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To tweet or not to tweet?

4 Jul, 17 | by Leslie Goode, Blogmaster

Blog post by Katy Turner (@katymeturner)

Who is responsible for tweet etiquette at conferences? Organisers? Presenters? Tweeters?

Conference organisers can certainly set the tone for an event with pronouncements like this one:

Tweet from Trish Groves (@trished)

Clear guide #ICTMC2017 on seeking permission to blog, tweet, take pics (I should’ve read this sooner)

photo

This feels rather heavy handed and puts all the responsibility onto tweeters to “get permission” which rules out real time tweeting and could limit or even censor open discussion of ideas including the community outside conference attendees. I am going venture that the above was written by someone (or a committee of someones) who doesn’t “tweet”.

In our connected 21st century world, most conferences actively encourage tweeting. There are some excellent guidelines e.g. Ten Simple Rules of Live Tweeting at Scientific Conferences
(http://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1003789#s2). These are aimed at conference organisers e.g. choose a short hashtag (and check for unexpected clashes), publicise hashtag, encourage tweeting, use twitter to enable questions from outside and tweeters (mechanics of what to tween and how to tweet responsibly).

What about the presenters themselves? Conferences are exciting because they are a place to share new ideas with the other 3 people in the world similarly passionate about modelling sexually transmitted infections (or whatever floats your boat). Tweeting can widen and broaden the conversation and include people inside and beyond the conference. How can we continue to extend and diversify the conversation, whilst also protecting unpublished research and intellectual property?

Here are my top tips for presenters

1) Visual cues on all slides as tweetable or not

Presenters can indicate how much tweeting of their talk is acceptable. This doesn’t need to be onerous. I used the following stickers on all my slides when I had early unpublished results in a couple of slides that I didn’t want tweeted (FIgure 1). Simple to explain and use.

Figure 1 To tweet or not to tweet

photo

2) Accurate informative reference information on all slides which include published data large enough to actually read

Ideally, references will be open access so tweeters can then help publicise the research by locating references and linking during the talk (I find this really useful as a twitter consumer) as well as linking to other relevant material the tweeter may be aware of.

3) Make slides tweet- (and audience-) friendly

Large, bold graphics and clear visual message make better tweets (and slides) than a table of numbers or list of bullet points.

If you have any other ideas for making tweeting work better for you during conference season we would like to hear from you.

The PrEP ‘care continuum/cascade’: how would it look?

8 Mar, 17 | by Leslie Goode, Blogmaster

We take for granted the value of the care continuum (or ‘cascade’), now increasingly seen as the key measure of health system response to HIV (Cassell (STIs editorial)).   The application of this model to HIV has provided a benchmark for evaluation in contexts as diverse as Moscow (Wirtz & Beyrer (STIs)), South Africa (Schwartz & Baral (STIs)) or the Netherlands (van Veen & van der Sande (STIs)).   But could the same model also offer a means of evaluation in the case of other complex sexual health interventions such as PrEP (Pre-Exposure Prophylaxis)?

An on-line soon-to-be-published paper by Nunn & Chan (N&C), building on an earlier attempt by Kelley & Rosenberg (K&R), does precisely this.  An important difference from the earlier paper seems to be the more concrete definition of a larger number of steps (nine as against five) – especially in the central area of ‘uptake’ and engagement in care.  Here K&R define three stages: ‘need for awareness of PrEP and willingness to use it’, ‘need for good access to healthcare’, and ‘need for a prescription for PrEP.  N&C replace these with a more concrete conceptualization of the process in five stages involving: an occasion where PrEP access is facilitated (4); an appointment arising from that occasion where the assessment is performed (5); the prescription of PrEP, where indicated (6); the actual initiation of PrEP (i.e. when the client starts taking the pills) (7).  Also important is N&C’s substitution of two final steps – adherence (8)) then retention (9) for K&R’s single final step of ‘adherence’.  N&C point out that, whereas, with ART, ‘adherence’ is once-and-for-all and secures the ultimate goal of viral suppression, in the case of PrEP, we can envisage multiple trajectories depending on whether PrEP continues to be indicated (e.g. the client may no longer be exposed to risk).  Finally, K&R’s first step – ‘identifying at risk MSM’ – gives way to three: identifying at risk individuals (1), enhancing HIV awareness (2), enhancing PrEP awareness (3).

