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IntroductionThe aim of clinical supervision (CS) is to engage in guided reflection in order to develop and enhance clinical practice1. There is evidence that CS positively impacts on clinical care as well as health professionals’ job satisfaction and retention2–4. We aimed to look at the current provision of CS for sexual health clinicians in the UK.MethodsA survey was developed to identify the current level of CS provision across the UK, and was sent to all BASHH members via the quarterly newsletter. CS was defined as: ‘A space to reflect on or discuss clinical or organisational situations rather than develop clinical skills’.Results105 clinicians working within UK sexual health clinics responded. 57%(60/105) had regular CS. 90%(54/60) found it beneficial to their clinical practice, and 78%(47/60) found it beneficial to their wellbeing. Of those who didn’t receive CS 82%(37/45) felt it would benefit their clinical practice and 86%(39/45) felt it would benefit their wellbeing. We found that doctors (80%) were significantly more likely to have group supervision than nurses (38%) or sexual health advisors (9%) (p<0.0001).DiscussionAlthough the majority of those receiving CS felt it to be beneficial to both their wellbeing and their clinical practice, delivery of CS across the UK varies widely. It is possible that developing standards for CS may help guide commissioning decisions and enhance the benefits for all sexual health clinicians.

There is little data on HIV prevalence or HIV pre-exposure prophylaxis (PrEP) use among gender-diverse people in the UK.1 Current guidelines recommend that PrEP be offered to transgender women (TGW) at risk of HIV through condomless anal sex and transgender men and women having condomless sex with partners.2 We aimed to explore the number of gender-diverse people who were eligible and using PrEP among attendees at our large sexual health service in Brighton, UK.

IntroductionLong Acting Reversible Contraception (LARC) are highly effective and cost effective forms of contraception. However, the cost effectiveness of LARC is reduced by early discontinuation. Understanding the reasons for early removal of intrauterine contraception (IUC) may reduce early discontinuation. We aimed to describe the patterns of discontinuation of IUC within a large city centre integrated sexual health clinicMethodsAll patients between Oct 2021- March 2022 attending to remove and discontinue IUC were audited to assess IUC type, length of use and reasons for removal.ResultsIn the study period, there were 541 IUC removals of which 157 (29%,95%CI=25-33) [Mirena N=67, Kyleena N=6, Jaydess N=8, 5-year IUD, N=29, 10 year IUD,N=27] discontinued IUC. The median age of discontinuing patients was 31-years(IQR=25-37). The median duration of IUC was 34 months (IQR=8-58,range=1-216). Mirena(48-months) survived significantly longer than Jaydess (28-months) and Kyleena (7-months)(p=0.001). The 10-year IUD (42 months) survived significantly longer than the 5-year IUD (13-months) (p=0.01). The most frequent reasons given for removal were abnormal vaginal bleeding (n=36,23%) and pain (n=24,15%). 51% (80/157) switched contraceptive method of which 86% (69/80) switched away from LARC to either a short acting, barrier, or fertility awareness method. 31% (10/32) of patients who declined further contraception had ongoing pregnancy risk.DiscussionA significant number of patients attend for early IUC removal due to abnormal bleeding and pain and the majority of those changing method chose methods with lower efficacy. Counselling patients about reasons for discontinuation and alternative methods remains important to help mitigate early discontinuation.

IntroductionEstimates of HIV prevalence amongst gender minorities are determined exclusively from scarce data for transgender women (TGW) who, globally, are disproportionately affected by HIV.1 Data for transgender men (TGM) and non-binary individuals (NBI) are extremely limited. Transgender people are often identified as an underserved group for HIV prevention, however data on use of pre-exposure prophylaxis (PrEP) for HIV are lacking.2 3 This study aimed to determine the prevalence of PrEP use amongst transgender attendees at our sexual health service.MethodsAll transgender people attending a single integrated sexual health service throughout 2021 were identified through GUMCAD coding and/or attendance at the services’ specialist trans clinic. Notes were reviewed for demographic data, PrEP eligibility and use. Confidence intervals (CI) were estimated with binomial exact test.Results108 patients were identified; 41/108 (38%) TGM, 38/108 (35%) TGW and 29/108 (27%) NBI. Median age was 36 years (IQR=24-38). 5(5%) were living with HIV, all TGW. 21/103 (20%) HIV negative patients were eligible for PrEP as per national guidelines. PrEP eligibility could not be determined from records for 15/103 (15%). 16/103 (16%, 95%CI=10-24) were currently using PrEP, 6(15%) TGM, 7(18%) TGW and 3(10%) NBI). A further 4 had previously used PrEP.DiscussionTo our knowledge this is the first description of PrEP use amongst transgender people from a UK sexual health clinic. Only a small proportion were currently using PrEP, with most deemed not eligible. Further research is needed to determine whether this is reflective of the wider transgender population and to identify their diverse sexual health needs.ReferencesBaral S, Poteat T, Strömdahl S, Wirtz A, Guadamuz T and Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013; 13(3): 214-22.World Health Organisation. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: 2021.Brady M, et al. BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP). HIV Med. 2019: 20; Suppl 2: s2-80.