Preparing sexual health services for the challenge of antibiotic resistant (AMR) bacteria

Katy Turner, Director of the Sexual Health Improvement Programme (SHIP) Health Integration Team (HIT), talks about their recent event on antimicrobial resistance in sexual health.

On Friday 21 September, SHIP HIT and British Association of Sexual Health and HIV (BASHH) hosted an open event focused on antimicrobial resistance in sexual health.

Around 50 clinicians, health professionals, Public Health England (PHE) staff, academics, laboratory staff, industry reps attended the meeting, mostly from the South West area, but we also welcomed participants from as far as Plymouth, Brighton, London and Cambridge and Wales.

We heard a number of expert talks, including from Sonia Fleming on government priorities for next five years, with a particular focus Lord O’Neill’s challenge to ensure no prescription without an appropriate diagnostic test. Mary Griffin also provided information about funding and support available through the Clinical Research Network (CRN).

Talks covered a lot of ground and thanks to all the speakers who gave us lots of food for thought. You can catch up with our workshop hashtag #SexHealthAMR.

We held two discussion sessions, the first involved some individual reflection and group working to come up with potential actions for our action plan, the second attempted to fill in any gaps and reflect on what had been learned that day.

I was surprised to learn that GPs work from different prescribing guidelines to GUM clinicians; that M. genitalium causes significant morbidity for individuals (and that delays in receiving effective treatment due to high levels of resistance add to stress and anxiety caused by the symptoms); and that the biggest barrier to introducing point of care tests is cost to commissioners (OK that last one wasn’t much of a surprise).

There were also lots of ideas for overcoming some of the challenges of AMR, such as faster updates to treatment guidelines (working with BASHH), improved use of data locally, sharing business plan templates and data on evaluations, as well as lobbying government to invest in new technologies.

We also heard about some creative approaches to making new technology available in clinics. Unity Sexual Health are working closely with PHE South West Regional Laboratory to get a high throughput NAAT machine in the clinic to speed up results: the machine is managed by the lab which deals with questions of quality assurance, and will enable patients to benefit from same day results and infection specific treatment when the service is up and running later this year.

Collaborating and sharing what does and doesn’t work is clearly the way forwards – but we recognised some of the challenges. These included new diagnostics can be complicated to implement in a timely way due to local commissioning/tendering arrangements. Whilst savings or cost effectiveness may be achieved in the system as a whole; if initial investment comes from one budget and savings appear elsewhere in the system the business case for change is problematic. Changes can also have significant opportunity start-up costs including need to retraining or risk to jobs; and these shouldn’t be underestimated.

We touched on the opportunities and challenges of PrEP in the context of resistant gonorrhoea: recognising the benefits of providing PrEP and engaging individuals in managing their own sexual health, including regular STI testing, however the challenge relating to shaming and stigma of condom use which could hamper STI (and HIV) control efforts was also highlighted.

In our enthusiasm and excitement for novelty and innovation we reminded ourselves that the basics of sexual health – prevention, promoting safer sex, condoms and partner notification all have an important role to play in controlling AMR.

We identified stakeholders not involved in this initial meeting who we may wish to engage in future e.g. general practice, pharmacists and industry as well as colleagues further afield around the UK

There was enthusiasm for running a similar meeting in 2019 – so watch this space (volunteers welcome!).

Please follow @bashh_uk and @SHIPSexHealth on twitter to keep up to date on future developments.