Is this nine-stage definition of a PrEP cascade overly “complex” (EECAAC2018)?

Answering such a question requires us to reflect on the function that the ‘cascade model’ is called upon to perform.  If the model divides up the total course of an intervention into a series of staged tasks, this is presumably because the health benefit depends on the completion of the whole intervention, yet the accomplishment of each step is necessary to the achievement of subsequent ones.  The idea of the cascade can provide a fair way of evaluating the progress of an intervention before its potential health benefits have been delivered – and can also identify the precise points at which the intervention is failing (i.e. where clients become ‘disengaged’).

It follows that each step should correspond to a potential outcome that is not inferable from previous or later outcomes but is worthy of independent evaluation.  If everyone who accesses PrEP (4) also attends an appointment at which suitability of PrEP is discussed (5), or everyone who adheres to PrEP (8) is also retained in PrEP (9), then steps (4) and (5), or steps (8) and (9), can be merged.  This is not stated in so many words by the authors of the model.  However, I would assume that it must lie at the basis of their thinking.

Improving Partner Notification with a new online tool from SXT Health CIC – by Anatole Menon-Johansson

5 May, 16 | by Jackie Cassell, Editor of STI

Improving levels of partner notification (PN) is key to reducing the transmission of STIs in the UK, but doing so has proved to be difficult, time consuming, and expensive for many. As few as 25% of sexual health care providers achieve the BASHH target of 0.6 partners seen for every patient diagnosed with an STI [1]. It’s a frustrating situation, but one that could be improved by harnessing the power of modern communications technology in the right way.

 

Extremely interesting work has already been done in this area, in the UK. In particular on Accelerated Partner Therapy (APT) [2], in which two proactive approaches towards PN have been modelled, shown to work, and to be regulation compliant. These approaches employ many non-standard techniques, including, for example, the use of SMS technology to send PIN numbers to partners. Unfortunately trials of APT have come up against significant recruitment problems and the results have been disappointing, but the new ideas and possibilities APT raises, deserve to be developed further.

 

This is what we, at SXT Health Community Interest Company (CIC) have been doing. We are a London-based social enterprise, run by sexual and reproductive health professionals, whose sponsors include Public Health England and Big Issue Invest. Our website, www.sxt.org.uk, already functions as an online signposting service, directing individuals to the right sexual and reproductive health services, based on their needs and preferences. We have just launched our interactive digital Contact Slip (idCS) – a new PN tool, carried on our website, which allows patients to decide how they want to inform sexual partners of an STI diagnosis. They can choose to do so anonymously or not, by email or text, within the clinic setting (helped by the clinician), or in private. The system gives the partner an ID number and helps them find an appropriate local clinic. It informs that clinic wherever they are in the UK (via the ID number) what the partner has been exposed to and when. It collates information on PN effectiveness (how many have been informed, seen by a health care worker) in one place. And it does all this without storing any personal information about the individuals involved.

 

We have been running a live pilot of our idCS in Lambeth and Southwark, through providers such as Guy’s & St Thomas’ NHS Foundation Trust (GSTT), King’s College Hospital, SH:24 www.sh24.org.uk, Burrell Street Clinic and Brook Clinic. Although we know we have a lot more work to do to improve the way the tool works, and to train the staff using it, we have had some encouraging results. Our tool already bears comparison with a more fully developed tool from the Netherlands, which was the subject of a cross sectional pilot study in 2012 [3]. The Dutch tool ‘Suggest-a-test’ (SAT), functioned in a similar way to our idCS – key differences being that it gave index patients the option of delivering PN via postal letter and gay dating site (as well as SMS and email); it named the STI in the initial notification (our idCS tells the partner that they have come into contact with ‘an STI’ – a clinic then uses our ID number to discover which one); and it asked partners to print their code and bring it to the STI testing centre (we assume that partners will be able to show the ID number in the email/SMS show via their smartphones). There are also, altogether, fewer steps to go through with our idCS – so that it can take as little as 60 minutes between a partner being told and being tested. The Dutch (SAT), and our (idCS) results so far, are summarized below.

