JSNA topic report: sexual and reproductive health

The following 3 data tables offer a snapshot of all the sexual health results indicating where Buckinghamshire is performing well and less well.

For each of the tables below the following applies:

• ID: The sort order that the indicator would normally appear on the Public Health England (PHE) interface.
• Name: Indicator name and description.
• Year: The year the data was collected.
• Range: The population targeted by the indicator that dictates the denominator used to calculate the indicator value from the count.
• + Result: Shows if a high or low value is considered as a positive result.

Buckinghamshire Values:

• Count: The number of recorded incidences.
• Value: The rate or percentage of the indicator where the numerator is the count and the denominator is dictated by the population of the range column.
• Rating: The rating in the Bucks column is the designated PHE fingertips performance. Better, similar, worse or higher,similar,lower compared to the CIPFA average value or a custom PHE benchmark value. Each denotes the significant differences with the comparators.
• Trend: The trend shows how the indicator has performed over the last few years, with the trend arrow showing if the indicator has gone up or down or remained constant and the colour coding showing if this can can be considered positive, negative or neutral.

CIPFA values

• Mean: The CIPFA mean average
• Median: There are 15 statistical neighbours to Bucks (16 total) so the median lies halfway between the 8th and the 9th neighbours sorted value- on the spine chart the median will be where the second quartile boundary transitions into the third
• Bucks rank: Buckinghamshire performance is benchmarked as a rank out of 16 from best to worst or for indicators coloured in blue a ranking from lowest to highest has been performed. The colour coding in the Rank column indicating the CIPFA quartile to which Buckingham has been assigned

Table 1 shows Buckinghamshire STI and HIV indicators ranked best to worst against CIPFA 15. The table shows that Buckinghamshire SH services are performing better[1] compared to CIPFA in the following nine areas.

• Repeat HIV testing in MSM (%)
• Chlamydia diagnostic rate/100,000 aged 25+
• HIV testing coverage MSM (%)
• HIV testing coverage Men (%)
• STI testing/100,000 for syphilis, HIV, gonorrhoea and chlamydia (excluding Chlamydia aged <25)
• HPV vaccination coverage for one dose (female 12-13)
• HIV testing coverage, total (%)
• HIV testing coverage, women (%)
• HIV diagnosed prevalence rate/1000 aged 15-59

Buckinghamshire sexual health services are lower compared to the CIPFA average in the following:

• STI testing positivity % for syphilis
• HIV, gonorrhoea and chlamydia (excluding chlamydia aged < 25) (low diagnosis rate and a low testing positivity rate)
• chlamydia diagnostic rate per 100,000
• all new STI diagnosis rate per 100,000

Buckinghamshire sexual health services are performing less well in the following indicators compared to the CIPFA average:

[1] The rating is based on designated PHE fingertips performance Better,Similar, Worse or Higher, Similar, Lower compared to the CIPFA average value or a custom PHE benchmark value.

Buckinghamshire’s lower testing rates of infection may indicate that Buckinghamshire have lower rates of infection. However, areas with low testing rates (in A13 in the table above), but higher rates of infection could indicate that Buckinghamshire are only screening those at greatest risk or with symptoms. Buckinghamshire have high rates of HIV testing in Men who have Sex with Men (MSM) (B2 in the table above), the low HIV detection rates may indicate lower incidences of HIV.

For syphilis, HIV, gonorrhoea and chlamydia (excluding chlamydia age <25) combined, Buckinghamshire has a high testing rate, a low diagnosis rate and a low testing positivity rate. This suggests the true prevalence of these could be low within Buckinghamshire, although it is important to note the testing rates are higher compared to other areas but this will not encompass the whole population.

In accordance with the national changes to the NCSP, opportunistic chlamydia screening will focus on women. In practice this means that chlamydia screening in community settings, such as GP surgeries and community pharmacies, will only be proactively offered to young women. Services provided by sexual health services remain unchanged.

These changes will affect all indicators for under 25 chlamydia screening. The programme detection rate indicators will be revised and will be measured against females only.

There is no change to the calculation of the detection rate indicator, which will continue to be reported at the population level with male and female breakdowns.

The changes in the programme aim to keep the existing levels of screening activity but focus them on screening women. Given this shift in activity (from male opportunistic screening to additional screening in females and improved management of positive cases,) it is expected that an increase in female diagnoses will be observed.

The percentage of HIV diagnoses made at a late stage in Buckinghamshire needs to be reduced overall; however, as more infections are prevented, the percentage diagnosed late will increase until all are found.

The summary table above shows Buckinghamshire has performed very well for all teenage pregnancy indicators 2019. Buckinghamshire’s total abortion rates and abortion rates for over 25s are high and have steadily increased in the last three years at a similar rate to CIPFA neighbours. Under 25s repeat abortions are also very high.

Buckinghamshire services achieved the highest rate of services prescribing Long-Acting Reversible Contraception (LARC). LARC methods are highly effective and cost efficient and can remain in place for years. Buckinghamshire is in the mid-range for the percentage of women choosing: LARC, Injection’s, IUDs and oral contraceptive pills. This indicates that a full range of contraception is available, and that one method of contraception is not being promoted at the expense of others. Buckinghamshire has a low (compared to benchmark areas) rate of GP prescribed LARC and would need to increase its rate by at least 30% to exceed the CIPFA average value.

The indicators in the summary table above have been rated as worse in Buckinghamshire compared to CIPFA average, or have been ranked in the bottom 6 out of 16 CIPFA Areas. These indicators should be monitored carefully. It is important to note that as national chlamydia screening guidance has changed, future results will not be comparable.

For the following indicators below, it may well be that Buckinghamshire has a high level of screening and is just not identifying infection because there is a lower prevalence of the STI’s listed in Buckinghamshire. This should be monitored over the next five years.

• New STI diagnosis (excluding chlamydia aged <25)/100,000 (A12)
• Gonorrhoea diagnostic rate/100,000 (A2)
• HIV diagnosed prevalence rate/1,000 aged 15 to 59 (B13)
• New HIV diagnosis rate/100,000 aged 15 + (B6)

The 7 indicators with worsening trends in the table 3 (red arrows) and the additional two indicators listed B1 and B4 should be monitored closely over the next 5 years.

• MSM
• HIV late diagnosis (%) in heterosexual men
• Total abortion rate/1000
• Over 25’s abortion rate/1000
• HIV testing coverage, total (%)
• HIV testing coverage, women (%)

Current national and local Sexual and Reproductive Health Profiles are available online.