A ‘Ground-Breaking’ Partner Notification Tool to Combat the Spread of HIV and all STIs in the UK

At SXT Health CIC, we are proud to announce the launch this month (December 2015) of our interactive digital Contact Slip – a new tool designed to help improve rates of Partner Notification and slow the spread of STIs in the UK. PHE’s Professor Kevin Fenton has called it one of 7 ‘ground-breaking initiatives’ to recently receive PHE funding. To find out more, please read on. You can also go to http://bit.ly/SXTfilms to see some 1 minute films of the tool in action, visit http://www.sxt.org.uk/pn/about for some key facts and figures, or contact enquiries@sxt.org.uk with specific enquiries.

The tool has been developed with the help of an HIV Prevention Innovation Fund from Public Health England and is being used across the London boroughs of Lambeth and Southwark. It is available to clinics throughout the UK.

Why we developed the tool - the Public Health challenge:

There were 440000 STIs diagnosed in the UK in 2014. The BASHH states that, for every patient diagnosed with an STI, a health care worker should verify that 0.6 partners have been seen at an STI testing centre within 1 month.

We know, from reviewing the clinical histories of index patients, that many have a number of partners, and all have at least one. The Key Performance Indicator (KPI) set by the BASHH, at 0.6 partners, is the best clinical practices have been able to achieve – many struggle to meet even this KPI, and STI rates are rising.

If we could improve levels of partner notification, we could significantly reduce the transmission of STIs in the UK.

The interactive digital Contact Slip on is designed to:

-Help health providers deliver PN effectively, and improve their PN rates

-Help the individual with the STI tell their partner(s)

-Help the partner(s) find a local testing service

-Give the health provider looking after the partner(s) the key information they need to deliver fast, high quality care

How it works:

Step 1 - Notify Partners at the Clinic

Step 2 - Notify Partners Away from the Clinic

Step 3 - Partners Receive Notification
Step 4 - Partners at the Clinic

There are some key reasons why it’s currently difficult to deliver PN:

-Embarrassment on the part of patients, wariness of stigma and fear rejection or violence

-For clinics, the logistics are often challenging – staff spend hours manually notifying partners, or trying to track down whether they have been tested by eg searching through databases or talking to other clinics

We have designed the idCS to address these issues - making it possible for patients to use it anonymously, and ensuring all personal details are deleted as soon as notification is sent. We have made it incredibly quick and easy for clinics to use, and ensured that it automatically records whether partners are seen at any STI treatment centre so that performance stats are readily available.

Tracking performance:

Each clinic has their own dashboard on the SXT website where they can see how many times the idCS has been used, how many partners have been notified, and how many have been tested at an STI treatment centre.

In summary, the idCS on offers some key advantages:

If you'd like help to improve your partner notification rates, or to find out more, contact enquiries@sxt.org.uk 

Intelligent signposting to sexual and reproductive health services in www.sxt.org.uk

SXT Health CIC is a social enterprise with a mission to improve access to sexual and reproductive health services. Its website www.sxt.org.uk signposts members of the public to the right SRH service, in the right place, at the right time, and is designed to meet the needs not just of patients, but of providers and commissioners too.  Patients are missing out on time sensitive services, providers find it a challenge to communicate their level of service detail and commissioners have difficulty mapping gaps of provision and marketing services to their population.  

The root cause of the problem is the asymmetry of information and difficulty communicating what services are being offered by day/time and location.  Most of the databases regarding sexual & reproductive health services do not have enough information to reassure patients that they are going to the correct provider.  The result is that many attend the nearest biggest service because they do not want to wait in vain.  Difficulties communicating about service provision lead to bottlenecks at the big clinics whilst other appropriate providers with capacity are being overlooked.

SXT Health CIC has created a robust solution to deal with this problem: www.sxt.org.uk works well for patients, and it also allows providers to advertise their services with the level of detail required to support intelligent signposting.

The link between the two is a decision tree that converts what the patient needs into information that they can act upon.  For example, if the client has symptoms that could be due to a sexually transmitted infection (STI) and they use www.sxt.org.uk and select ‘Same day results (problems)’, they will be directed to those services that offer microscopy and can give them a more accurate diagnosis on the day. www.sxt.org.uk also distinguishes between simple & complex STI treatment so that clients visit a provider who can accurately treat their infection.  

This decision tree supports higher risk clients (such as men who have sex with men) by ensuring that they are directed to those clinics that can offer HIV point of care tests, triple site testing and Hepatitis B vaccination.  

