British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection 2008

Fakoya, Ade; Lamba, Harpal; Mackie, Nicola; Nandwani, Rak; Brown, Ann; Bernard, Edwin J; Gilling-Smith, Carole; Cj, Lacey; Sherr, Lorraine; Claydon, P; Wallage, S; Gazzard, Brian

doi:10.1111/j.1468-1293.2008.00634.x

Cited by 114 publications

(112 citation statements)

References 201 publications

(269 reference statements)

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“…Opt-out self-screening is effective and acceptable (34) and the detected incidence of STIs in MSM was doubled when testing was supported by prompts in the electronic patient record (419). BASHH/BHIVA/FSRH sexual health in HIV guidelines recommend at least an annual offer of STI screening (401) and BHIVA monitoring guideline recommends 3-6 monthly syphilis testing to increase detection of asymptomatic infections (400), consistent with BASHH guidance for all MSM (76). Regular serological testing for syphilis can increase the detection of asymptomatic infections (420).…”

Section: Recommendationsmentioning

confidence: 99%

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2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

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This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG’s document ‘Framework for guideline development and assessment’ published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for ‘Identification of problematic recreational drug and alcohol use’ section and ‘Sexual problems and dysfunctions in MSM’ section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years’ time, 2022.

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Section: Recommendationsmentioning

confidence: 99%

“…The existing guidelines for treating men who have sexual dysfunctions such as ED and PE (443,444,447), including men who are HIV-positive (401), are applicable to working with MSM. However, none of these guidelines provide specific guidance in working with MSM, regardless of HIV status.…”

Section: Managementmentioning

confidence: 99%

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

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“…In particular, it is disappointing that not all centres perform routine baseline resistance testing despite this test being recommended in guidelines since 2003 [1,7]. Similarly, both British Association of Sexual Health and HIV (BASHH) and BHIVA recommend [5,6] offering sexual health screening routinely at HIV diagnosis and follow-up but this was not reported by all centres. It is also of concern that hepatitis B virus vaccination is not being offered to all nonimmune patients at diagnosis of HIV, and that not all centres repeat hepatitis and syphilis serology regularly.…”

Section: Discussionmentioning

confidence: 99%

“…PEP, post-exposure prophylaxis. [4,5] As this was a survey of reported local policy and individual patient case notes were not reviewed, the findings may not reflect accurately actual practice, but can be viewed as indicative of clinicians' intended practice.…”

Section: Discussionmentioning

confidence: 99%

“…At present in the UK there are separate clinical guidelines for different aspects of HIV management, including antiretroviral therapy (ART), hepatitis B and C virus coinfection, sexual and reproductive health, and immunization [1][2][3][4][5][6]. Various recommendations regarding assessment and monitoring of patients at different stages of HIV disease are scattered through these guidelines, but hitherto no attempt has been made to draw together and consolidate comprehensive guidance on this topic.…”

Section: Introductionmentioning

confidence: 99%

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A national review of assessment and monitoring of HIV‐infected patients

Lomax¹,

Curtis²,

Johnson³

2009

HIV Medicine

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The British HIV Association (BHIVA) audit subcommittee aimed to survey UK clinic policy and practice regarding baseline assessment and immunization of newly diagnosed HIV-positive patients, and frequency of follow-up and testing in established patients in the UK. ResultsOne hundred and eleven centres participated in the survey. Baseline HIV resistance testing was routinely performed in 89.2% of centres. A policy of routine screening for hepatitis B was in place in 99% of centres. Only 91% of centres were routinely offering a sexual health screen at diagnosis. Frequency of routine follow-up for patients not requiring antiretroviral therapy (ART) and stable on ART varied between three and six months. DiscussionThis review showed variations in practice regarding the post diagnosis assessment and routine monitoring of HIV patients. It is of concern that not all centres perform baseline HIV resistance testing. It has also been noted that hepatitis B vaccination is not being offered to non-immune patients at diagnosis. Less frequent follow-up of stable patients (both on and off ART) should allow resources to be focused on those with specific clinical needs.

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Management of precancerous anal intraepithelial lesions in human immunodeficiency virus–positive men who have sex with men: Clinical effectiveness and cost‐effectiveness

Deshmukh

Chiao

Cantor

et al. 2017

Cancer

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BACKGROUND: Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) are at disproportionately high risk for anal cancer. There is no definitive approach to the management of high-grade squamous intraepithelial lesions (HSIL), which are precursors of anal cancer, and evidence suggests that posttreatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves HSIL treatment effectiveness. The objectives of this study were to evaluate the optimal HSIL management strategy with respect to clinical effectiveness and cost-effectiveness and to identify the optimal age for initiating HSIL management. METHODS: A decision analytic model of the natural history of anal carcinoma and HSIL management strategies was constructed for HIV-positive MSM who were 27 years old or older. The model was informed by the Surveillance, Epidemiology, and End Results-Medicare database and published studies. Outcomes included the lifetime cost, life expectancy, quality-adjusted life expectancy, cumulative risk of cancer and cancer-related deaths, and cost-effectiveness from a societal perspective. RESULTS: Active monitoring was the most effective approach in patients 29 years or younger; thereafter, HSIL treatment plus adjuvant qHPV vaccination became most effective. When cost-effectiveness was considered (ie, an incremental cost-effectiveness ratio [ICER] < $100,000/quality-adjusted life-year), do nothing was cost-effective until the age of 38 years, and HSIL treatment plus adjuvant qHPV vaccination was cost-effective beyond the age of 38 years (95% confidence interval, 34-43 years). The ICER decreased as the age at HSIL management increased. Outcomes were sensitive to the rate of HSIL regression or progression and the cost of high-resolution anoscopy and biopsy. CON-CLUSIONS: The management of HSIL in HIV-positive MSM who are 38 years old or older with treatment plus adjuvant qHPV vaccination is likely to be cost-effective. The conservative approach of no treatment is likely to be cost-effective in younger patients. Cancer 2017;123:4709-19.

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British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection 2008

Cited by 114 publications

References 201 publications

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

A national review of assessment and monitoring of HIV‐infected patients

Management of precancerous anal intraepithelial lesions in human immunodeficiency virus–positive men who have sex with men: Clinical effectiveness and cost‐effectiveness

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