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,
UK
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.
