Quality statement 2: Discussing prevention and testing with people who are at risk of sexually transmitted infections

Quality statement

People identified as being at risk of sexually transmitted infections have a discussion about prevention and testing.

Rationale

Discussing how to prevent and be tested for sexually transmitted infections (STIs) can increase opportunities for testing and harm reduction. A structured discussion can help identify and reduce behaviours that put a person at risk of STIs.

Quality measures

Structure

a) Evidence of local arrangements to ensure that trained healthcare professionals are available to discuss behaviour change with people identified as being at risk of STIs.

Data source: Local data collection, such as training records and staff rotas.

b) Evidence of local processes to ensure that people identified as being at risk of STIs have a discussion about prevention and testing.

Data source: Local data collection, such as service protocols.

Process

Proportion of people identified as being at risk of STIs who have a discussion about prevention and testing.

Numerator – the number in the denominator who have a discussion about prevention and testing.

Denominator – the number of people identified as being at risk of STIs.

Data source: Local data collection. Documenting that a discussion has taken place could form part of an electronic health record.

Outcome

a) Coverage of testing for STIs: proportion of people attending the service who are tested for STIs.

Data source: Local data collection, for example, the proportion of young people screened for chlamydia and HIV testing coverage are collected as part of Public Health England's Sexual and reproductive health profiles.

b) New STI diagnoses (excluding chlamydia in people aged under 25) per 100,000 people aged 15 to 64.

Data source: These data are collected as part of Public Health England's Sexual and reproductive health profiles.

c) Chlamydia detection rate per 100,000 people aged 15 to 24.

Data source: These data are collected as part of Public Health England's Sexual and reproductive health profiles.

What the quality statement means for different audiences

Service providers (such as primary care services, contraceptive services, genitourinary medicine clinics and community sexual health services) ensure that they have healthcare professionals trained in sexual health who discuss the prevention of and testing for STIs with people identified as being at risk. Service providers should ensure that healthcare professionals signpost people at risk to high-quality supporting information and services, including online sexual health services.

Healthcare professionals (such as GPs, midwives, practice nurses and doctors who work in sexual health services) have one-to-one structured discussions with people identified as being at risk of STIs about how they can reduce their risk and how to get tested. Healthcare professionals should signpost people at risk to high-quality supporting information and services, including online sexual health services.

Commissioners (clinical commissioning groups, local authorities and NHS England) work together to ensure that they commission a range of services that provide information on the prevention of and testing for STIs to people identified as being at risk. Commissioners ensure that services that engage with people who are less likely to attend primary care or sexual health services are included.

People who are at risk of getting an STI talk to their healthcare professional about how to prevent STIs. They should also be given information about how to get tested for STIs and where to get further advice.

Source guidance

Definitions of terms used in this quality statement

Discussion about prevention and testing

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 to 20 minutes. The number of sessions will depend on individual need.

[NICE's guideline on sexually transmitted infections and under-18 conceptions: prevention, recommendation 2]

People at risk of sexually transmitted infections

This includes the following key groups and behaviours:

  • men who have sex with men

  • people who have come from or who have visited areas of high HIV prevalence

  • people who misuse alcohol or substances, or both

  • people who have early onset of sexual activity

  • people who have condomless sex and frequently change or have multiple sexual partners.

[NICE's guideline on sexually transmitted infections and under-18 conceptions: prevention, recommendation 2]

Equality and diversity considerations

A discussion about prevention and testing for STIs should be age appropriate and accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English, or who have reduced literacy skills. People should have access to an interpreter or advocate if needed.

Healthcare professionals should be trained to identify and respond to the specific needs of lesbian, gay, bisexual, and transgender people when discussing prevention and testing for STIs.