Audit of sexual and reproductive health care provided to HIV positive women within an integrated sexual health service

Audit of sexual and reproductive health care provided to HIV positive

women within an integrated sexual health service

F. Hawkins, B. Brett, N. Callander, N. Desmond, P. Benn, S. Dawson

The Sexual Health Service, The Garden Clinic, Upton Hospital, Slough PCT,


Introduction: In the United Kingdom since 1999, the number of new HIV

diagnoses among heterosexual men and women has exceeded that among homosexual

men. There has been a six-fold increase in the cohort of HIV positive men and

women attending The Garden Clinic, Slough since 1997. HIV positive women have

sexual and reproductive health care (SRHC) needs in addition to management of

their HIV infection.

Aims: To audit the provision of SRHC against locally agreed standards,

which are in keeping with DoH guidelines (MedFASH, 2003). To describe changes

implemented in SRHC provision following this audit.

Methods: A retrospective case note review of all female HIV positive

patients diagnosed in 2002 (n=30). Details regarding screening for sexually

transmitted infections (STIs), cervical cytology, contraception, and

pre-conceptual care within the six months following diagnosis were collected

using a standard proforma.

Results: Of the 30 women, 27 (90%) were Black African, including 18

from Zimbabwe. Partner’s HIV status was recorded in 27/30 (90%), 7/30 (23%)

were HIV-positive, 3/30 (10%) HIV-negative, and 11/30 (37%) of unknown status.

Six women (20%) had no partner. Use of a barrier was recorded in 15/30 (50%),

however of those with known or potentially discordant HIV status only 6/14

(42.9%) reported using condoms. STI screening had been done in 21/30 (70%) in

the previous year and cervical cytology history was documented in 22/30 (73.3%)

women. 19/22 (86%) had had cytology taken in the previous year; 2/22 (9%) were

overdue, 1/22 (5%) was pregnant and therefore cytology deferred. Contraceptive

method was recorded in 23/ 28 (82%). Two women were postmenopausal. Only six

patients were using long-term methods; three an injectable, one an implant, one

an IUD, and one woman had been sterilised. Nine were using condoms, two the COC

and six had no partner. EC was discussed in six patients and supplied in advance

to two. Preconception advice was documented in only two individuals.

Conclusions: For most, screening for STIs and cervical cytology was

undertaken and contraceptive method documented. This was only the case in a

minority regarding preconceptual advice and EC. A specialist clinic for SRHC has

now been established and a new HIV proforma with prompts regarding STIs,

cytology and contraception has been introduced. Further data is currently being

collected following these interventions.

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