 

PN tool

being used

Index

Patients

Contactable

Contacts

[CC]

Partners

Told

(%CC)

Partners opened

Link (%PT)

Partners seen in clinic (%PT) No. of clinics partners seen in
SAT (91/7) 67 402 213 (53) 124 (56) 45 (20) 2
idCS

(56/7)

203 426 149 (35) 90 (60) 35 (23) 14

 

We are encouraged that the % of contacts opening our link, and then being seen in clinic, are both slightly higher than in the case of SAT. Before our idCS undergoes a fully evaluated trial, we want to improve on these figures, and also address the markedly lower % of ‘Partners Told’ via our tool, compared with SAT. We hope that by doing so, our tool will ultimately out-perform SAT.

 

To increase number of ‘Partners Told’ via our idCS, we plan to encourage those staff currently trialing the tool to offer provider led PN (which is so far yielding much better results than patient initiated notification). We plan to introduce online training module for the staff currently using the tool. We also plan to use digital signage & marketing in clinics outlining the benefits of PN to patients, and priming them to expect to be asked about this in their consultation.

 

We hope that after refinement, testing and full evaluation, the idCS will come to be seen as an indispensible tool for the health care worker delivering PN – something that will take some of the more time-consuming aspects of the process out of their hands (the sending of notifications, the tracking of outcomes), that’ll increase their chances of success (with more options to offer patients, including an anonymous embarrassment-free way of telling partners) and will free them up to do the side of their job no online tool can do better than them – the counseling, and informed decision making. We anticipate that our idCS will save health care providers money. Current PN methods are estimated to be (in the case of Chlamydia) between £9-27 per positive index case [1], not including testing or treatment. Our tool will be available to providers at a cost of £2 per index patient they expect to diagnose annually. By taking PN online, and automating those parts of the process that can be automated, we believe we can cut costs, standardize the process across the country, improve data management, and, most important of all, improve PN rates.

 

 

1 Turner K, Adams E, Grant A, et al. Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study. BMJ 2011;342:c7250

http://www.bmj.com/content/342/bmj.c7250

 

2 Estcourt CS, Sutcliffe LJ, Copas A, et al. Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial. Sex Transm Infect 2015;91:548-554 http://sti.bmj.com/content/91/8/548.full

 

3 Hannelore M Gotz, Martijn S van Rooijen, Pjer Vriens, et al. Initial evaluation of use of an online partner notification tool for STI, called ‘suggest a test’: a cross sectional pilot study. Sex Transm Infect 2014;90(3)195-200

http://sti.bmj.com/content/90/3/195.full

Correction to Gotz et al. 90(3):195 http://sti.bmj.com/content/91/1/74.1.full

 

Editor-in-Chief Vacancy, Sexually Transmitted Infections

11 Mar, 16 | by flee

Sexually Transmitted Infections (sti.bmj.com) is the world’s longest running international journal on sexual health, publishing peer reviewed original research, descriptive epidemiology, evidence-based reviews and comment on the clinical, public health, translational, sociological and laboratory aspects of sexual health from around the world. It also has an active online presence via a regular blog, podcasts, and social media channels. The journal is owned by BMJ and is an official journal of the British Association of Sexual Health and HIV and the Australasian Chapter of Sexual Health Medicine.