It can also support signposting to more specialist services such as Transgender and Fetish clinics as well as support online HIV testing initiatives or flag new problems affecting the community such as Shigella causing severe diarrhoea.

For the provision of emergency contraception, www.sxt.org.uk always promotes the best treatment which is the copper intrauterine device and can direct the women to the nearest open provider; however, it also knows which services offer Levonorgestrel (effective <72hrs) and Ulipristal acetate (effective <120hrs) so that a client who opts for a hormonal method is directed to the most appropriate local provider.

www.sxt.org.uk uses the decision tree to categorize contraception by its efficacy.  Under the most effective methods (typical failure rate < 3/100 per year) it provides information and sign posts to local services for implants, the intrauterine system / device and injectable methods.


Pills / Patch / Ring have their own category because they are the most popular method of contraception and their failure rate is 8/100 per year with typical use.  The least effective methods (> 8/100 per year failure rate) have their own category with information about these methods and, if appropriate, where the client can find the service or advice.

Intelligent signposting is key to optimizing access to sexual & reproductive health care services and www.sxt.org.uk is the only platform with the necessary level of detail to deliver this requirement.

If you are a provider and would like to help improve access to sexual & reproductive health services please visit www.sxt.org.uk to join.

Bringing data to life on www.sxt.org.uk – what our analytics can do for providers

SXT Health CIC is a social enterprise with a mission to improve access to sexual and reproductive health services. Its website www.sxt.org.uk signposts members of the public to the SRH services. It then stores that information, anonymously, and makes it available to providers so that they can understand how and why their services are being used.

When it comes to marketing your services, it's difficult to predict what the most effective strategy will be. It's not always easy to answer the key questions:

• Where are our clients coming from?
• Why did they come to us?
• Did they get the service they wanted?

It is possible to extract this data from www.sxt.org.uk, even though the client is completely anonymous.  SXT Health CIC is committed to providing its stakeholders with high quality information, so that together we can improve access to services.

For providers, analytics and clinic feedback pages have been created.  The analytics page shows what services clients have looked for and which provider they chose.  It is possible to see this in two formats: as a heat map or listed chronologically.  All this data can be downloaded for in depth analysis too.

The video below shows how each provider can see how they are supporting access to sexual & reproductive health services.

If you are a provider and would like to help improve access to sexual & reproductive health services please visit www.sxt.org.uk to join.

Filling the Gap – what www.sxt.org.uk can do for health commissioners

SXT Health CIC is a social enterprise with a mission to improve access to sexual and reproductive health services. Its website www.sxt.org.uk signposts members of the public to the right SRH service, in the right place, at the right time, and is designed to meet the needs not just of patients, but of providers and commissioners too.

For health commissioners, real-time gap analysis is essential to understand who is doing what, where and when. To deliver high quality gap analysis it is important that:

1. all sexual & reproductive health services are in one database

2. the same database can be reviewed as a map & a list of providers

3. the provider list can be filtered by the services provided

4. the services can be filtered by location & the hours of service

www.sxt.org.uk can provide real-time gap analysis and commissioners can apply for access to a special login that provides the level of oversight cited above. Once high quality real-time information is available it is then possible to commission services where there are gaps.

The www.sxt.org.uk database is growing all the time and the flexibility of this tool supports providers in keeping their data up to date. As more commissioners and providers engage with www.sxt.org.uk it is possible to enter a virtuous cycle where the service can develop in line with local intelligence about demand and other public health indices. The analytics dashboard for commissioners enables them to set filter (A) by the area of the search, service group and date ranges. It is also possible to see real-time use (B) of www.sxt.org.uk and identify when a client used the service, what they were looking for and which provider they chose. Feedback about www.sxt.org.uk (C) and confirmation that the client received the service can also be seen on this dashboard.

If you would like to login to www.sxt.org.uk as a commissioner please email feedback@sxt.org.uk

www.sxt.org.uk – The best way to find time sensitive services that are open now

SXT Health CIC is a social enterprise with a mission to improve access to sexual and reproductive health services. Its website www.sxt.org.uk signposts members of the public to the right SRH service, in the right place, at the right time, and is designed to meet the needs not just of patients, but of providers and commissioners too.

There are three time sensitive services which www.sxt.org.uk excels at providing local information for:

• Emergency contraception

• PEP following HIV exposure

• Treatment following  sexual assault

Accessing these services is supported by quick buttons on the website's home page.

