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Brief Summary

GUIDELINE TITLE

One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups.

BIBLIOGRAPHIC SOURCE(S)

  • National Institute for Health and Clinical Excellence (NICE). One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Feb. 50 p. (Public health intervention guidance; no. 3). [15 references]

GUIDELINE STATUS

This is the current release of the guideline.

In March 2010, these recommendations will be reviewed and the state of the evidence base at that time will be reassessed. A decision will then be made about whether it is appropriate to update the guidance. If it is not updated at that time, the situation will be reviewed again in March 2012.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

This document constitutes the Institute's formal guidance on one to one interventions to prevent sexually transmitted infections (STIs) and under 18 conceptions. The recommendations in this section are presented without any reference to evidence statements. Appendix A in the original guideline document repeats the recommendations and lists their linked evidence statements.

Recommendation 1

Who is the target population?

Key groups at risk of STIs including:

  • Men who have sex with men
  • People who have come from or who have visited areas of high human immunodeficiency virus (HIV) prevalence

Behaviours that increase the risk of STIs include:

  • Misuse of alcohol and/or substances
  • Early onset of sexual activity
  • Unprotected sex and frequent change of and/or multiple sexual partners

Who should take action?

Health professionals working in:

  • General practice
  • Genito-urinary medicine (GUM)
  • Community health services (including community contraceptive services)
  • Voluntary and community organisations
  • School clinics

What action should they take?

  • Identify individuals at high risk of STIs using their sexual history. Opportunities for risk assessment may arise during consultations on contraception, pregnancy or abortion, and when carrying out a cervical smear test, offering an STI test or providing travel immunisation. Risk assessment could also be carried out during routine care or when a new patient registers.
  • Have one to one structured discussions with individuals at high risk of STIs (if trained in sexual health), or arrange for these discussions to take place with a trained practitioner.

Recommendation 2

Who is the target population?

Key groups at risk of STIs including:

  • Men who have sex with men
  • People who have come from or who have visited areas of high HIV prevalence

Behaviours that increase the risk of STIs include:

  • Misuse of alcohol and/or substances
  • Early onset of sexual activity
  • Unprotected sex and frequent change of and/or multiple sexual partners

Who should take action?

Health professionals trained in sexual health who work in:

  • General practice
  • GUM
  • Community health services (including community contraceptive services)
  • Voluntary and community organisations
  • School clinics

What action should they take?

  • Have one to one structured discussions with individuals at high risk of STIs. The discussions should be structured on the basis of behaviour change theories. They should address factors that can help reduce risk-taking and improve self-efficacy and motivation. Ideally, each session should last at least 15–20 minutes. The number of sessions will depend on individual need.
  • For details of a range of behaviour change theories see Predicting Health Behaviour by Mark Conner and Paul Norman.

Recommendation 3

Who is the target population?

Patients with an STI

Who should take action?

  • Health professionals working in general practice, GUM and community health services (including community contraceptive services), voluntary and community organisations and school clinics. (However, they may need to refer the patient to a specialist.)
  • Specialists with responsibility for helping to contact, test and treat partners of patients with an STI (partner notification). They may be sexual health advisers, general practitioners or practice nurses providing enhanced sexual health services, chlamydia screening coordinators or GUM clinicians.

What action should they take?

  • Help patients with an STI to get their partners tested and treated (partner notification), when necessary. This support should be tailored to meet the patient's individual needs.
  • If necessary, refer patients to a specialist with responsibility for partner notification. (Partner notification may be undertaken by the health professional or by the patient.)
  • Provide the patient and their partners with infection-specific information, including advice about possible re-infection. For chlamydia infection, also consider providing a home sampling kit.

Recommendation 4

Who is the target population?

Population served by a Primary Care Trust (PCT)

Who should take action?

PCT commissioners

What action should they take?

  • Ensure that sexual health services, including contraceptive and abortion services, are in place to meet local needs. All services should include arrangements for the notification, testing, treatment and follow-up of partners of people who have an STI (partner notification).
  • Define the role and responsibility of each service in relation to partner notification (including referral pathways).
  • Ensure staff are trained.
  • Ensure there is an audit and monitoring framework in place.

Recommendation 5

Who is the target population?

Vulnerable young people aged under 18. This may include young people:

  • From disadvantaged backgrounds
  • Who are in – or leaving – care
  • Who have low educational attainment

For a more detailed definition of vulnerable young people see Department for Education and Skills (2006) "Teenage Pregnancy: Accelerating the Strategy to 2010."

