Biomedical subjects
M G Brook
Publications and source records attributed to M G Brook.
Survey of HIV and hepatitis B or C co-infection management in the UK 2004.
The objective of this study is to evaluate the current management practices of patients with HIV and hepatitis B or C co-infection. A postal survey was made of 186 clinics in the UK between October 2003 and January 2004. In total, 100/186 (54%) clinics responded: 16% estimated their hepatitis B prevalence to be above 10%, 27% estimated their hepatitis C to be above 10%. Problems were identified in a minority of clinics including: not routinely screening HIV-positive patients for hepatitis C (6%), restrictions on diagnostic tests required for the management of hepatitis infection and offering inappropriate treatment for hepatitis B infection. The use of diagnostic liver biopsies varied and clinics reported restrictions on access to hepatitis C therapy, with a consequent impact on waiting times. In conclusion, we identified several areas of concern in the diagnosis and management of HIV/hepatitis co-infection in several UK HIV treatment centres.
BHIVA guidelines on HIV and chronic hepatitis: coinfection with HIV and hepatitis C virus infection (2005).
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BHIVA guidelines on HIV and chronic hepatitis: coinfection with HIV and hepatitis B virus infection (2005).
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Findings from the British HIV Association's national clinical audit of first-line antiretroviral therapy and survey of treatment practice and maternity care, 2002.
OBJECTIVES: To assess the impact of and adherence to the British HIV Association (BHIVA) guidelines in routine clinical practice in the UK and Ireland. METHODS: A self-completed postal survey of practice with regard to HIV management and maternity care of HIV-positive women was carried out. A case-note review of all patients starting their first antiretroviral (ART) therapy (up to a maximum of 25 patients) between April and September 2002 was also performed. RESULTS: A total of 113 treatment centres participated. Ninety-nine units (88%) use the BHIVA ART guidelines as part of their treatment policy. Problems revealed by the survey include limited access to some ARTs in a small number of units and a wait longer than 4 weeks before the first assessment of patients started on ART in some units. Thirty-one centres (33%) felt that their maternity services had reached the government target of >90% antenatal HIV testing by October 2002. A total of 942 case-notes audited showed shortfalls in reported pretreatment testing of blood glucose, lipids and hepatitis C virus. Three patients had not strictly met the BHIVA guidelines for starting ART, but all had a high viral load (>100 000 HIV-1 RNA copies/mL). The majority (844 patients; 90%) had started on recommended therapies, most commonly two nucleoside reverse transcriptase inhibitors and a nonnucleoside reverse transcriptase inhibitor. The other 98 patients (10%) were given a variety of nonstandard triple or quadruple ART. CONCLUSIONS: This audit again shows a high rate of consistency and quality of care of patients with HIV across the UK and Ireland. Problems with pretreatment assessment and early follow up of patients starting ART have been found.
Management of HIV-related lymphoma in HIV treatment centres in North Thames Region.
We describe an audit of lymphoma care in HIV-positive patients. In the smaller units (< 500 patients) areas of potentially sub-optimal care were identified.
Diagnosis of Chlamydia trachomatis in North Thames region 2003.
A multi-centre re-audit of tests used for chlamydia diagnosis in GU medicine clinic attendees from February 2003 to March 2003 in the North Thames region showed improvements since our previous audit in 1999, with a significant increase in the proportion of clinics using nucleic acid amplification tests and non-invasive testing.
Treatment of Chlamydia trachomatis in North Thames region 2003.
Following on from the survey of techniques used for testing chlamydia, a multi-centre re-audit of the treatment of C. trachomatis in genitourinary clinic attendees in the North Thames region from February to March 2003 was performed. This showed an improvement since our previous audit with a significant increase in the number of centres following national guidelines in antibiotic prescribing and offering test of cure in clinically indicated cases.
Screening for non-gonococcal urethritis.
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BHIVA Guidelines: coinfection with HIV and chronic hepatitis B virus.
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BHIVA guidelines: coinfection with HIV and chronic hepatitis C virus.
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Maintaining patient access to GUM clinics: is it compatible with appointments?
