Quality standard

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

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

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, 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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, 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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, 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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The proportion of young people screened for chlamydia and HIV testing coverage are collected as part of the Office for Health Improvement and Disparities' 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 the Office for Health Improvement and Disparities' 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 the Office for Health Improvement and Disparities' 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 (integrated care systems, 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.

Definitions of terms used in this quality statement

Discussion about prevention and testing

Discussions should be structured on the basis of behaviour change theories and recognise people's individual needs. Discussions could include:

  • information and education about:

    • STIs

    • the impact of alcohol and drugs on sexual decision making

  • information about:

    • sexual health services available, including that they are free, confidential and open access

    • the rates of STIs to explain why some groups are at higher risk

    • the impact of stigma

  • sex-positive approaches to providing advice on the consistent and correct use of barrier methods

  • risk assessment and risk-reduction activities, for example developing personalised risk-reduction plans, identifying triggers and setting goals

  • Information Motivation Behavioural skills (IMB) model approaches and motivational interviewing techniques to guide conversations about risk reduction or safer-sex practices and address informational, motivational and skills-based barriers to change

  • activities to increase sexual self-efficacy (for example, talking about sexual consent, negotiating the use of barrier methods and negotiating sexual preferences) and broader self-efficacy (for example, self-esteem)

  • activities exploring the links between emotion and sexual behaviour, and coping skills (for example, using cognitive behavioural approaches)

  • a plan for follow-up (for example, repeated contact to review progress or make new plans).

[NICE's guideline on reducing sexually transmitted infections, recommendations 1.1.8, 1.1.9 and 1.2.8]

People at risk of sexually transmitted infections

People are most at risk of STIs if they are involved in higher rates of condomless sex with multiple partners or frequently change partners. There may be more people practising these behaviours in some groups than others, but this does not mean that everyone in the group is necessarily at higher risk. For example, gay, bisexual and other men who have sex with men are a higher risk group for STIs and HIV, but this does not mean that every person in that group is at higher risk. [NICE's guideline on reducing sexually transmitted infections, terms used in this guideline]

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.