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National audit of Syphilis management and Impact of COVID 19
Sexually Transmitted Infections ; 98(Suppl 1):A81-A82, 2022.
Article in English | ProQuest Central | ID: covidwho-2020311
ABSTRACT
IntroductionThe 2021 SAS Group national audit focused on management of Syphilis, following a previous National Audit Group audit in 2017. The main aim was to assess performance against auditable outcomes specified in 2015 BASHH guidelines, with a secondary aim of assessing the impact of the covid-19 pandemic.MethodsThe audit comprised a survey comparing clinic policy and practice pre- and during the pandemic, anda case-note review of the last 30 adults (≥16) per clinical service diagnosed with syphilis between 1st March and 31st December 2020 or all if fewer than 30.Responses were received from 53 services.Results•In the clinic survey, a minority of services reported changes between pre- and during the pandemic1. Reduced availability/use of dark field microscopy2. Increased availability/use of rapid antibody testing3. Reductions in follow-up screening4. Shift to doxycycline for early syphilis5. Reduced access to provider referral for PNCase notes review highlighted•91.6% had a pre-treatment quantitative RPR/VDRL.•95.0% adhered fully to a recommended regimen.•Only 80.2% of had agreed contact outcomes, or decision not to contact, documented for each of their contacts.•Of individuals who tested HIV negative at presentation with early syphilis, 68.2% were re-tested 3weeks to 6 months later.DiscussionThere were larger differences between results of this audit and the 2017 one, possibly reflecting the smaller number of participating services.At a national level despite the pandemic management of syphilis was generally good, although recommended 97% standards were missed.Availability of diagnostics 2017 BASHH audit (N=160) Pre-pandemic Mar-Dec 2020 Dark ground microscopy Available and routinely used in suitable cases Available but not routinely used 36.2% 30.6% 11 (20.8%) 14 (26.4%) 6 (11.3%) 13 (24.5%) Access to treponemal PCR Available and routinely used in suitable cases Available but not routinely used 53.7% 18.7% 37 (69.8%) 6 (11.3%) 36 (67.9%) 7 (13.2%) Treponemal EIA/CLIA able to detect IgG* Available and routinely used in suitable cases Available but not routinely used 98.1% 0.0% 50 (94.3%) 0 (0.0%) 48 (90.6%) 3 (5.7%) Treponemal EIA/CLIA able to detect IgM* Available and routinely used in suitable cases Available but not routinely used 90.6% 8.1% 43 (81.1%) 5 (9.4%) 45 (84.9%) 6 (11.3%) TPPA Available and routinely used in suitable cases Available but not routinely used 96.9% 0.6% 51 (96.2%) 0 (0.0%) 51 (96.2%) 2 (3.8%) Rapid treponemal antibody testing Available and routinely used in suitable cases Available but not routinely used 30.0% 9.4% 16 (30.2%) 3 (5.7%) 18 (34.0%) 5 (9.4%) Clinic policy 2017 BASHH audit (N=160) Pre-pandemic Mar-Dec 2020 Repeat syphilis screening 6 weeks after a single high risk exposure Formal policy Not formal policy but routinely recommended 26.9% 48.8% 13 (24.5%) 21 (39.6%) 11 (20.8%) 19 (35.8%) Repeat syphilis screening 12 weeks after a single high risk exposure Formal policy Not formal policy but routinely recommended 58.1% 33.7% 36 (67.9%) 16 (30.2%) 36 (67.9%) 16 (30.2%) Three-monthly syphilis screening in individuals with frequent high risk exposure Formal policy Not formal policy but routinely recommended 46.2% 46.9% 31 (58.5%) 20 (37.7%) 31 (58.5%) 19 (35.8%) Repeat screening two weeks after presentation in those with dark field or PCR negative ulcerative lesions that could be due to syphilis Formal policy Not formal policy but routinely recommended 26.9% 56.2% 16 (30.2%) 22 (41.5%) 13 (24.5%) 22 (41.5%) Quantitative RPR/VDRL measurement three months after treatment for early syphilis Formal policy Not formal policy but routinely recommended 80.0% 19.4% 47 (88.7%) 5 (9.4%) 43 (81.1%) 6 (11.3%) Quantitative RPR/VDRL measurement six months after treatment for early syphilis Formal policy Not formal policy but routinely recommended 79.4% 18.7% 44 (83.0%) 4 (7.55) 38 (71.7%) 6 (11.3%) Follow-up HIV testing after one month for individuals who test HIV negative on presenting with early syphilis Formal policy Not formal olicy but routinely recommended 39.4% 51.9% 16 (30.2%) 21 (39.6%) 15 (28.3%) 20 (37.7%) Preferred or usual treatment for early syphilis 2017 BASHH audit (N=160) Pre-pandemic Mar-Dec 2020 IM benzathine penicillin 100.0% 52 (98.1%) 47 (88.7%) Doxycycline 0.0% 0 (0.0%) 4 (7.5%) Other 0.0% 1 (1.9%)* 2 (3.8%)** *Based on individual situation;**one both, one based on individual situation.Methods of partner notification available 2017 BASHH audit (N=160) Pre-pandemic Mar-Dec 2020 Patient referral 99.4% 52 (98.1%) 52 (98.1%) Provider referral 97.5% 48 (90.6%) 45 (84.9%) Electronic means of contact 28.7% 15 (28.3%) 15 (28.3%) Stage of syphilis 2017 BASHH audit (N=3017) 2021 SAS Group audit Your service Early asymptomatic/incubating Primary Secondary Early latent Late latent Tertiary Not answered 9.1% 34.6% 25.7% 29.4% NA NA 1.2% 96 (6.6%) 388 (26.7%) 262 (18.0%) 340 (23.4%) 341 (23.5%) 16 (1.1%) 11 (0.8%) RPR or VDRL titre obtained pre-treatmentKey

