Skip to main content
Top
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison

Authors: Nicole HTM Dukers-Muijrers, Carlijn Somers, Christian JPA Hoebe, Selwyn H Lowe, Anne-Marie EJWM Niekamp, Astrid Oude Lashof, Cathrien AMVH Bruggeman, Hubertus JM Vrijhoef

Published in: BMC Public Health | Issue 1/2012

Login to get access

Abstract

Background

Hospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration.

Methods

The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM) attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254), and quality rating.

Results

Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals). Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good.

Conclusions

The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.
Appendix
Available only for authorised users
Literature
2.
go back to reference Hutchinson J, Goold P, Wilson H, Jones K, Estcourt C: Sexual health care of HIV-positive patients: an audit of a local service. Int J STI AIDS. 2003, 14: 493-10.1258/095646203322025821.CrossRef Hutchinson J, Goold P, Wilson H, Jones K, Estcourt C: Sexual health care of HIV-positive patients: an audit of a local service. Int J STI AIDS. 2003, 14: 493-10.1258/095646203322025821.CrossRef
3.
go back to reference Farley TA, Cohen DA, Wu SY, Besch CL: The value of screening for sexually transmitted diseases in an HIV clinic. J Acquir Immune Defic Syndr. 2003, 33: 642-648. 10.1097/00126334-200308150-00014.CrossRefPubMed Farley TA, Cohen DA, Wu SY, Besch CL: The value of screening for sexually transmitted diseases in an HIV clinic. J Acquir Immune Defic Syndr. 2003, 33: 642-648. 10.1097/00126334-200308150-00014.CrossRefPubMed
4.
go back to reference Gruskin S, Ferguson L, O'Malley J: Ensuring sexual and reproductive health for people living with HIV: an overview of key human rights, policy and health systems issues. Reprod Health Matters. 2007, 15: 4-26. 10.1016/S0968-8080(07)29028-7.CrossRefPubMed Gruskin S, Ferguson L, O'Malley J: Ensuring sexual and reproductive health for people living with HIV: an overview of key human rights, policy and health systems issues. Reprod Health Matters. 2007, 15: 4-26. 10.1016/S0968-8080(07)29028-7.CrossRefPubMed
6.
go back to reference Soni S: White JA: Self-Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in the Human Immunodeficiency Virus Clinic. High Yields and High Acceptability. Sex Trans Dis. 2011, 38: 1107-1109. 10.1097/OLQ.0b013e31822e6136.CrossRef Soni S: White JA: Self-Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in the Human Immunodeficiency Virus Clinic. High Yields and High Acceptability. Sex Trans Dis. 2011, 38: 1107-1109. 10.1097/OLQ.0b013e31822e6136.CrossRef
7.
go back to reference Church K, Lewin S: Delivering integrated HIV services: time for a client-centred approach to meet the sexual and reproductive health needs of people living with HIV?. AIDS. 2010, 24: 189-193. 10.1097/QAD.0b013e328333aeb3.CrossRefPubMed Church K, Lewin S: Delivering integrated HIV services: time for a client-centred approach to meet the sexual and reproductive health needs of people living with HIV?. AIDS. 2010, 24: 189-193. 10.1097/QAD.0b013e328333aeb3.CrossRefPubMed
8.
go back to reference Heller R, Fernando I, MacDougall M: Factors associated with a clinician’s offer of screening HIV-positive patients for sexually transmitted infections, including syphilis. Int J STI AIDS. 2011, 22: 351-352. 10.1258/ijsa.2010.010410.CrossRef Heller R, Fernando I, MacDougall M: Factors associated with a clinician’s offer of screening HIV-positive patients for sexually transmitted infections, including syphilis. Int J STI AIDS. 2011, 22: 351-352. 10.1258/ijsa.2010.010410.CrossRef
9.