Who should take action?

  • GPs, nurses and other clinicians working in healthcare settings such as primary care, community contraceptive services, antenatal and postnatal care, abortion and GUM services, drug/alcohol misuse and youth clinics, and pharmacies
  • GPs, nurses and other clinicians working in non-healthcare settings such as schools and other education and outreach centres

What action should they take?

  • Where appropriate, provide one to one sexual health advice on:
    • How to prevent and/or get tested for STIs and how to prevent unwanted pregnancies
    • All methods of reversible contraception, including long-acting reversible contraception (LARC) (in line with National Institute for Health and Clinical Excellence (NICE) clinical guideline 30)
    • How to get and use emergency contraception
    • Other reproductive issues and concerns
  • Provide supporting information on the above in an appropriate format.

Recommendation 6

Who is the target population?

Vulnerable young women aged under 18 who are pregnant or who are already mothers. This may include young women:

  • From disadvantaged backgrounds
  • Who are in – or leaving – care
  • Who have low educational attainment

For a more detailed definition of vulnerable young people see Department for Education and Skills (2006) "Teenage Pregnancy: Accelerating the Strategy to 2010."

Who should take action?

  • Midwives and health visitors who provide antenatal, postnatal and child development services

What action should they take?

  • Regularly visit vulnerable women aged under 18 who are pregnant or who are already mothers.
  • Discuss with them and their partner (where appropriate) how to prevent or get tested for STIs and how to prevent unwanted pregnancies. The discussion should cover:
    • All methods of reversible contraception, including LARC (in line with NICE clinical guideline 30), and how to get and use emergency contraception
    • Health promotion advice, in line with NICE guidance on postnatal care (NICE clinical guideline 37)
    • Opportunities for returning to education, training and employment in the future
  • Provide supporting information in an appropriate format.
  • Where appropriate, refer the young woman to the relevant agencies, including services concerned with reintegration into education and work.

CLINICAL ALGORITHM(S)

The original guideline document contains a clinical algorithm for one to one interventions to prevent STIs and under 18 conceptions.

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type and quality of supporting evidence is identified and graded for each recommendation (see Appendix A in the original guideline document).

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • National Institute for Health and Clinical Excellence (NICE). One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Feb. 50 p. (Public health intervention guidance; no. 3). [15 references]

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2007 Feb

GUIDELINE DEVELOPER(S)

National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.]

SOURCE(S) OF FUNDING

National Institute for Health and Clinical Excellence (NICE)

GUIDELINE COMMITTEE

NICE Project Team
Public Health Interventions Advisory Committee (PHIAC)

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

NICE Project Team Members: Mike Kelly, CPHE Director; Antony Morgan, Associate Director; Geraldine McCormick, Analyst; Amanda Killoran, Analyst; Bhash Naidoo, Technical Adviser (Health Economics)

Public Health Interventions Advisory Committee (PHIAC) Members: Mrs Cheryll Adams, Professional Officer for Research and Practice Development with the Community Practitioners' and Health Visitors' Association (CPHVA); Professor Sue Atkinson, CBE Independent Consultant and Visiting Professor in the Department of Epidemiology and Public Health, University College London; Professor Michael Bury, Emeritus Professor of Sociology at the University of London and Honorary Professor of Sociology at the University of Kent; Professor Simon Capewell, Chair of Clinical Epidemiology, University of Liverpool; Professor K K Cheng, Professor of Epidemiology, University of Birmingham; Mr Philip Cutler, Forums Support Manager, Bradford Alliance on Community Care; Professor Brian Ferguson, Director of the Yorkshire and Humber Public Health Observatory; Professor Ruth Hall, Regional Director, Health Protection Agency, South West; Ms Amanda Hoey, Director, Consumer Health Consulting Limited; Mr Andrew Hopkin, Senior Assistant Director for Derby City Council; Dr Ann Hoskins, Deputy Regional Director of Public Health for NHS North West; Ms Muriel James, Secretary for the Northampton Healthy Communities Collaborative and the King Edward Road Surgery Patient Participation Group; Professor David R Jones, Professor of Medical Statistics in the Department of Health Sciences, University of Leicester; Dr Matt Kearney, General Practitioner, Castlefields, Runcorn and GP Public Health Practitioner, Knowsley; Ms Valerie King, Designated Nurse for Looked After Children for Northampton PCT, Daventry and South Northants PCT and Northampton General Hospital, Public Health Skills Development Nurse for Northampton PCT; Dr Catherine Law (Chair) Reader in Children's Health, Institute of Child Health, University College London; Ms Sharon McAteer, Health Promotion Manager, Halton PCT; Professor Klim McPherson, Visiting Professor of Public Health Epidemiology, Department of Obstetrics and Gynaecology, University of Oxford; Professor Susan Michie, Professor of Health Psychology, BPS Centre for Outcomes Research & Effectiveness, University College London; Dr Mike Owen, General Practitioner, William Budd Health Centre, Bristol; Ms Jane Putsey, Lay Representative, Chair of Trustees of the Breastfeeding Network; Dr Mike Rayner, Director of British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford; Mr Dale Robinson, Chief Environmental Health Officer, South Cambridgeshire District Council; Professor Mark Sculpher, Professor of Health Economics at the Centre for Economics (CHE), University of York; Dr David Sloan, Retired Director of Public Health; Dr Dagmar Zeuner, Consultant in Public Health, Islington PCT

