Epidemiology of STIs and Unplanned Pregnancies in Tower Hamlets
Explore the epidemiology of sexually transmitted infections (STIs) and unwanted pregnancies in young people in Tower Hamlets. Learn about the aims of the Sexual Health & Contraception enhanced service to address these issues and the statistics regarding STIs, re-infection rates, teenage pregnancies, and abortion rates in the area.
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Epidemiology of STIs & unwanted pregnancies in young people in Tower Hamlets Dr Jane Hutchinson Primary care facilitator in sexual health 14thJanuary 2016
Aims of the Sexual Health & Contraception enhanced service are to increase STI screening increase diagnosis & effective management of STIs reduce the spread of STIs increase uptake of effective methods of contraception to reduce the number of unwanted pregnancies Across all ages but with specific emphasis on young people
Epidemiology of STIs in Tower Hamlets 2014 8th highest rates of STIs in England (8/326 LA) STIs diagnosed in 1961/100,000 population (797/100,000 in rest of England) 26% of those diagnosed with STI in GUM clinics were 15-24 years old (46% in rest of England) 68% of those diagnosed were male 61.5% of them were MSM Absolute number of STI diagnoses is highest in White people followed by those with Mixed ethnicity & then Asian / Asian British but rates are lowest in Asians
Young people diagnosed with an STI in TH In time period 2010-14 11.8% 15-19 yr old women & 11.8% 15-19 yr old men presenting with a new STI at GUM clinic became re- infected with an STI within 12 months teenagers may be at risk of reinfection because they lack the skills and confidence to negotiate safer sex
Teenage pregnancies Most teenage pregnancies are unplanned about 50% end in abortion For many teenagers, having a baby can result in poor outcomes for teenage parent & child in terms of health of both and poverty Rate of conceptions in under 18 yr olds is an indicator of PHOF
Teenage pregnancies in TH in 2013 Under 18 conception rate 18.7 / 1000 females aged15-17yrs (24.3/1000 in England) 227th out of 324 LAs Between 1998 2013 TH achieved 67.7% reduction in <18 conception rate 47.8% in England Among under 18 conceptions proportion leading to abortion in TH 71.6% 51.1% in England
Abortion rate in Tower Hamlets in 2014 Abortion rate 19.1 / 1,000 female population aged 15-44 yrs (16.5 in England) 41st/ 146 Upper Tier Local Authorities (UTLA) Women <25 who had an abortion in 2014 26.2% had had a previous abortion (27% in England) 76th/ 146 UTLA
Contraceptive care in SRH services in 2014 Proportion of attendances by TH residents where LARC, injectables & UDM prescribed in SRH services lower in ages <16; 16-17; 18-19 in TH compared to England
Contraceptive care in General Practice in 2014 Prescribing Analysis & Cost (PACT) data provide info on prescribable contraception from general practice Total LARCs n = 1052 (2.4% of total contraception prescribed in TH primary care) 2.8% in London; 3.7% in England Injectables n= 2336 (5.3% total contraception) 6.8% in London; 11.4% in England User Dependent Methods n = 40,738 (92.3% total contraception) 90.4% in London; 84.9% in England
Sexual health & contraception Network Integrated Service specification 2015-16
STI screening Financial incentives which apply across all ages for screening for various STIs 15 per test for Chlamydia & Gonorrhoea (up to one test per patient per quarter) 10 per blood test for HIV, Hepatitis B & syphilis (once per year) Additional incentive for those aged 15-24 in relation to Chlamydia (& Gonorrhoea) testing 5 per patient once >15% of 15-24 yr olds in Network tested
Summary of payment schedule for STI screening Activity Payment Chlamydia / Gonorrhoea screening, any age 15 (up to one test per patient per quarter) 15 per test PLUS additional incentive payment ( 5 - 10) per patient once >15% of 15- 24 yr olds in Network tested Chlamydia / Gonorrhoea screening, age 15 - 24 Blood test 10 per patient (one test per patient per year) Managing patients with positive STI results, notifying sexual partners &follow-up consultation 50 per positive For patients who have completed a course of Hepatitis B vaccine * 177.75 *Demonstrated through three injection entries on EMIS AND follow up serology (sAb) at least six weeks after completion
HIV screening (all ages) HIV screen done Networks 2012-13 2013-14 2014-15 1305 Network 1 913 1128 1731 Network 2 1296 1480 481 Network 3 111 152 677 Network 4 196 661 753 Network 5 413 357 975 Network 6 179 640 737 Network 7 392 595 279 Network 8 180 263 Totals 3680 5276 (43% inc) 6938 (32% inc)
Chlamydia & Gonorrhoea screening in 15-24 year olds April 2014 - March 2015 15-24 year olds registered with network No. chlamydia screens done % 15-24 year olds screened No. positive % positivity Network 1 7926 584 20 3.4 7.4 Network 2 5990 713 29 4.1 11.9 Network 3 4613 134 7 5.2 2.9 Network 4 3638 317 18 5.7 8.7 Network 5 3289 371 21 5.7 11.3 Network 6 5316 335 12 3.4 6.3 Network 7 5655 413 17 4.1 7.3 Network 8 4666 256 10 3.9 5.5 Total 41093 3123 134 4.3 (3.9%) 7.6 (7.1%) (2827 last year) (111 last year)
LARC payment schedule IUCD/IUS Insertion: 82 Check: Removal: 33 21.11 Implant Insertion: 43 Check: Removal: 33 21.11
LARC insertion data (from CEG; not age specific) Total number of LARC insertions (sum of all three methods) carried out in primary care 1002 (in 2013-14) 904 (in 2014-15) 9.7% decrease between the last 2 financial years mainly due to drop in number of IUCD insertions Based on activity in first 6/12, project that by end of this financial year: IUT insertions will have dropped by about 34% Implant insertions will be static
IUCD insertion (2013-14) 34 36 0 44 48 49 70 38 319 IUCD insertion (2014-15) 16 15 0 12 24 22 49 55 193 Mirena insertion (2013-14) 42 25 1 32 Mirena insertion (2014-15) 9 34 0 30 Network 1 Network 2 Network 3 Network 4 Network 5 Network 6 Network 7 Network 8 Total Network 1 Network 2 Network 3 Network 4 29 31 31 45 26 23 68 68 Network 5 Network 6 Network 7 Network 8 Total 236 258 Implant insertion (2013-14) 35 53 0 76 53 44 92 94 447 Implant insertion (2014-15) 18 43 3 94 51 80 89 75 453 Network 1 Network 2 Network 3 Network 4 Network 5 Network 6 Network 7 Network 8 Total
LARC insertions by age: 2013-14 & 2014-15 (CEG data) Age 26-30 31-35 36-40 41-45 46-55 56+ Total 13-16 17-20 21-25 348 313 206 111 101 8 2013-14 1273 0 25 161 290 250 141 97 66 5 2014-15 1072 4 27 192
Engaging with young people as a high risk group Sexually active under 25 year olds should be screened for Chlamydia every year on change of sexual partner Routine offer of a re-test at about 3/12 after treatment completion for patients who test positive for CT group at high risk of reinfection
Aims of the Sexual Health & Contraception enhanced service are to increase STI screening increase diagnosis & effective management of STIs reduce the spread of STIs increase uptake of effective methods of contraception to reduce the number of unwanted pregnancies Two things you can do to fulfil these aims 1. test at least one sexually active (young) patient per day for Chlamydia & Gonorrhoea consider putting a Chlamydia swab & urine pot on your clinic room desk at the start of each clinic 2. carry out a Contraception Review with at least one (young) female patient per day
