Sunday 8 December 2019

Getting to Zero HIV

Getting to Zero HIV (and addressing other sexually transmitted infection epidemics)

Where did Getting to Zero HIV come from?
WHO / UNAIDS campaign since 2011 when it was beginning to be understood that effective treatment was a key tool for prevention

The latest UNAIDS 90:90:90 campaign aims to diagnose 90% of people with HIV, engage 90% into care to start HIV treatment and that 90% of patients become undetectable (i.e. uninfectious).  In a few countries this target has already been reached; however, find the remaining undiagnosed HIV positive individuals is an ongoing challenge

To achieve the first "90" - we need targeted testing and effective partner services to reduce the cost to make a diagnosis and ensure that we can get to zero HIV by 2030 with an emphasis on 'Fast-track cities'; however, each city has a limit to the resources that they can spend on this problem

When trying to work out the cost to diagnose a case of HIV a back of the envelope calculation is a useful exercise but it should be taken with a pinch of salt

The table below uses the following sources & assumptions:

  • The background incidence rate is key to doing these calculations from low incidence countries where it is 9/100,000 (England, PHE)  & 12/100,000 (CDC Atlas, Massachusetts) to some sub-Saharan countries where it is 100x times higher e.g. Eswatini 862/100,000 (UNAIDS HIV estimates)
  • The background rate will affect all the following estimates so I have focused on a country with low incidence
  • Testing in sexual health clinics has a 3/1000 diagnostic rate (18 months data from inner London clinic)
  • Outreach testing has three times the yield of 10/1000 (based on conversation with NAZ Latina)
  • The BASHH / BHIVA audit in 2018 on HIV partner services found that 18% of partners were infected whilst in countries where less patients are undetectable this number has been as high as 35% (20% was chosen as a representative figure)

Testing strategy
HIV diagnostic rate (#/1000)
Diagnostic cost to diagnose one case of HIV ($20/test)
Screening blood donors
Targeted testing in specific venues
x 25 less
Outreach & testing in ‘at risk’ communities
x 83 less
Testing sex partners of patient diagnosed with HIV
x  1666 less

Tuesday 8 December 2015

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 to see some 1 minute films of the tool in action, visit for some key facts and figures, or contact 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 

Monday 28 September 2015

Numbers needed to test to find one infection

 Sexually Transmitted Infections (STIs) are transmitted across sexual networks through partner change and the majority of STIs are silent and do not produce signs or symptoms.  In many cases the person infected and possibly spreading infections is unaware they are an STI transmitter.  Testing for STIs is recommended when individuals have multiple partners or at a time of partner change and the tests are simple for individuals to do either via home testing, visiting a clinic or their family doctor.  A local testing service can be found using SXT ( 

The tests to do are shown in the table below:

Gender / Sexuality
Blood test
(HIV & Syphilis)
Urine test (Chlamydia & Gonorrhoea)
Throat swab (Chlamydia & Gonorrhoea)
Anal swab (Chlamydia & Gonorrhoea)
Vaginal swab (Chlamydia & Gonorrhoea)
Male heterosexual


Man who has sex with men

? Testing the throat & rectum in women depends on the sexual history

These sensitive tests can accurately rule out an infection if they are done after what is known as the 'window period', which is two weeks for Chlamydia / Gonorrhoea and six weeks for Syphilis / HIV.  If low risk individuals are tested then the numbers of individuals to test to find one infection is high.  For example if 1% of the tested population has a single infection then 100 people would need to be tested to find one infection.  The National Chlamydia Screening Program tests young people less than 25 years of age because the prevalence of infection in this group is around 10%; consequently, for every ten young people tested one Chlamydia infection is found.

The picture below shows the analysis from Guy's & St Thomas' from the first six months of 2015 for Gonorrhoea.  This bacterium is important because it is very infectious and it evolves antibiotic resistance over time.  In the UK, Gonorrhoea is mostly diagnosed in men who have sex with men and in heterosexual from the Black African / Caribbean community. 

This data shows the importance of informing partners and getting them tested.  One in three partners need to be tested to find one Gonorrhoea infection.  There is no difference in the number of male & female partners that need to be tested to find one infection in this analysis even though there are 17 times more diagnoses of Gonorrhoea in men (1 in 16 versus 1 in 283).

IF all contactable partners of an STI are informed & tested then it would be theoretically possible to significantly reduce an infection from a sexual network; however, to date no single tool has been developed to support the person with the infection, partners and providers to effectively deliver partner notification and measure the impact of this important service.   

Sunday 29 March 2015

Time sensitive searches on SXT

Some things require urgent action.  

In sexual & reproductive health these are:

SXT modified the landing page to reflect client searches.  Of the last 7398 SXT users; 20% were for emergency contraception, 7% because of symptoms, 3% for PEP and 1% because of sexual assault.

If you provide any of these services make sure your profile in SXT is up to date.

If you want to join our mission to improve access to services add a link for SXT on your web page and the SXT logo if you wish too.

All ideas on how we can work together to improve access should be sent to 

Thursday 26 March 2015

Intelligent signposting to sexual and reproductive health services in

SXT Health CIC is a social enterprise with a mission to improve access to sexual and reproductive health services. Its website 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: 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 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. 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, 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. 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 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 to join.