Sexually Transmitted Infections seeks a new Editor-in-Chief that understands the impact that a high quality scholarly journal can have on improving knowledge and practice in sexual health. The successful candidate will recognise the need to engage the journal’s audiences at all levels, develop its print and online content, and extend its reach. They will establish a vision for the role that continues the momentum created by the current editorial team, advances the journal’s international reputation and profile, and provides engaging and informed content.
The Editor-in-Chief will report to BMJ but have final responsibility for the editorial content and strategy of the journal, with support from their appointed editorial team and the publishing team. This individual should have stature in the field of sexual health, a distinguished publication record, and editorial experience. Editorial support and training will be provided, as well as an annual honorarium. The Editor-in-Chief should expect to spend up to a day in total each week on journal-related activities.
The main responsibilities of the Editor-in-Chief include, but are not limited to:
1. Providing the highest possible quality of scientific content to augment the knowledge, impact and practice of clinicians involved in the field
2. Developing and maintaining an internationally relevant and coherent scientific strategy and vision for the journal
3. Building and maintaining a supportive team of highly qualified international colleagues to serve as members of the editorial board and reviewers
4. Encouraging submission of high quality papers
5. Ensuring the integrity of the review process and providing guidance to authors, reviewers and editorial team members as appropriate
6. Developing procedures for effective triage and review of scientific manuscripts to ensure timely and excellent support is maintained for authors and reviewers
7. Adding value to the journal by commissioning editorials, reviews, educational material and online content, and seeking opportunities to publish themed issues and supplements
8. Supervising the journal’s response to appeals, complaints, suggestions from readers and ethical problems regarding published work
9. Building and maintaining collaborative relationships with affiliated organisations to enhance the journal’s visibility and ensure it meets the needs of the readership
Joint applications will be considered from two or more individuals willing to act as a team to focus on the professional and academic aspects of the journal. Applicants need not be based in the UK and international applicants (or joint applicants based in different countries) are encouraged.
The closing date for applications is 11th April 2016. Interviews will be held in May in central London, UK, or via videoconference. It is envisaged that the outgoing Editor-in-Chief will gradually hand over responsibility for running the journal over the second half of 2016, with the successful candidate officially taking up the post from 1st January 2017. The term of office will be 5 years in the first instance.
The application should include your CV, a letter explaining your interest in the post, your views of the strengths, weaknesses, opportunities and threats for the journal (a basic analysis of the journal and its competitors), and an outline of what your editorial policy and vision might be.
Applications should be sent to Miss Lindsey Fountain, Associate Publisher at BMJ, at lfountain@bmj.com.

Should the Faculty of Sexual and Reproductive Health and Keele University Postgraduate Award in Medical Education be compulsory for GUM trainees?

30 Jan, 15 | by Leslie Goode, Blogmaster

Author: Dr Zana Ladipo, New Croft Sexual Health Centre, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK

Sexual Health services in the United Kingdom are changing from separate Genitourinary Medicine (GUM) clinics and Faculty of Sexual and Reproductive Health (FSRH) clinics to a more integrated Sexual Health service, a one-stop shop for patients. There is now a debate as to whether this may lead to a loss of expertise1 and whether it will improve patient care2 -3 and provide more career opportunities for staff.1 Of particular concern is a difference between the two career tracks in the respective opportunities they offer to acquire teaching training skills.

On the FSRH side, trainees are required to have passed their Diploma in FSRH (DFSRH) and their membership exams, and, with the planned merging of the services, are increasingly being advised to obtain the Diploma in GUM. But they have also been required to do the FSRH & Keele University Post Graduate Award in medical education (PGA Med Ed).

On the GUM side, trainees are required to achieve the GUM, HIV and FSRH diplomas.  But only some pursue a qualification in medical education, e.g. the Royal College of Physicians Certificate in Medical Education.  This represents a significant disadvantage for GUM trainees. It isn’t just that the PGA Med Ed improves teaching and feedback skills: it also enables the graduate to become a Faculty Registered Trainer (FRT) and train others towards obtaining the DFSRH, which is a compulsory qualification for both GUM and FSRH trainees. Doctors and nurses in all specialities are required to take on roles involving increasing amounts of medical education.4 Most have little formal training in this area.  In these times of austerity and budget cuts, offering training towards the DFSRH can be a useful way for a clinic to generate revenue by attracting external paying candidates as well as providing local training.

Most importantly, however, without the PGA Med Ed, GUM trainees cannot obtain FRT status. I have spoken about the PGA Med Ed to other GUM trainees, all of whom were unaware of this. Only one other GUM doctor and I attended the course in March 2014, and I think this may be due more to lack of knowledge about the course among GUM trainees rather than a lack of interest. I do not feel it should be compulsory for GUM trainees, but simply aim to increase awareness of its availability and usefulness. Information on the course can be found at the FSRH website (http://www.fsrh.org/) under ‘Training’. I hope that after reading this letter you agree that the PGA Med Ed is a worthwhile qualification for GUM specialists working in or starting an integrated service.

