2.34; P < 0.05), sdUAI with a detectable viral load (AOR 3.86; P < 0.01), hepatitis C (AOR 6.58; P < 0.01), and bacterial STI diagnosis (AOR 2.65; P < 0.01). Slamsex was associated with increased odds of UAI (AOR 6.11; P < 0.05), hepatitis C (AOR 9.39; P < 0.001), and bacterial STI diagnosis (AOR 6.11; P < 0.001). CONCLUSIONS: Three in ten sexually active HIV-positive MSM engaged in chemsex in the past year, which was positively associated with self-reported depression/anxiety, smoking, nonsexual drug use, risky sexual behaviours, STIs, and hepatitis C. Chemsex may therefore play a role in the ongoing HIV and STI epidemics in the UK.
Bruton PJ, Rai T, Day S, et al., 2018, Patient perspectives on the HIV continuum of care in London: a qualitative study of people diagnosed between 1986 and 2014, BMJ Open, Vol: 8, ISSN: 2044-6055
Objectives: To describe the experiences of the HIV treatment cascade of diagnosis, engagement with care and initiation of treatment, from the perspective of patients; we explored whether this differed according to the year of their diagnosis, for example whether they had experienced HIV care in the pre-treatment era.Design: Qualitative interview study with framework analysisSetting: Two large HIV adult outpatient clinics in central London. Participants: 52 HIV positive individuals, 41 men, 11 women, purposively sampled to include people who had been diagnosed at different stages in the history of the epidemic classified as four ‘generations’: pre-1996 (pre-ART), 1997 to 2005 (complex ARTs), 2006 to 2012 (simpler ARTs), 2013 onwards (recent diagnoses).Results: Some important differences were identified; for earlier generations, the visible illness and deaths from AIDS made it harder to engage with care following diagnosis. Subsequent decisions about starting treatment were deeply influenced by the fear of severe side-effects from early antiretroviral therapy (ART). However, despite improvements in ART and life expectancy over the epidemic we found a striking similarity across participants’ accounts of the key stages of the care continuum, regardless of when they were diagnosed. Diagnosis was a major traumatic life event for almost everyone, fear of testing positive or having low self-perceived risk affected the timing of testing and diagnosis, engaging with care was facilitated by a flexible approach from services/clinicians and initiating treatment was a major life decision. Conclusion: We found patients’ experiences are influenced by when they were diagnosed, with earliest cohorts facing substantial challenges. However, being diagnosed with HIV and starting treatment continue to be significant life-altering events even in the era of effective, simple treatments. Despite the advances of biomedical treatment services should continue to recogn
Beardon S, Patel K, Davies B, et al., 2018, Informal Carers' Perspectives on the Delivery of Acute Hospital Care for Patients with Dementia: A Systematic Review, BMC Geriatrics, Vol: 23, ISSN: 1471-2318
Background: Providing high quality acute hospital care for patients with dementia is an increasing challenge asthe prevalence of the disease rises. Informal carers of people with dementia are a critical resource for improvinginpatient care, due to their insights into patients’ needs and preferences. We summarise informal carers’ perspectives ofacute hospital care to inform best practice service delivery.Methods: We conducted a systematic search of bibliographic databases and sought relevant grey literature. We usedthematic synthesis analysis to assimilate results of the studies and describe components of care that influence perceivedquality.Results: Twenty papers met the inclusion criteria. Findings identified four overarching components of care thatinfluenced carer experience and their perceptions of care quality: ‘Patient care’, ‘Staff interactions’, ‘Carer’s situation’ and‘Hospital environment’. Need for improvement was identified in staff training, provision of help with personal careneeds, and dignified treatment of patients. Carers need to be informed, involved and supported during hospitaladmission in order to promote the most positive experience.Conclusion: This review identifies common perspectives of informal carers of people with dementia in the acutehospital setting and highlights important areas to address to improve the experience of an admission for both carerand patient.