The client only needs to add the first part of their postcode or use the 'locate me' function on their smartphone to see what is open & local.

Time sensitive service information in under a minute

If your service is not in www.sxt.org.uk and you provide one of these services please visit the site to join today. We are looking forward to hearing from you.

www.sxt.org.uk - a platform tailor-made for sexual and reproductive healthcare providers

www.sxt.org.uk is the only provider-run database of sexual and reproductive healthcare. We have used our own on-the-job experience to create a platform which meets the needs of the people who work in this area of healthcare, tackles some of the day to day frustrations they face, and is easy for them to use and incorporate into their management practices. Here's how we've done it ..

Four years ago, we launched SXT as a simple SMS service; however, the lack of flexibility with text messages, especially when compared to smartphones, pushed us into developing a web service, which then became mobile friendly for clients in August 2013. In February 2015, we turned www.sxt.org.uk into a mobile friendly website for providers too.

The information technology hurdle

The problem of out-of-date internet browsers on computers across the NHS has been one of the biggest barriers to providers joining and using www.sxt.org.uk effectively.  Those who signed up to and used the site early had to use their computer at home to do so because their work software did't function properly.  In 2012 we used a Google chrome patch to try and make the site work on Internet Explorer 6 but few members of staff would download it because they thought that they would need administrator rights.  Internet Explorer 7 is better and so are early versions of Firefox but still www.sxt.org.uk does not look its best on these older browsers.  

Going mobile means that staff can use the computers that they carry around in their pocket to bypass the limitations of their computers at work.  The first step for all providers is to see if their service has already been uploaded to www.sxt.org.uk from NHS Choices or other databases.  The minute-long video below shows the simple steps to check our database.  If you are already on the website then please claim your service so that you can edit your hours of operation, services and profile.  If you are not, then you will see the simple steps to register and join.

Registering in www.sxt.org.uk

The Time Barrier

If you work in a busy service it might, at first, be difficult to see the benefit of taking the time to join www.sxt.org.uk.   After all, services already have a plethora of requests from commissioners, NHS bodies and other organisations (GMFA, THT, NAT and others) asking for a paper or electronic copy of the hours of operation, services, the types of clients being seen ... so why on earth should you join another information service?  But www.sxt.org.uk is not just another information service asking for the same, it is the chance to stop all the duplication and sharing of partial information about provision described above.

www.sxt.org.uk has been designed for providers to simply and accurately capture the details of their service.  Once they have been added, your details are visible not just to clients, but to all the other organisations requesting it.  Upload the data just once, so that it can be used many times, without you wasting time repeating the task.  It's simple to update your details, and this information can be shared either as a print out or via the SXT application programming interface that enables the database to share service information in real-time.

It takes less than a minute to register with SXT, another minute to apply to add a provider or outreach venue (see first video below) and less than 20 minutes to add details for a complex service and go live (see second video below).

Entering provider details on www.sxt.org.uk

Going live on www.sxt.org.uk

Keeping up to date

The mobile version of www.sxt.org.uk is now a super quick way to keep up to date.  Once you log in to www.sxt.org.uk on your mobile phone you can add the web page to your home screen.  Your mobile phone will remember the login details and consequently you will be able to see your service(s) with a touch of one icon.  As you can see from the video above it is as simple as checking a box to add a service, change hours of service or close for a day.

Enough already

Some providers may have concerns that marketing services on www.sxt.org.uk will attract more clients, when they are already having difficulty seeing the patients who currently attend.  Many services see patients with a diverse set of needs and a sizable fraction could be seen at another time or by another provider.

Equitable access is the aspiration of all providers; however, there are some patients who need to take priority because they require time sensitive services (such as emergency contraception or PEP), they are under 16 years of age or they have painful symptoms (e.g. the first episode of anogenital herpes).  As a health care system we need to ensure that we match capacity with demand to meet the needs described above. The best way to do this is to ensure that patients know which local services can meet their needs.  It is a system failure when patients who want a simple test wait hours and bottle neck around a service, making it difficult for a patient who needs a priority service to be seen.

www.sxt.org.uk has been designed for all providers of sexual & reproductive health services.  It does not matter if the service is online, a 100 hour pharmacy, a once a week outreach clinic or a seven day a week university hospital provider, www.sxt.org.uk meets needs across the network of provision.  It is only by communicating all services effectively to patients that we can distribute the work appropriately and optimize access to services. If you agree, and want to support our work, please visit www.sxt.org.uk and join.

