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UK National Audit of Chlamydial Infection Management. National Audit Group British Association for Sexual Health & HIV. Case notes audit Interim results. 20 February 2008. Case definition. Any one of the KC60 C4A, C4B, or ISD(D)5 C41A, C41B or C41R and seen in the audit interval - PowerPoint PPT Presentation
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National Audit Group
UK National Audit of Chlamydial Infection
Management National Audit Group
British Association for Sexual Health & HIV
National Audit Group
Case notes audit
Interim results20 February
2008
National Audit Group
Case definition• Any one of the KC60 C4A, C4B, or ISD(D)5
C41A, C41B or C41R and seen in the audit interval
• GUM clinic or Sexual Reproductive Healthcare clinic
• Audit interval: 2 January and 31 March 2007 inclusively
• Sample number: first 30 patients seen in the audit interval (or all cases if less than 30 seen)
• Data collected: 3 September 2007 to 31 October 2007
National Audit Group
Demography
National Audit Group
Participation
15 of 15 UK Regions*; 193 GUMed clinics; 6 SRH clinics (90 cases)
Number of cases
5032 (regional range 0.6-16%) – see chart3 London Regions 1618 (32%)
*Note: South East & South West Thames is “South Thames”
Essex data included in “North Thames”
National Audit Group
Number of cases (N=5032)
0
5
10
15
20
25
N Tha
mes
=81
6
S Tha
mes
=802
W M
idlan
ds =43
2
N Wes
t =38
7
Yorks
hire
=31
0
Scotla
nd =
307
S Wes
t =30
3
Wale
s =28
7
Anglia
=27
7
Trent
=26
9
Norther
n =26
6
Mer
seys
ide =
190
Oxfo
rd =
179
Wes
sex
=177
N Irel
and
=30
%
National Audit Group
Age (years)
Number
%N Regional range%
<16 88 2 0-4
16-18 801 16 12-23
19-24 2489 50 41-60
25-34 1263 25 20-31
35-44 284 6 2-8
45-54 77 2 0-3
55-64 20 0.4 0-1
>65 1 0.02 0-0.1
Not known 9 0.2 0-2
National Audit Group
Gender Number
% Regional
range%
Male, total (%N) 2546 51 46-60
Male, het (%Male
total)2365 93 85-98
MSM (%Male total) 162 6 2-12
Male unknown sex pref
(%Male total)19 1 0-5
Female (%N) 2474 49 39-54
Female preg (%
Female total)26 1 0-3%
Not known (%N) 12 0.2 0-1.5
National Audit Group
Ethnic group Number %N Regional range %
White 3929 78 58-98
Black Caribbean 211 4 0-12
Black African 124 2 0-6Black Other 84 2 0-7Chinese/SE Asian 36 0.7 0-1Indian 32 0.6 0-2Pakistani 29 0.6 0-2Bangladeshi 10 0.2 0-1Hispanic 10 0.2 0-2Arabic 7 0.1 0-1Other 153 3 0-8Not known 407 8 0-32
National Audit Group
SampleCountry Total number
casesJan-Mar 07
Number BASHH Audit
Sample
England 24870* 4408 18%
Scotland 4466† 307 7%
Wales Data awaited 287
N Ireland Data awaited 30
*Health Protection Scotland: http://www.documents.hps.scot.nhs.uk/ewr/pdf2007/0720.pdf
† Health Protection Agency. Personal Communication
National Audit Group
Reasons for testingMore than 1 reason possible
Reason Number
%N Regional range %
Symptoms 2317 46 38-53
STI screen 1707 34 27-42
Contact of chlamydia 1135 23 18-28
Based on Sexual Hx 784 16 3-31
Medico-legal case 5 0.1 0-0.06
Not documented 23 0.5 0-3
National Audit Group
Presenting features: female cases (n=2474)
ReasonNumbe
r %N Regional range %
No symptoms 1273 52 43-60
Vaginal discharge 690 28 18-35
Lower abdominal pain 306 12 6-19
Dysuria 205 8 4-14
PCB or IMB 178 7 0-10
Mucopurulent cxitis a/o cx ctact bleeding
82 3 0-7
Complications of chlamydial infection
31 1 0-3
Conjuctivitis 6 0.2 0-0.7
Pharyngeal symptoms 1 0.04 0-0.5
Other symptoms 263 11 3-31
National Audit Group
Presenting features: male cases (n=2546)
ReasonNumbe
r %N Regional range %
No symptoms 1175 46 31-50
Dysuria 858 34 28-50
Urethral discharge 685 27 23-30
Rectal symptoms 19 0.8 0-2
Lower abdominal pain 17 0.7 0-2
Complications of chlamydial infection
37 1.4 0-5
Conjuctivitis 8 0.3 0-1
Pharyngeal symptoms 3 0.1 0-0.8
Other symptoms 325 13 8-24
National Audit Group
Test method - NAATs
Overall, 4679 (93%, regional range 100-69%) cases had NAAT testing documented from at least one of urinary, cervical, vulvovaginal, urethral or rectal sampling
National Audit Group
Other chlamydial testsEIA Number of
tests
Women (n=2474) 406
Men, heterosexual (n=2365) 129
Men, homosexual (n=162) 6
Tissue culture
Total of 210 tests
DFA
Total of 9 tests
National Audit Group
Chlamydial tests in women