OBJECTIVES: To determine whether a planned change from a walk-in service to a system in which 35% of appointments were prebooked and 65% obtained on the day, preserved access to the service for patients with, or at risk of, STIs. To describe patients' attitudes and behaviours in relation to accessing the clinic, and relate these to disease status and other epidemiological factors. To evaluate the effect of the change on clinical outcomes. To develop a tool for evaluating access to services. METHOD: A natural experiment was studied, in which a cohort of patients attending just before the change in appointments policy (phase 1) was compared with a cohort following the change (phase 2). A questionnaire was administered to all new patients, and linked to disaggregated epidemiological and demographic data and case notes. RESULTS: The age, ethnic, symptom status, and disease mix of the clinic did not change significantly, and more patients were seen in phase 2. Time from telephoning to being seen did not change. Under 25s and Afro-Caribbeans used prebooked appointments less than others. Partner notification improved and HIV testing rates increased, while staff preferred the new system. CONCLUSION: This specific appointment system in a GUM clinic preserved access for high risk groups. However, this may not generalise to systems with a higher proportion of prebooked appointments.
Chaperoning in genitourinary medicine clinics.
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Treating sexually transmitted infections in primary care: a missed opportunity?
OBJECTIVES: To explore patterns of primary care attendance, barriers to the use of primary care, and views on services in a population of first time genitourinary medicine (GUM) clinic attenders. METHOD: A cross sectional survey of new patients attending a mainly walk-in outer London GUM clinic, in which responses were linked to clinical data. RESULTS: 40.5% of all patients and 39.9% of those with an STI had already seen a GP for their current problem. This did not vary with age or symptom status. Duration of symptoms was highly significantly longer in patients who had attended a GP than in patients who attended a GUM clinic in the first instance. When patients who had not seen a GP were asked the reason for this, a third of responses cited the convenience of a GUM clinic or difficulty in accessing primary care services, while only 3% cited embarrassment and only 2% examination or gender issues. CONCLUSION: Many patients initially attend GP services for STIs, and primary care is therefore already an important setting with potential for STI control. However, delay in treatment through attendance at primary care, and barriers in access to primary care, need to be addressed in the planning of future services.
Partner notification in primary care.
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Which factors affect access to STD care? A comparison of a hospital based clinic and an outreach service.
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Management of HIV and hepatitis B or C co-infection in 15 HIV treatment centres. Disparity between protocols and practice.
Our aim was to ascertain current guidelines and clinical practices prevalent in HIV treatment centres in the North Thames Region of England on the care of patients co-infected with HIV and hepatitis B or C. A self-completed postal survey of clinic guidelines and retrospective case-note reviews was performed. Fifteen of the 27 units completed the survey and generally had clinic guidelines consistent with current national guidelines. Stated policy was usually to screen HIV patients for hepatitis B virus (HBV) and hepatitis C virus (HCV) and to offer specific therapy for the hepatitis as well as the HIV. Many units were unable to contribute cases to the case-note review, probably through lack of case-identification, and therefore 11 units contributed 27 case-note reviews on HIV/HBV and five units contributed 11 case-note reviews on HIV/HCV. Fifty-six percent (25/45) of patients of HBV patients were HBeAg+ve and 88% (22/25) of these had received specific hepatitis B therapy although for 59% (13/22) this was with lamivudine as part of a highly active antiretroviral therapy regimen. None of the HIV/HCV patients had received or been referred for HCV-specific therapy. Testing for hepatitis A immunity in HBV or HCV patients with a view to vaccination was done in only 50% although 96% of HIV/HCV patients had been screened for HBV. There are significant differences between the clinics' intended and actual management of HIV and chronic viral hepatitis co-infection.
Sexually acquired hepatitis.
OBJECTIVES: To assess current knowledge of sexually transmitted viral hepatitis in relation to epidemiology, clinical presentation, management, and diagnosis with particular reference to resource-poor settings. METHOD: A search of published literature identified through Medline from 1966 to October 2001, the Cochrane Library, and reference lists taken from each article obtained. Textword and MeSH searches for hepatitis A, B, C, D, E, G, delta, GB virus, GBV-C, and TT virus were linked to searches under the textword terms sex$, prevent$, and MeSH subheadings, microbiology, complications, drug therapy, therapy, diagnosis, epidemiology, transmission, and prevention and control. CONCLUSIONS: In heterosexual relationships, hepatitis B is readily transmitted sexually and hepatitis C and D less so, with no evidence for sexual transmission of hepatitis A. Hepatitis types A-D are all transmissible sexually in male homosexual relationships under certain conditions. In resource-poor countries sexual transmission is generally only a significant route of transmission for hepatitis B.