outcome:

The percentage of confirmed syphilis cases having a record of a RPR or VDRL titre obtained pre-treatment (standard 97% confirmed syphilis cases) 2017 BASHH audit (N=3017) 2021 SAS Group audit Your service Pre-treatment quantitative RPR/VDRL obtained Of which, on day of starting treatment Not done Not answered 94.8% 56.4% 2.7% 2.6% 1332 (91.6%) 1011 (69.5%) 28 (1.9%) 94 (6.5%) Key

outcome:

The percentage of confirmed syphilis cases having fully adhered to a recommended treatment (standard 97% confirmed syphilis cases) 2017 BASHH audit (N=3017) 2021 SAS Group audit 2021 SAS Group audit (early syphilis only) Your service Excluded from outcome because treated elsewhere/previously treated Denominator for this outcome 14 3003 (100.0%) 10 1444 (100.0%) 4 1082 (100.0%) Single dose stat regimen Fully adhered to other regimen Subtotal outcome met 85.0% 11.6% 96.7% 900 (62.3%) 472 (32.7%) 1372 (95.0%) 889 (82.2%) 166 (15.3%) 1055 (97.5%) Did not fully adhere Suitable regimen not reported Not treated Not documented/not known/not answered 0.4% 0.3% 0.3% 2.3% 26 (1.8%) 0 (0.0%) 1 (0.1%) 45 (3.1) 5 (0.5%) 0 (0.0%) 0 (0.0%) 22 (2.0%) Partner notificationNumber of contacts within relevant lookback period 2021 SAS Group audit Your service 0 1 2 3 4 5 6-10 11-20 21 or more Not answered 81 (5.6%) 583 (40.1%) 368 (25.3%) 134 (9.2%) 73 (5.0%) 54 (3.7%) 80 (5.5%) 23 (1.6%) 21 (1.4%) 37 (2.5%) Key

outcome:

The percentage of cases having the outcome of (an) agreed contact action(s), or the decision not to contact, documented for all contacts, within the appropriate look back interval (standard 97% confirmed syphilis cases) 2017 BASHH audit (N=3017) 2021 SAS Group audit 2021 SAS Group audit (early syphilis only) Your service Done Not done Not sure Not answered 73.8% 17.6% 5.6% 2.9% 1166 (80.2%) 183 (12.6%) 75 (5.2%) 30 (2.1%) 876 (80.7%) 138 (12.7%) 48 (4.4%) 24 (2.2%)
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Full text: Available Collection: Databases of international organizations Database: ProQuest Central Type of study: Experimental Studies Language: English Journal: Sexually Transmitted Infections Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: ProQuest Central Type of study: Experimental Studies Language: English Journal: Sexually Transmitted Infections Year: 2022 Document Type: Article