Davies B, Turner KME, Frolund M, et al., 2018, Pelvic inflammatory disease risk following negative results from chlamydia nucleic acid amplification tests (NAATs) versus non-NAATs in Denmark: A retrospective cohort study, PLoS Medicine, Vol: 15, ISSN: 1549-1277
BackgroundNucleic Acid Amplification Tests (NAATs) are the recommended test type for diagnosing Chlamydia trachomatis (chlamydia). However, less sensitive diagnostic methods—including direct immunofluorescence (IF) and enzyme-linked immunoassay (ELISA)—remain in use in lower resourced settings. We estimate the risk of pelvic inflammatory disease (PID) following undiagnosed infection in women tested with non-NAATs and estimate the health gain from using accurate diagnostic tests.Methods and findingsWe used Denmark’s national Chlamydia Study dataset to extract all chlamydia tests performed in women aged 15–34 years (1998–2001). Tests were categorised as non-NAAT (IF/ELISA) or NAAT and limited to each woman’s first test in the study period. We linked test data to hospital presentations for PID within 12 months from the Danish National Patient Register. The study included 272,105 women with a chlamydia test, just under half (44.78%, n = 121,857) were tested using NAATs. Overall, 6.38% (n = 17,353) tested positive for chlamydia and 0.64% (n = 1,732) were diagnosed with PID within 12 months. The risk of PID following a positive chlamydia test did not differ by test type (NAAT 0.81% [95% CI 0.61–1.00], non-NAAT 0.78% [0.59–0.96]). The risk of PID following a negative test was significantly lower in women tested with NAATs compared to non-NAATs (0.55% [0.51–0.59] compared to 0.69% [0.64–0.73]; adjusted odds ratio (AOR) 0.83 [0.75–0.93]). We estimate that 18% of chlamydia infections in women tested with a non-NAAT were undiagnosed and that the risk of progression from undiagnosed chlamydia infection to PID within 12 months was 9.52% (9.30–9.68). Using non-NAATs could lead to an excess 120 cases of PID per 100,000 women tested compared to using NAATs. The key limitations of this study are under ascertainment of PID cases, misclassification bias in chlamydia and PID exposure status, bias to the association
Forshaw J, Gerver SM, Gill M, et al., 2017, The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis, BMC Infectious Diseases, Vol: 17, ISSN: 1471-2334
BackgroundThere is an established correlation between maternal education and reduction in childhood mortality. One proposed link is that an increase in maternal education will lead to an increase in health care access and vaccine uptake. Vaccinations are a central preventative child health tool, therefore demonstrating the importance of understanding factors that can improve coverage. This review aims to establish if there is a correlation between increasing maternal education and vaccine uptake and if this varies between continents, setting and time.MethodsAn electronic database search was conducted using Medline Ovid, Embase and The Cochrane Library using a combination of keywords and appropriate MeSH terms for maternal education and child vaccination. Bibliographies were also hand searched. Data was extracted and entered onto a Microsoft Excel spreadsheet and analysed using STATA 13.0 software. The primary outcome of effect size of maternal education on completion of childhood vaccinations was analysed at different levels. Secondary outcomes were explored using subgroup analyses of differences between continents, rural or urban settings, and dates.ResultsThe online search yielded 3430 papers, 37 were included in this study. The analysis showed increasing child vaccination uptake with increasing maternal education. Overall, analysis showed that the odds of full childhood vaccination were 2.3 times greater in children whose mother received secondary or higher education when compared to children whose mother had no education. There was large variability in the effect size between the studies included.ConclusionsImproving maternal education is important for increasing childhood vaccination uptake and coverage. Further research is needed in higher income countries.