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

All members of the Public Health Interventions Advisory Committee are required to make an oral declaration all potential conflicts of interest at the start of the consideration of each public health intervention appraisal. These declarations will be minuted and published on the National Institute for Health and Clinical Excellence (NICE) website.

Members are required to provide in writing an annual statement of current conflicts of interests, in accordance with the Institute's policy and procedures.

Potential members of the Public Health Programme Development Groups (PDG), and any individuals having direct input into the guidance (including expert peer reviewers), should provide a formal written declaration of personal interests. A standard form has been developed for this purpose which also includes the Institute's standard policy for declaring interests. This declaration of interest form should be completed before any decision about the involvement of an individual is taken.

Any changes to a Group member's declared conflicts of interests should also be recorded at the start of each PDG meeting. The PDG Chair should determine whether these interests are significant.

If a member of the PDG has a possible conflict of interest with only a limited part of the guidance development or recommendations, that member may continue to be involved in the overall process but should withdraw from involvement in the area of possible conflict. This action should be documented and be open to external review. If it is considered that an interest is significant in that it could impair the individual's objectivity throughout the development of public health guidance, he or she should not be invited to join the group.

GUIDELINE STATUS

This is the current release of the guideline.

In March 2010, these recommendations will be reviewed and the state of the evidence base at that time will be reassessed. A decision will then be made about whether it is appropriate to update the guidance. If it is not updated at that time, the situation will be reviewed again in March 2012.

GUIDELINE AVAILABILITY

AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

  • Prevention of sexually transmitted infections and under 18 conceptions. Quick reference guide. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Feb. 6 p. (Public Health Intervention Guidance 3). Available in Portable Document Format (PDF) from the National Institute for Health and Clinical Excellence (NICE) Web site.
  • Costing template: one to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV and to reduce the rate of under 18 conceptions especially among vulnerable and at risk groups. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Feb. Various p. (Public Health Intervention Guidance 3). Available in Portable Document Format (PDF) from the NICE Web site.
  • Costing report: one to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV and to reduce the rate of under 18 conceptions especially among vulnerable and at risk groups. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Feb. 36 p. (Public Health Intervention Guidance 3). Available in Portable Document Format (PDF) from the NICE Web site.
  • Slide set: one to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 May. 26 p. (Public Health Intervention Guidance 3). Available in Portable Document Format (PDF) from the NICE Web site.
  • Implementation advice: one to one interventions to reduce the transmission of sexually transmitted infections (STI)s including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 May. 22 p. (Public Health Intervention Guidance 3). Available in Portable Document Format (PDF) from the NICE Web site.
  • Audit criteria: one to one interventions to reduce the transmission of sexually transmitted infections (STI)s including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Apr. 17 p. (Public Health Intervention Guidance 23). Available from the NICE Web site.
  • Methods for development of NICE public health guidance. London (UK): National Institute for Health and Clinical Excellence (NICE); 2006 Mar. 131 p. Electronic copies: Available in Portable Document Format (PDF) from the NICE Web site.

Print copies: Available from the National Health Service (NHS) Response Line 0870 1555 455. ref: N1186. 11 Strand, London, WC2N 5HR.

PATIENT RESOURCES

None available

NGC STATUS

This summary was completed by ECRI on June 18, 2007. The information was verified by the guideline developer on July 16, 2007.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

DISCLAIMER

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