Dr Zana Ladipo

 

REFERENCE LIST

  1. French RS, Coope CM, Graham A, et al. One stop shop versus collaborative integration: what is the best way of delivering sexual health services?  Sex Transm Infect 2006,82;3:202-6 (STIs/French&Graham)
  2. Dawson, SG, Callander N, Roche C, et al. Integrated sexual health care: the development and review of one model of service delivery. Int J STD AIDS 2000;11:428-34 (Dawson&Roche)
  3. Kinn S, MacDonald C, Hinks S, et al. Clients and staff views on facilities and services, before and after the convergence of sexual, reproductive and women’s services. Eur J Contracept Reprod Health Care 2003;8:65-74 (Kinn&Hinks)
  4. Hutchinson, L. ABC of learning and teaching: Educational environment. BMJ 2003;326:810 (Hutchinson)

 

 

Call for papers: Trichomonas vaginalis

16 May, 12 | by Leslie Goode, Blogmaster

We’re inviting contributions for two special themed issues:

Trichomonas vaginalis – deadline 31st October 2012
Further information >>
Criminalizing contagion – deadline 14th December 2012
Further information >>

Call for papers on Criminalizing Contagion

31 Jan, 12 | by Jackie Cassell, Editor of STI

The BMJ Group journals Sexually Transmitted Infections (impact factor 3.029) and the Journal of Medical Ethics (impact factor 1.391), in conjunction with academics at the Centre for Social Ethics and Policy (University of Manchester) and the Health Ethics and Law Network (University of Southampton), would like to publish a collection of articles on the criminalization of disease and sexually transmitted infections. We invite article contributions to be published as part of this themed collection.[1]

Themes

The use of criminal law to respond to infectious disease transmission has far-reaching implications for law, policy and practice. It presupposes co-operation between clinicians and criminal justice professionals, and that people who infect others can be effectively and fairly identified and brought to justice. There is a potentially difficult relationship between criminal justice and public health bodies, whose priorities do not necessarily coincide. We are interested in receiving papers of broad interest to an international readership of medical ethics scholars and practicing clinicians on any of the following topics:

  • Legislative and policy reform on disease and sexually transmitted infections
  • Health services and the police: privacy, state interference and human rights
  • Evidence and ethics: prosecuting ‘infectious’ personal behaviours
  • Clinicians and the courts: the role of health professionals and criminal justice
  • The aims of criminalization and public health: a compatibility problem?
  • International comparative studies on disease and criminalization: policy, practice and legal issues

Publication

1. Up to eight articles will published in a special section in an issue of Sexually Transmitted Infections in 2013.

2. Two articles will be published in a special section in an issue of Journal of Medical Ethics in 2013.

All articles will be blind peer reviewed according to each individual journal’s editorial policies. Final publication decisions will rest with the Editors in Chief: Professor Jackie Cassell (STI) and Professor Julian Savulescu (JME).

Important Dates

Please submit your article to either journal no later than December 14th 2012.

Submission Instructions

For Sexually Transmitted Infections:

Articles for STI should be a maximum of 2,500 words and submitted via the journal’s website: http://sti.bmj.com/. Please choose the special issue ‘Criminalizing Contagion’ during the submission process.

For Journal of Medical Ethics:

Articles for JME should be a maximum of 3,500 words, and submitted via the journal’s website: http://jme.bmj.com/. Please choose the special issue ‘Criminalizing Contagion’ during the submission process.

Further submission instructions are on the journals’ respective websites. If you would like to discuss any aspect of your submission, including possible topics and the journals involved, please contact the guest editors in the first instance: Dr David Gurnham (David.Gurnham@manchester.ac.uk), Dr Catherine Stanton (Catherine.Stanton@manchester.ac.uk) or Dr Hannah Quirk (Hannah.Quirk@manchester.ac.uk).


[1] Some of the contributors may also be invited to present their papers at one of three sessions of a proposed ESRC seminar series on the same topic, to be organised by the guest editors. If funding for the seminar series is awarded by the ESRC (in April 2012), they will take place in winter 2012/13 and summer 2013 (Southampton), and winter 2013/14 and summer 2014 (Manchester).

Do you want to write for us?

11 Dec, 11 | by Jackie Cassell, Editor of STI

We are seeking contributions on clinical topics of interest to our readers, for the “How To” series, edited by Dr Sarah Edwards. Could you write for your colleagues on a topic of practical relevance to clinicians? Perhaps a common clinical conundrum, or an area not covered by guidelines where evidence is lacking?

If you would like to propose a topic, please send the following information to Sarah at sarah.edwards@wsh.nhs.uk

* What is the topic?
* Why is it of interest to clinical readers?
* Explain why you are well placed to write this article.
* Who will write it (this may be a less experienced clinician, supervised by a senior mentor)?
* Your suggested deadline for submitting a first draft.