Kim S-H, Eaton JW, Davies B, et al., 2017, Patterns in chlamydia detection rate in young adults aged 15–24 years in England, 2012–15: longitudinal analysis of routine data, Public Health Science 2017
BackgroundThe National Chlamydia Screening Programme (NCSP) in England recommends chlamydia testing for sexually active young adults (aged 15–24 years). The Public Health Outcomes Framework (PHOF) suggests that implementation and delivery of the NCSP should identify 2300 cases or more of chlamydia per 100 000 residents (15–24 years old). The commissioning of chlamydia screening moved to local authorities in 2013. We describe performance of local authorities against the PHOF chlamydia screening recommendation.MethodsWe used chlamydia test data from Public Health England (2012–15), index of multiple deprivation (2015) data from National Office of Statistics, and population data to describe the association between the proportion of local authorities achieving the PHOF chlamydia detection rate recommendation and deprivation at local authority level, adjusted for population size and proportion of tests performed in a genitourinary medicine setting.FindingsThe number of chlamydia tests performed within the NCSP declined by 17% (1 860 000 in 2012 to 1 538 000 in 2015) over the study period. The proportion of local authorities that achieved the PHOF chlamydia diagnosis rate recommendation fell 39% (from 23% [75/324] in 2012 to 14% [45/324] in 2015). Throughout the 4-year period, local authorities in the most-deprived quintile were more likely to attain the recommendation than were local authorities in the least-deprived quintile (adjusted odds ratio 10·6 (95% CI 3·0–37·9) in 2012, 15·9 (2·0–129·5) in 2015).InterpretationThere has been a reduction in the number of chlamydia tests performed within the NCSP and a larger reduction in the proportion of local authorities meeting the chlamydia diagnosis rate recommendation since 2012. This finding suggests that the decline in testing may disproportionately affect those most at risk of chlamydia infection. There are also marked inequalities in attainment of the
Davies B, Turner KME, Andersen B, et al., 2017, P3.25 Quantification of the risk of pelvic inflammatory disease following a chlamydia trachomatis test by diagnostic test type, ISSTDR 2017
Introduction Nucleic Acid Amplification Tests (NAATs) are the recommended test type for diagnosing Chlamydia trachomatis (chlamydia). However poorer performing methods remain in use. We compared the risk of pelvic inflammatory disease (PID) in women tested for chlamydia by diagnostic test type.Methods We used a sub-set of the Danish Chlamydia study that included all female residents of Denmark who were tested for chlamydia (1998–2001) when aged 15–34 years. Chlamydia tests performed on urinary or genital samples with a definitive positive or negative result were categorised as non-NAAT (ELISA; IF; “antigen”) or NAAT (PCR; SDA; TMA; LCR; DNA/RNA) and limited to each woman’s first test. Test records were linked to hospital presentations for PID within 12 months. Women with previous PID or PID diagnosed on the same date as the test were excluded. We used logistic regression to compare the risk of PID by test type adjusted for age, test year and test result.Results Of the 2 72 105 women in the study, 44.78% were tested using NAAT, 6.38% tested positive for chlamydia and 0.64% were diagnosed with PID within 12 months. Overall, the adjusted risk of PID within 12 months of a chlamydia test was higher following a positive test (AOR 1.40 (95%CI 1.18–1.67) and in older women (25–34 years 1.36 (1.23–1.49)) and lower in women tested using a NAAT (0.87 (0.78–0.96)) and in the more recent time interval (2000/2001 0.89 (0.80–0.99)). In women with a positive test, and presumably treated infection, the risk of PID did not differ by test type (1.25 (0.87–1.79)). In women with a negative test, the risk of PID was lower following a NAAT (0.84 (0.75–0.93)).Conclusion Women with a negative result from a non-NAAT chlamydia test have a 16% higher risk of PID by 12 months compared to women with a negative result from a NAAT. This is presumably due to the increased proportion of false negative tests with th
White P, Fox J, Weber J, et al., 2017, HOW MUCH CAN HIV TRANSMISSION BE REDUCED IN HIGH-RISK MSM BY TARGETING TESTING TO DETECT AND TREAT PRIMARY HIV INFECTION (PHI)? ANALYSIS OF A COHORT STUDY USING AN INDIVIDUAL-BASED MODEL, P5.23 How much can hiv transmission be reduced in high-risk msm by targeting testing to detect and treat primary hiv infection (PHI)? analysis of a cohort study using an individual-based model, Publisher: BMJ PUBLISHING GROUP, Pages: A243-A244, ISSN: 1368-4973
Davies B, Turner KM, Andersen B, et al., 2017, QUANTIFICATION OF THE RISK OF PELVIC INFLAMMATORY DISEASE FOLLOWING A CHLAMYDIA TRACHOMATIS TEST BY DIAGNOSTIC TEST TYPE, ISSTDR 2017, Publisher: BMJ PUBLISHING GROUP, Pages: A102-A102, ISSN: 1368-4973
Howarth AR, Day S, Greene L, et al., 2017, “They made me feel comfortable”: a comparison of methods to measure patient experience in a sexual health clinic, BMC Health Services Research, Vol: 17, ISSN: 1472-6963