go back to reference Esler D, Ooi C: Adressing sexually transmissible infection in HIV-positive patients. A clinical audit. Sex Health. 2007, 4: 75-76. 10.1071/SH06059.CrossRefPubMed Esler D, Ooi C: Adressing sexually transmissible infection in HIV-positive patients. A clinical audit. Sex Health. 2007, 4: 75-76. 10.1071/SH06059.CrossRefPubMed
10.
go back to reference Carne C, McClean H, Bunting P, Wilkins E, Tucker L, Baguley S, et al: UK national audit of sexual health care for people with HIV infection: case-notes audit. Int J STI AIDS. 2007, 18: 639-642. 10.1258/095646207781568547.CrossRef Carne C, McClean H, Bunting P, Wilkins E, Tucker L, Baguley S, et al: UK national audit of sexual health care for people with HIV infection: case-notes audit. Int J STI AIDS. 2007, 18: 639-642. 10.1258/095646207781568547.CrossRef
11.
go back to reference Teague R, Mijch A, Fairley CK, Sidat M, Watson K, Boyd K, et al: Testing rates for sexually transmitted unfections among HIV-infected men who have sex with men attending two different HIV services. Int J STI AIDS. 2008, 19: 200-202. 10.1258/ijsa.2007.007131.CrossRef Teague R, Mijch A, Fairley CK, Sidat M, Watson K, Boyd K, et al: Testing rates for sexually transmitted unfections among HIV-infected men who have sex with men attending two different HIV services. Int J STI AIDS. 2008, 19: 200-202. 10.1258/ijsa.2007.007131.CrossRef
12.
go back to reference Vriend HJ, Koedijk FD, van den Broek IVF, van Veen MG, Op de Coul EL, van Sighem AI, et al: Sexually transmitted infections, including HIV, in the Netherlands in 2010. 2011, Bilthoven, the Netherlands: Centre for Infectious Disease Control - National Institute for Public Health and the Environment (RIVM) Vriend HJ, Koedijk FD, van den Broek IVF, van Veen MG, Op de Coul EL, van Sighem AI, et al: Sexually transmitted infections, including HIV, in the Netherlands in 2010. 2011, Bilthoven, the Netherlands: Centre for Infectious Disease Control - National Institute for Public Health and the Environment (RIVM)
13.
go back to reference Kalichman SC, Pellowski J, Turner C: Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention. Sex Transm Infect. 2011, 87: 183-190. 10.1136/sti.2010.047514.CrossRefPubMedPubMedCentral Kalichman SC, Pellowski J, Turner C: Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention. Sex Transm Infect. 2011, 87: 183-190. 10.1136/sti.2010.047514.CrossRefPubMedPubMedCentral
14.
go back to reference Fleming DT: Wasserheit JN; From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999, 75: 3-17. 10.1136/sti.75.1.3.CrossRefPubMedPubMedCentral Fleming DT: Wasserheit JN; From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999, 75: 3-17. 10.1136/sti.75.1.3.CrossRefPubMedPubMedCentral
15.
go back to reference Ng BE, Butler LM, Horvath T, Rutherford GW: Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection. Cochrane Database Syst Rev. 2011, 3 (CD001220): 10.1002/14651858.CD001220.pub3. Ng BE, Butler LM, Horvath T, Rutherford GW: Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection. Cochrane Database Syst Rev. 2011, 3 (CD001220): 10.1002/14651858.CD001220.pub3.
16.
go back to reference Cohen MS, Hoffman IF, Royce RA, Kazembe P, Dyer JR, Daly CC, et al: Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997, 349: 1868-1873. 10.1016/S0140-6736(97)02190-9.CrossRefPubMed Cohen MS, Hoffman IF, Royce RA, Kazembe P, Dyer JR, Daly CC, et al: Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997, 349: 1868-1873. 10.1016/S0140-6736(97)02190-9.CrossRefPubMed
17.
go back to reference Brickley DB, Almers L, Kennedy CE, Spaulding AB, Mirjahangir J, Kennedy GE, et al: Sexual and reproductive health services for people living with HIV: a systematic review. AIDS Care. 2011, 23: 303-314. 10.1080/09540121.2010.507746.CrossRefPubMed Brickley DB, Almers L, Kennedy CE, Spaulding AB, Mirjahangir J, Kennedy GE, et al: Sexual and reproductive health services for people living with HIV: a systematic review. AIDS Care. 2011, 23: 303-314. 10.1080/09540121.2010.507746.CrossRefPubMed