• 2093 (85%) women had cervical or vaginal NAATs
• of the remaining 381 not having cervical or vaginal NAATs– 134 (35%) had urine NAATs (of whom 52
(39%) had a genital examination performed)– 18 (5%) had urethral NAATS– 229 (60%) had no cervical, vulvovaginal,
urinary or urethral NAATS
National Audit Group
Chlamydial tests in men
• 1723 (68%) men had urinary NAATS
• Of the remaining 823 not having urinary NAATs
• 699 (85%) had urethral tests• 124 (15%) had neither urinary nor
urethral tests
National Audit Group
Site Number of tests
%N
Regional range %
Homosexual men (n=162) 141 87 75-100
Heterosexual men (n=2365)
1668 71 61-100
Women (n=2474) 1668 67 56-92
Other tests for STIs: Syphilis
National Audit Group
Other tests for STIs: HIVSite Number
of tests%N
Regional range %
Homosexual men (n=162) 118 73 58-100
Heterosexual men (n=2365)
1580 67 56-100
Women (n=2474) 1609 65 54-92
National Audit Group
Treatment Number
%N Regional range %
Azithromycin 1 gram stat 2712 54 16-90
Doxycycline100mg bd 7d 1868 37 0-79
Erythromycin 500 mg bd 7d
12 0.2 0-1
Ofloxacin 200 mg bd 7d 3 0.1 0-0.4
Ofloxacin 400 mg bd 7d 6 0.1 0-0.5
Not documented 55 1 0-3
NO amoxycillin, Deteclo or oxytetracycline used
Treatment: uncomplicated infxn.
National Audit Group
Treatment: pregnant women
• Twenty of 26 pregnant women were treated with azithromycin
• ?suggests that most prescribers treating pregnant women consider that erythromycin is not an “adequate alternative” to azithromycin (the manufacturer’s advice stated by the British National Formulary
British National Formulary. [http://www.bnf.org/bnf/bnf/current/126828.htm]. (Accessed 09 February 2008)
National Audit Group
Information-givingInformation Numbe
r %N Regional range
%
Abstinence 4160 83 43-91
Chlamydia 3827 76 40-89
Written Info 2510 50 0-70
National Audit Group
Follow-up: modes of FUMode Numbe
r %N Regional range
%
‘Phone or txt 2144 43 25-64
In clinic 1985 39 22-58
No follow-up 1184 24 8-42
Not documented 46 1 0-2
Another agency 29 0.6 0-2
Not known 21 0.4 0-1
National Audit Group
Follow-up: time to FUMode Numbe
r %N Regional range
%
Same day 43 1 0-1
1-7 726 14 8-30
8-14 1366 27 10-38
15-21 531 11 5-18
22-28 262 5 3-9
29-365 533 11 4-11
Anomalous 60 1 0-2
Not reported 1529 31 11-48
National Audit Group
Partner notification Numbe
r % Regional
range %
Provided by a HA or other suitably trained HCP (%N=5032)
4577 91 86-91
Method documented (n= 4577)
4227 92 83-97
Outcome documented (n= 4577)
3394 74 59-87
National Audit Group
CEG standard for contact tracing
• Auditable Outcome Measures
• Partner notification recommendation: In 2004, a systematic review of UK GUM clinics’ work showed that a mean of 0.43 contacts per case of chlamydia were screened in large city clinics and 0.64 contacts per case of chlamydia were screened in other clinics
http://www.bashh.org/guidelines/2006/chlamydia_0706.pdf
National Audit Group
National Audit Group
Note: please look at the corresponding question in the Case notes questionnaire for this table
National Audit Group
Conclusions: 1• Largest national audit to date (more clinics)
– 187 (71%) of the 262 UK GUMed clinics plus 6 SRH clinics
• Ethnic group not always recorded 8% (0-32%)• 83% aged 19 years or over• Relatively few MSM overall (3% all cases)• About ½ cases no symptoms• 1/3 attending for routine or asymptomatic screens,
– ?implications for service provision/workload reduction
National Audit Group
Conclusions: 2• Main test used are NAATs• Main testing sites in women are cervical or vulval• 73% MSM tested for HIV, range 58-100%• Main treatment is azithromycin (54% cases), but
a lot of doxycycline is also used (37% cases)• Most pregnant women treated with azithromycin• Lack of written information provided (only 50%
cases overall)• More follow-up done by ‘phone or texting than in
clinic• 25% cases no FU
National Audit Group
Conclusions: 3
• >90% of cases having PN had this provided by a HA or other suitably trained HCP
• PN outcomes not documented for 25% cases provided with PN advice
• 40% cases not documented as having treatment verified for contact(s), with wide range 0-51%
• The national estimate of average number of contacts screened per index was 0.45, with regional performances between 0.29 to 0.73
National Audit Group… the end