BackgroundHigh quality sexual health services are needed to improve both individual and public health outcomes. This study set out to explore what is important to patients who visit a sexual health clinic, and examine their understanding of standard survey questions, in order to inform the collection and interpretation of patient experience data that are used to improve services.MethodsWe conducted a cross-sectional, qualitative study. In the first part of the interview, we used “discovery interviews” to explore patients’ experiences of attending a central London walk-in sexual health clinic. In the second part, we asked patients how they would respond to eight standard patient experience survey questions and to provide an explanation for each of their responses. We conducted a thematic analysis of the interview data.ResultsWe interviewed seventeen participants (nine women, eight men) of different ethnicities and backgrounds. All interviewees were positive about their experience. They described how staff had made them feel “comfortable”, and talked about how staff spent time, listened and did not rush them, despite being a very busy clinic.In response to the survey questions, fourteen patients rated their as care excellent or very good overall. However, survey questions were interpreted in different ways and were not always easily understood.ConclusionsThe open-ended “discovery interviews” provided new insights into aspects of care that were most valued or could improve. Standard patient experience questions provide a rating but little elucidation of the experiences that lie behind patients’ responses. They do not always measure aspects of care valued by patients or identify areas for improvement. They are not uniformly understood and necessarily collapse a wide range of experiences and views into categories that may seem inappropriate. Qualitative methods have a key role in measuring patient experience and involving p
Elmes JAR, Skovdal M, Nhongo K, et al., 2017, A reconfiguration of the sex trade: How social and structural changes in eastern Zimbabwe left women involved in sex work and transactional sex more vulnerable, PLOS One, Vol: 12, ISSN: 1932-6203
Understanding the dynamic nature of sex work is important for explaining the course of HIV epidemics. While health and development interventions targeting sex workers may alter the dynamics of the sex trade in particular localities, little has been done to explore how large-scale social and structural changes, such as economic recessions–outside of the bounds of organizational intervention–may reconfigure social norms and attitudes with regards to sex work. Zimbabwe’s economic collapse in 2009, following a period (2000–2009) of economic decline, within a declining HIV epidemic, provides a unique opportunity to study community perceptions of the impact of socio-economic upheaval on the sex trade. We conducted focus group discussions with 122 community members in rural eastern Zimbabwe in January-February 2009. Groups were homogeneous by gender and occupation and included female sex workers, married women, and men who frequented bars. The focus groups elicited discussion around changes (comparing contemporaneous circumstances in 2009 to their memories of circumstances in 2000) in the demand for, and supply of, paid sex, and how sex workers and clients adapted to these changes, and with what implications for their health and well-being. Transcripts were thematically analyzed. The analysis revealed how changing economic conditions, combined with an increased awareness and fear of HIV–changing norms and local attitudes toward sex work–had altered the demand for commercial sex. In response, sex work dispersed from the bars into the wider community, requiring female sex workers to employ different tactics to attract clients. Hyperinflation meant that sex workers had to accept new forms of payment, including sex-on-credit and commodities. Further impacting the demand for commercial sex work was a poverty-driven increase in transactional sex. The economic upheaval in Zimbabwe effectively reorganized the market for sex by reducing previousl
Davies B, turner KME, Leung S, et al., 2017, Comparison of the population excess fraction of chlamydia trachomatis infection on pelvic inflammatory disease at 12-months in the presence and absence of chlamydia testing and treatment: systematic review and retrospective cohort analysis, PLOS One, Vol: 12, ISSN: 1932-6203