18.
go back to reference King R, Estey J, Allen S, Kegeles S, Wolf W, Valentine C, et al: A Family planning intervention to reduce vertical transmission of HIV in Rwanda. AIDS. 1995, 9: S45-S51.PubMed King R, Estey J, Allen S, Kegeles S, Wolf W, Valentine C, et al: A Family planning intervention to reduce vertical transmission of HIV in Rwanda. AIDS. 1995, 9: S45-S51.PubMed
19.
go back to reference Richardson JL, Milam J, McCutchan A, Stoyanoff S, Bolan R, Weiss J, et al: Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS. 2004, 18: 1179-1186. 10.1097/00002030-200405210-00011.CrossRefPubMed Richardson JL, Milam J, McCutchan A, Stoyanoff S, Bolan R, Weiss J, et al: Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS. 2004, 18: 1179-1186. 10.1097/00002030-200405210-00011.CrossRefPubMed
20.
go back to reference Wingood GM, DiClemente RJ, Mikhail I, Lang DL, McCree DH, Davies SL, et al: A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: the WiLLOW Program. J Acquir Immune Defic Syndr. 2004, 37: S58-S67.CrossRefPubMed Wingood GM, DiClemente RJ, Mikhail I, Lang DL, McCree DH, Davies SL, et al: A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: the WiLLOW Program. J Acquir Immune Defic Syndr. 2004, 37: S58-S67.CrossRefPubMed
21.
go back to reference Jones DL, Weiss SM, Bhat GJ, Feldman DA, Bwalya V, Budash DA: A sexual barrier intervention for HIV +/−Zambian women: acceptability and use of vaginal chemical barriers. J Multicult Nurs Health. 2004, 10: 27-33. Jones DL, Weiss SM, Bhat GJ, Feldman DA, Bwalya V, Budash DA: A sexual barrier intervention for HIV +/−Zambian women: acceptability and use of vaginal chemical barriers. J Multicult Nurs Health. 2004, 10: 27-33.
22.
go back to reference Jones DL, Weiss SM, Bhat GJ, Bwalya V: Influencing sexual practices among HIV-positive Zambian women. AIDS Care. 2006, 18: 629-634. 10.1080/09540120500415371.CrossRefPubMedPubMedCentral Jones DL, Weiss SM, Bhat GJ, Bwalya V: Influencing sexual practices among HIV-positive Zambian women. AIDS Care. 2006, 18: 629-634. 10.1080/09540120500415371.CrossRefPubMedPubMedCentral
23.
go back to reference Stringer EM, Kaseba C, Levy J, Sinkala M, Glodenberg RL, Chi BH, et al: A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the HIV. Am J Obstet Gynecol. 2007, 197: 144-e1-e8.CrossRefPubMedPubMedCentral Stringer EM, Kaseba C, Levy J, Sinkala M, Glodenberg RL, Chi BH, et al: A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the HIV. Am J Obstet Gynecol. 2007, 197: 144-e1-e8.CrossRefPubMedPubMedCentral
24.
go back to reference Coyne KM, Hawkins F, Desmond N: Sexual and reproductive health in HIV-positive women: a dedicated clinic improves service. Int J STI AIDS. 2007, 18: 420-421. 10.1258/095646207781024766.CrossRef Coyne KM, Hawkins F, Desmond N: Sexual and reproductive health in HIV-positive women: a dedicated clinic improves service. Int J STI AIDS. 2007, 18: 420-421. 10.1258/095646207781024766.CrossRef
25.
go back to reference Hamlyn E, Barrett S, Kelsey J, Lockyer S, Weiz T, Poulton M: Improvement in screening for sexually transmitted infections in HIV-positive patients following implementation of a nurse-led clinic. Int J STI AIDS. 2007, 18: 424-426. 10.1258/095646207781024720.CrossRef Hamlyn E, Barrett S, Kelsey J, Lockyer S, Weiz T, Poulton M: Improvement in screening for sexually transmitted infections in HIV-positive patients following implementation of a nurse-led clinic. Int J STI AIDS. 2007, 18: 424-426. 10.1258/095646207781024720.CrossRef
26.
go back to reference Kissinger P, Clark R, Rice J, Kutzen H, Morse A, Brandon W: Evaluation of a program to remove barriers to public health care for women with HIV infection. South Med J. 1995, 88: 1121-1125. 10.1097/00007611-199511000-00007.CrossRefPubMed Kissinger P, Clark R, Rice J, Kutzen H, Morse A, Brandon W: Evaluation of a program to remove barriers to public health care for women with HIV infection. South Med J. 1995, 88: 1121-1125. 10.1097/00007611-199511000-00007.CrossRefPubMed
