PHIAC took account of a number of factors and issues in making the recommendations.
3.1 Much of the evidence is US-based. However, PHIAC considered that it was sufficiently applicable to the UK context to inform the recommendations. Members also considered the consistency of findings across the studies to assess the strength of evidence.
3.2 PHIAC recognised that one to one inventions are only one element of a broader sexual health strategy that is needed to prevent STIs and under 18 conceptions. PHIAC did not assess the relative effectiveness (and cost effectiveness) of one to one interventions versus other types of intervention.
3.3 PHIAC considered that implementation of the recommendations will make an important contribution to the modernisation of sexual health services, in line with the 'National strategy for sexual health and HIV' (DH 2001). The guidance promotes universal provision of one to one sexual health interventions for the prevention and early detection of STIs and the prevention of under 18 conceptions. This should be part of the routine care offered in primary care (including that offered by enhanced services in general practice) and by contraceptive services. One to one sexual health interventions should also be provided by pharmacists who are trained in this area. (Again, they may provide this as part of enhanced services.)
3.4 This guidance complements current developments concerned with the asymptomatic screening of STIs (such as the Chlamydia Screening Programme and HIV testing). PHIAC recognised that individuals who are at risk of STIs need a choice of options, including rapid and open access to testing services, as well as one to one sexual health advice.
It should be noted that PHIAC did not consider the effectiveness of the National Chlamydia Screening Programme. However, evidence relating to the effectiveness of one to one interventions in preventing chlamydia was considered. Specific recommendations on HIV testing and treatment were not within the scope of this guidance.
3.5 People at risk of STIs can only benefit from sexual health services if they are accessible, convenient and confidential. It is important that services are developed in consultation with the client group.
Vulnerable young people and individuals who engage in risky sexual behaviours tend not to attend primary care or community health services on a regular basis. Less traditional settings will need to be considered for the provision of sexual health services for these clients. Education, training, employment and youth services will all play an important role in pointing young people to sexual health services.
3.6 The configuration of sexual health services will be dependent on local circumstances and capacities. Local sexual health networks will need to agree a suitable model of service delivery for the prevention and treatment of STIs and the prevention of under 18 conceptions. (STI services should cover testing, risk assessment, treatment of infection, partner notification and follow up.) This model should define the respective roles of primary care, community contraception services, specialist GUM and other services.
PHIAC recognised that the recommendations do not stand alone. They should be implemented in conjunction with infection-specific prevention and treatment guidelines and protocols. When working with young people, the recommendations should be implemented with regard to the Fraser guidelines 'Gillick v West Norfolk & Wisbech AHA & DHSS (1985)' and guidance produced by the Teenage Pregnancy Unit.
3.7 The training requirements of those involved in delivering one to one sexual health interventions (within both NHS and non-NHS settings) will need to be assessed. Current training guidance and access to accredited courses should assist in meeting these requirements.