What www.sxt.org.uk can do for clients, providers, commissioners and public health

SXT Health CIC is a social enterprise with a mission to improve access to sexual & reproductive health services. It has created www.sxt.org.uk - a mobile enabled website with a lot to offer to clients, providers, commissioners and pubic health.

Clients

www.sxt.org.uk has been designed first and foremost for clients - to help them find the right health service in the right place at the right time.  

The website works on all machines regardless of their screen size, and, thanks to responsive programming, it also works on mobile phones without the client needing to download an App.  

It is possible for the client to share pages from the website by email or SMS to, for example, inform a partner of available services. This can be done anonymously if the client wishes. Finally, there is a slide out feedback form so that clients can score the SXT service. This is currently completed by 8.5% of clients and 81% give a score of eight or more out of ten.

Providers

Changes have been made to the ‘back end’ of the website to help providers overcome some of the IT difficulties they may encounter at work, e.g. with older internet browsers.  Firstly, providers can sign up and edit their SXT pages, quickly and simply, on a smartphone.  

Providers can use their page on www.sxt.org.uk as a flexible advert, giving up to the minute information on opening times, services available, how/whether to book, and how best to travel to them. They can give different staff management rights over the page. And they can access analytics on how/why their services are being used, as well as feedback from clients.

Commissioners

It is difficult to appreciate where there are gaps in service and yet this information is key to optimize commissioning.  Gap analysis is available in real-time within www.sxt.org.uk, so that commissioners can view client use and providers chosen, with an oversight of provision that can be filtered by service, hours of operation and location.  

The impact of targeted marketing can be visualized in www.sxt.org.uk, where it is possible to see usage for a specific location and providers chosen, to determine client behaviour.  Like for providers, this information can be downloaded in formats that support analysis in separate software to inform and develop future programs.

Public health

This is a confidential service for all users, but it is possible to, anonymously, follow the client's journey through the website - from digital public health advert, to finding a provider, right through to whether they received a service, which they can rate with a simple thumbs up | thumbs down.  

The anonymous digital end-to-end tracking makes it possible for the first time to calculate an objective return on investment for public health marketing campaigns.

To fins out more, please visit www.sxt.org.uk, or watch this 5 minute film.

SXT - Why it was created, what we do, and how it has been achieved.

Why?

SXT Health CIC is a social enterprise with a mission to improve access to sexual & reproductive health services.  It was formed to meet the needs of clients, providers and commissioners and its goal is to optimise the relationship between capacity and demand.  

What?

www.sxt.org.uk is a mobile enabled website which guides clients to the right service in the right place at the right time.  Providers simply control their details within the database and www.sxt.org.uk translates this for clients so that they can act upon accurate information.  Commissioners are provided with a real-time gap analysis to support their development of the service.

The providers on www.sxt.org.uk have come from two main sources:

1. Providers signing up to www.sxt.org.uk and adding their services (n>300) [SXT verified]

2. Uploaded from other online databases (n>2000) - these services can be claimed by the provider

The provider has the ability to edit all the information about their service to ensure that they are accurately represented on www.sxt.org.uk.  As soon as changes are made they are live for clients to see.  All the information provided to clients is sourced from NHS Choices, the Family Planning Association and other reputable sources.

www.sxt.org.uk is as good as the data it holds and providers are encouraged to claim a service or register for free today to support the SXT mission

When?

The key events on the timelines have been:

• The idea was conceived and the community interest company was formed 2009
• The website & SMS engine started in January 2011
• A client facing mobile friendly version of www.sxt.org.uk was released August 2013
• The slide out feedback form was introduced at this time too (8.5% of clients who chose a single service give feedback and 81% give a score that is eight or more out of ten)
• A login for commissioners was developed in October 2014
• Providers were given access to a mobile friendly version of www.sxt.org.uk in February 2015

How?

To date SXT has been funded by the generous grants from:

• UnLtd / 4iP in July 2009
• Guy’s & St Thomas’ Charity in August 2010 & 2013

In November 2014 Big Issue Invest awarded SXT a corporate social venturing loan to build up the service.

The business model of SXT is to deliver digital public health marketing packages to raise awareness and improve access to services.

All money raised by the community interest company will be used to pay for its services and any surplus reinvested into the SXT mission.

If you are a provider and would like to support SXT’s mission please visit www.sxt.org.uk or watch this 1 minute video on how to join.