It’s feasible for sexual health clinics to take steps to
invite ‘high-risk’ patients to come back for re-screening, and doing so leads
to a high number of new diagnoses being made, London clinicians report in the December
issue of Sexually Transmitted Infections.
When they implemented the strategy with 301 gay or bisexual
men who had just been diagnosed with a bacterial sexually transmitted
infection (STI), two-thirds came back for a check-up three months later. At the
second visit, five new HIV diagnoses and 15 new STI diagnoses were made.
People who have previously been diagnosed with a sexually
transmitted infection are a group of patients who have a greater risk of having
another STI or HIV in the future. If an effective way of encouraging repeat
screening can be identified, this may allow for the early diagnosis of infections.
While a number of organisations recommend that sexually
active gay men should test for HIV “at least” once a year, UK clinical
guidelines are not clear on the frequency with which gay men who have had an
STI should re-screen. Moreover it is likely that only a minority of men come in
for a check-up every few months.
In order to increase rates of re-screening, clinicians at
the Mortimer Market Centre (a central London clinic popular with gay men) set
up a system in which patients were phoned by a health adviser and invited to
make an appointment for a check-up, three months after their last visit.
The clinic only invited gay or bisexual men who had been
diagnosed with chlamydia, gonorrhoea, syphilis or LGV. Staff made up to three
attempts to contact the patient; if an appointment was made but the patient did
not attend, the clinic attempted to arrange one more appointment.
The check-up was managed in the same way as for other gay or
bisexual men without symptoms. At the time, standard tests were for HIV, syphilis,
gonorrhoea (urethra, rectum and throat) and chlamydia (urethra).
During the nine-month evaluation period, 301 men were asked
if they would be happy for the clinic to contact them by phone in order to be
invited to make a new appointment for a check-up in the future. All men had just been diagnosed with a
bacterial STI, 9% were also HIV-positive, half reported unprotected anal sex in
the past three months, three-quarters were white, and their average age was 32.
Of the 301 patients:
- Half (153 men) came back to the clinic because of
the recall programme; 12% of this group had STI symptoms.
- One in six (53 men) came back to the clinic for
another reason; 49% had symptoms.
- Just under one third (95 men) did not come back to the clinic during the recall period. They either did not want to take part in the programme (30 men),
made an appointment but did not turn up (27), could not be reached by telephone
(21) or were no longer in the area (17).
Men with HIV were over-represented amongst those who did not come back to the clinic.
On the other hand, men who did come back for re-screening
appeared to report more unprotected sex and more sexual partners than
non-attenders. However these differences were not statistically significant in
this small study.
Several diagnoses of gonorrhoea, chlamydia and syphilis were
made at re-screening: nine in those men attending because of the programme,
and six in men attending for other reasons.
HIV was diagnosed in four men attending because of the
programme and in one man who attended for another reason. Two of these patients
had declined testing at their previous appointment; the other three had tested
negative at their previous appointment but had not noticed any seroconversion
The authors describe the incidence (rate of new infections)
as “high” for both bacterial STIs and HIV. They suggest that the identification
of recent HIV infections is particularly important as men may otherwise
inadvertently pass on their infection.
The results of this study should be considered alongside an
Australian study earlier this year which found that sending a text message
reminder to ‘high-risk’ gay men every four months increased the numbers who
returned for HIV testing during a nine-month period – from 31% to 64%.
Text messages are very simple and cheap to send through automated
procedures, while making telephone contact with patients is a more
labour-intensive approach. However the London clinicians suggest that phone
calls may result in more patients re-screening, and so be more cost-effective.
“This evaluation has demonstrated that recall for
re-screening of MSM diagnosed as having a bacterial STI is a feasible strategy
both in terms of the high rates of re-screening achieved and the number of new
diagnoses made,” they say. Further studies with control groups, which examine
cost-effectiveness, are called for, they conclude.