Background: The impact of Chlamydia trachomatis (chlamydia) control on the incidence of pelvic inflammatory disease (PID) is theoretically limited by the proportion of PID caused by chlamydia. We estimate the population excess fraction (PEF) of treated chlamydia infection on PID at 12-months in settings with widespread chlamydia control (testing and treatment) and compare this to the estimated PEF of untreated chlamydia. Methods: We used two large retrospective population-based cohorts of women of reproductive age from settings with widespread chlamydia control to calculate the PEF of treated chlamydia on PID at 12-months. We undertook a systematic review to identify further studies that reported the risk of PID in women who were tested for chlamydia (infected and uninfected). We used the same method to calculate the PEF in eligible studies then compared all estimates of PEF. Results: The systematic review identified a single study, a randomised controlled trial of chlamydia screening (POPI-RCT). In the presence of testing and treatment <10% of PID at 12-months was attributable to treated (baseline) chlamydia infections (Manitoba: 8.86%(95%CI 7.15-10.75); Denmark: 3.84%(3.26-4.45); screened-arm POPI-RCT: 0.99%(0.00-29.06)). In the absence of active chlamydia treatment 26.44% (11.57-46.32) of PID at 12-months was attributable to untreated (baseline) chlamydia infections (deferred-arm POPI-RCT). The PEFs suggest that eradicating baseline chlamydia infections could prevent 484 cases of PID at 12-months per 100,000 women in the untreated setting and 13-184 cases of PID per 100,000 tested women in the presence of testing and treatment. Conclusion: Testing and treating chlamydia reduced the PEF of chlamydia on PID by 65% compared to the untreated setting. But in the presence of testing and treatment over 90% of PID could not be attributed to a baseline chlamydia infection. More information is needed about the aetiology of PID to develop effective strategies for impro
BackgroundGenital infections caused by Chlamydia trachomatis are the most prevalent bacterial sexually transmitted infection worldwide. Screening of sexually active young adults to detect and treat asymptomatic infections might reduce chlamydia transmission and prevent reproductive tract morbidity, particularly pelvic inflammatory disease (PID) in women, which can cause tubal infertility and ectopic pregnancy.ObjectivesTo assess the effects and safety of chlamydia screening versus standard care on chlamydia transmission and infection complications in pregnant and non-pregnant women and in men.Search methodsWe searched the Cochrane Sexually Transmitted Infections Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, CINAHL, DARE, PsycINFO and Web of Science electronic databases up to 14 February 2016, together with World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies.Selection criteriaRandomised controlled trials (RCTs) in adult women (non-pregnant and pregnant) and men comparing a chlamydia screening intervention with usual care and reporting on a primary outcome (C. trachomatis prevalence, PID in women, epididymitis in men or incidence of preterm delivery). We included non-randomised controlled clinical trials if there were no RCTs for a primary outcome.Data collection and analysisTwo review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias. We resolved disagreements by consensus or adjudication by a third reviewer. We described results in forest plots and conducted meta-analysis where appropriate using a fixed-effect model to estimate risk ratios (RR with 95% confidence intervals, CI) in intervention vs control groups. We conducted a pre-specified sensitivity analysis of the primary outcome, P
Chandrasekaran L, Davies B, Eaton J, et al., 2016, Chlamydia diagnosis rate in England in 2012: an ecological study of local authorities, Sexually Transmitted Infections, Vol: 93, Pages: 226-228, ISSN: 1472-3263
Objectives Local authorities (LAs) in England commission chlamydia screening as part of the National Chlamydia Screening Programme. It is recommended that LAs achieve a chlamydia diagnosis rate of ≥2300 cases per 100 000 population aged 15–24. We describe national patterns in attainment of the chlamydia diagnosis rate recommendation and possible implications of using it to measure LA-level performance.Methods We used publicly available data sets from England (2012) to explore the association between LAs attaining the recommended chlamydia diagnosis rate and population size, socioeconomic deprivation, test setting and sex.Results We used data from 1 197 121 recorded chlamydia tests in females and 564 117 in males. The chlamydia diagnosis rate recommendation was achieved by 22% (72/324) of LAs overall (43% female population; 8% male population). LAs in the highest deprivation quintile were more likely to reach the recommendation than those in the least-deprived quintile for both sexes (women: unadjusted prevalence ratio (UPR) 7.43, 95% CI 3.65 to 15.11; men: UPR 7.00, 95% CI 1.66 to 29.58). The proportion of tests performed in genitourinary medicine clinics was negatively associated with attainment of the recommended diagnosis rate (UPR 0.95, 0.93 to 0.97).Conclusions Chlamydia diagnosis rate recommendations that reflect local area deprivation (as a proxy for disease burden) may be more appropriate than a single national target if the aim is to reduce health inequalities nationally. We suggest LAs monitor their chlamydia diagnosis rate, test coverage and test positivity across a range of measures (including setting and sex) and pre/post changes to commissioned services. Critical evaluation of performance against the recommendation should be reflected in local commissioning decisions.