28.
go back to reference Martin-Misener R, Valaitis R: A Scoping literature Review of Collaboration between Primary Care and Public Health. A Report to the Canadian Health Services Research Foundation. 2008, avalaible from http://www.swchc.on.ca/., February Martin-Misener R, Valaitis R: A Scoping literature Review of Collaboration between Primary Care and Public Health. A Report to the Canadian Health Services Research Foundation. 2008, avalaible from http://​www.​swchc.​on.​ca/​., February
29.
go back to reference Hekkink CF, Sixma HJ, Wigersma L, Yzermans CJ, van der Meer JTM, Bindels PJE, et al: QUOTE-HIV: an instrument for assessing quality of HIV care from the patients’ perspective. Qual Saf Health Care. 2003, 12: 188-193. 10.1136/qhc.12.3.188.CrossRefPubMedPubMedCentral Hekkink CF, Sixma HJ, Wigersma L, Yzermans CJ, van der Meer JTM, Bindels PJE, et al: QUOTE-HIV: an instrument for assessing quality of HIV care from the patients’ perspective. Qual Saf Health Care. 2003, 12: 188-193. 10.1136/qhc.12.3.188.CrossRefPubMedPubMedCentral
30.
go back to reference Heiligenberg M, Rijnders B, van der Loeff MF S, de Vries HJ, van der Meijden WI, Geerlings SE, et al: High prevalence of sexually transmitted infections in HIV-infected men during routine outpatient visits in the Netherlands. Sex Transm Dis. 2012, 39 (1): 8-15. 10.1097/OLQ.0b013e3182354e81.CrossRefPubMed Heiligenberg M, Rijnders B, van der Loeff MF S, de Vries HJ, van der Meijden WI, Geerlings SE, et al: High prevalence of sexually transmitted infections in HIV-infected men during routine outpatient visits in the Netherlands. Sex Transm Dis. 2012, 39 (1): 8-15. 10.1097/OLQ.0b013e3182354e81.CrossRefPubMed
31.
go back to reference Dutch Guidelines HIV patients [In Dutch: Richtlijnen Controles HIV-patiënten. Bij eerste consult bij HIV-seropositieve patiënt. 2010, Tilburg: NVHB/Dutch Association of HIV-treating physicians, updated 2011 may 26; cited 2011 june 28; http://www.nvhb.nl/. Dutch Guidelines HIV patients [In Dutch: Richtlijnen Controles HIV-patiënten. Bij eerste consult bij HIV-seropositieve patiënt. 2010, Tilburg: NVHB/Dutch Association of HIV-treating physicians, updated 2011 may 26; cited 2011 june 28; http://​www.​nvhb.​nl/​.
32.
go back to reference Heiligenberg M, van der Loeff MF S, de Vries HJ, Speksnijder AG, Geerlings SE, Coutinho R, et al: Low prevalence of asymptomatic sexually transmitted infections in HIV-infected heterosexuals visiting an HIV clinic in the Netherlands. AIDS. 2012, 13; 26 (5): 646-649.CrossRef Heiligenberg M, van der Loeff MF S, de Vries HJ, Speksnijder AG, Geerlings SE, Coutinho R, et al: Low prevalence of asymptomatic sexually transmitted infections in HIV-infected heterosexuals visiting an HIV clinic in the Netherlands. AIDS. 2012, 13; 26 (5): 646-649.CrossRef
33.
go back to reference Glick SN, Morris M, Foxman B, Aral SO, Manhart LE, Holmes KK, Golden MR: A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women. JAIDS. 2012, 60 (1): 83-90. 10.1097/QAI.0b013e318247925e.PubMedPubMedCentral Glick SN, Morris M, Foxman B, Aral SO, Manhart LE, Holmes KK, Golden MR: A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women. JAIDS. 2012, 60 (1): 83-90. 10.1097/QAI.0b013e318247925e.PubMedPubMedCentral
Metadata
Title
Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison
Authors
Nicole HTM Dukers-Muijrers
Carlijn Somers
Christian JPA Hoebe
Selwyn H Lowe
Anne-Marie EJWM Niekamp
Astrid Oude Lashof
Cathrien AMVH Bruggeman
Hubertus JM Vrijhoef
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-1118

Other articles of this Issue 1/2012

BMC Public Health 1/2012 Go to the issue