British Association for Sexual Health and HIV (BASHH) conference May 2011

15 May, 11 | by Jackie Cassell, Editor of STI

This week saw the British Association of Sexual Health and HIV (BASHH) descend on Newcastle, in the North East of England, and not far from the Angel of the North, one of the wonders of Britain. This meeting, attended by over 500 sexual health clinicians, always provides an impressive array of research studies from small centres and large teaching hospitals alike.

Last year, we reported in our blog a 10 top papers session in which Steve Taylor voted best paper of the year an STI paper from Australia, reporting a decline in HPV vaccination his top paper of 2010. The audience was fascinated this year by Professor Kit Fairley’s presentation of recent Australian data from the same centre, where the 4-valent vaccine Gardasil appears to have had a dramatic effect on genital warts in the youngest cohort of women vaccinated before they became sexually active. We look forward to hearing more.

We were delighted that this year’s BASHH conference again voted an STI published initiative as a winner – this time of a prize for service innovation. Gary Brook described his team’s experience of using electronic health records to reduce time to treatment, and to improve partner notification outcomes, in two STI papers (see below).  Though many clinics now use electronic records to some degree, few have used them with such an effective and determined focus on their potential to improve clinical outcomes. For this, the team was awarded the Cathy Harman memorial prize – STI is delighted to have published this research, demonstrating real benefit for patients. You might like to listen to the podcast on this research, at STI.bmj.com

doi:10.1136/sti.2010.042432

doi:10.1136/sti.2010.042440

UK services need to be more proactive about HIV testing!

9 Apr, 11 | by Leslie Goode, Blogmaster

At the same time as the release of depressing figures by the UK Health Protection Agency (HPA) showing a doubling of the annual rate of fresh HIV diagnoses in the UK, the National Institute for Health and Clinical Excellence (NICE) has just issued two sets of recommendations on HIV prevention.
Annual figures for new diagnoses of UK-acquired HIV have risen steadily from 1,950 in 2001 to 3,780 in 2010. Three fifths of these diagnoses are “late” diagnoses (i.e. after the point treatment should have begun). The HPA places a figure of £32 million annually on the failure to prevent the 3,780 cases diagnosed this year.
Two documents have been issued by NICE containing detailed recommendations regarding the most at risk groups – respectively, men who have sex with men (MSM), and UK black Africans. The aim of both documents is to recommend a more proactive approach to HIV testing. The strategy builds on current UK guidelines (British HIV Association et al. 2008) advocating the “normalization” of HIV tests, and specifically recommending that in certain areas – e.g. where more than 2 in 1000 people have been diagnosed with HIV – tests be offered to everyone.
Specific guidance in the MSM document is directed to those capable of playing a role in different capacities. Specialist sexual health services should offer testing to all who attend. Primary and secondary care providers should recommend testing at registration or admission, not only to individuals at high risk, but to everyone in areas where there is high prevalence (more than 2 in 1000), or a large community of men having sex with men. Health care promoters are specifically urged to promote testing in their promotional literature. Finally, planning services should work in partnership with relevant local organizations to gather data, assess local need and develop a strategy in respect to both of these at risk groups.
The recommendations for black Africans, though complementary and covering some of the same ground, are differently structured and more complex. The failure of the two documents to dovetail is no doubt an unfortunate result of the differing needs of the respective groups. The latter document builds on current UK guidelines (British HIV Association 2008) recommending that HIV testing be offered to men and women from countries of high prevalence as well as the guidelines mentioned above. The different emphasis in the latter document, and the preponderance of recommendations addressed to directors and commissioners of public health, may reflect the smaller role of specialist sexual health services, on the one hand, and the real possibility (and challenge) of community engagement, on the other, with responsibility falling on public health commissioners to ensure that that the needs of high risk communities are met through the provision of primary and secondary health care services within their sphere of operation.
Recommendations to “collect information about current HIV diagnoses” may pose a challenge to public health services lacking the necessary epidemiological expertise.

National Institute for Health and Clinical Excellence, “Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among men who have sex with men”, PH34, March 2011

National Institute for Health and Clinical Excellence, “Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among black Africans in England”, PH33, March 2011

http://www.nice.org.uk/

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