Day S, Coombes RC, McGrath-Lone L, et al., 2016, Stratified, precision or personalised medicine? Cancer services in the “real world” of a London hospital, Sociology of Health & Illness, Vol: 39, Pages: 143-158, ISSN: 0141-9889
We conducted ethnographic research in collaboration with a large research-intensive London breast cancer service in 2013-14 so as to understand the practices and potential effects of stratified medicine. Stratified medicine is often seen as a synonym for both personalised and precision medicine but these three terms, we found, also related to distinct facets of treatment and care. Personalised medicine is the term adopted for the developing 2016 NHS England Strategy, in which breast cancer care is considered a prime example of improved biological precision and better patient outcomes. We asked how this biologically stratified medicine affected wider relations of care and treatment. We interviewed formally 33 patients and 23 of their carers, including healthcare workers; attended meetings associated with service improvements, medical decision-making, public engagement, and scientific developments as well as following patients through waiting rooms, clinical consultations and other settings. We found that the translation of new protocols based on biological research introduced further complications into an already-complex patient pathway. Combinations of new and historic forms of stratification had an impact on almost all patients, carers and staff, resulting in care that often felt less rather than more personal.
Davies B, Turner K, Frolund M, et al., 2016, Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark, Lancet Infectious Diseases, Vol: 16, Pages: 1057-1064, ISSN: 1473-3099
Background: Uncertainty in the risk of reproductive complications (pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI)) following chlamydia infection and repeat infection hampers the design of evidence-based chlamydia control programmes. We estimate the association between diagnosed chlamydia and episodes of hospital healthcare (in-patient, out-patient and emergency department) for a reproductive complication.Methods: We constructed and analysed a retrospective population-based cohort of women aged 15-44 years from administrative records in Denmark (1995-2012). Findings: The 516,720 women (103,344 positive, 182,879 negative, 230,497 never-tested) had a mean follow-up of 7.96 years. Compared to women with only negative tests, the risk of each complication was 30% higher in women with ≥1 positive test (adjusted hazard ratios (AHRs) PID 1·50(1·43-1·57); EP 1·31(1·25-1·38); TFI 1·37(1·24-1·52)) and 60% lower in women who were never-tested (AHRs PID 0·33(0·31-0·35); EP 0·42(0·39-0·44); TFI 0·29(0·25-0·33)). A positive test had a minor absolute impact on health as the difference in the lifetime incidence of complications was small between women who tested positive and those who tested negative (PID 0.6%; EP 0.2%; TFI 0·1%). Repeat infections increased the risk of PID by a further 20% (AHR 1·20(1·11-1·31)). Interpretation: A single diagnosed chlamydia infection increased the risk of all complications and a repeat diagnosed infection further increased the risk of PID. Therefore control programmes must prevent first and repeat infections to improve women’s reproductive health.
Majeed F, Hansell A, Saxena S, et al., 2016, How would a decision to leave the European Union affect medical research and health in the United Kingdom?, Journal of the Royal Society of Medicine, Vol: 109, Pages: 216-218, ISSN: 1758-1095
AIM AND OBJECTIVES: to understand the purpose, impact and experience of nurse handover from patient and staff perspectives. BACKGROUND: poor communication is increasingly recognised as a major factor in healthcare errors. Handover is a key risk point. Little consensus exists regarding the practice in nursing but the trend is towards bedside handover. Research on patient and staff experiences of handover is limited. DESIGN: a qualitative and observational study on two acute wards in a large urban hospital in the UK. METHODS: interviews conducted with patients and staff and observation of handovers, ward rounds and patient-staff interactions. RESULTS: diverse forms of nurse handover were found, used in combination: office based (whole nursing team), nurse in charge (NIC) to NIC, and bedside. Patients' and nurses' views concurred on the purpose of bedside handover-transference of information about the patient between two nurses-and about the medical ward round, which was seen as a discussion with the patient. Views diverged regarding the purpose and value of office handover. Bedside handover differed in style, content, and place of delivery, often driven by concerns regarding confidentiality and talking over patients, and there were varied views on the benefits of patient involvement in bedside handover. Nurses worked beyond their shift end to complete handover. Communication problems within the clinical team were identified by staff and patients. CONCLUSIONS: while it is important to agree the purpose of handover and develop appropriate structure, content and style, it need not be a uniform process in all clinical areas. Nurse training to deliver bedside handover and patient information on the purpose of handover and the patient's role would be beneficial.
Ward H, Bruton J, Rai T, et al., 2016, "Clean" or "dirty": the changing experiences of care and support among MSM diagnosed with HIV, Publisher: WILEY-BLACKWELL, Pages: 61-61, ISSN: 1464-2662
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