Research and analysis

HPR volume 14 issues 23 and 24: news (23 December)

Updated 23 December 2020

Impact of COVID-19 on prevention, testing, diagnosis and care for STIs, HIV and viral hepatitis

The Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV division of PHE’s National Infection Service has undertaken analyses of surveillance data from multiple settings to assess the impact of the coronavirus (COVID-19) pandemic on STI, HIV and hepatitis service provision and epidemiology.

Provisional data are presented up to June, August or September 2020, depending on the source, in the report, The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for sexually transmitted infections, HIV and viral hepatitis in England. Charts and graphs are presented that illustrate the trends described in brief below.

Between March and May 2020, there was a reduction in a number of measures of service provision and patient outcomes. These are:

• consultations at sexual health services (SHSs) and specialised HIV services
• testing for viral hepatitis in drug services, prisons, general practice and SHSs
• testing for HIV and STIs in SHSs
• vaccination of gay, bisexual and other men who have sex with men (MSM) against HPV, hepatitis B and hepatitis A
• diagnoses of viral hepatitis, HIV and STIs
• hepatitis C treatment initiations

These early findings indicate that the COVID-19 pandemic response, including social and physical distancing measures, has led to a re-prioritisation and disruption in provision of, and patient access to, health services for HIV, STIs and hepatitis.

A modest rebound in HIV, STI and hepatitis tests and diagnoses, and HCV treatment initiations, since June 2020 might indicate a recovery in service provision and demand, the latter also potentially influenced by changes in risk perception and behaviour. However, the respective numbers of consultations, vaccinations, tests, diagnoses, and treatment initiations in the summer of 2020 were considerably lower compared to the corresponding months in 2019.

Innovation in service delivery such as online or tele-consultations for HIV and hepatitis, STI and blood-borne virus (BBV) self-sampling kits, and expanded community outreach testing and linkage to care for hepatitis C, has happened at pace during 2020. While this has enabled access to services during the COVID-19 response, there is a critical need to evaluate the impact of these changes on health inequalities, as hepatitis C, HIV and many STIs predominantly affect socially disadvantaged and/or marginalised groups who already experience poor health outcomes.

PHE has worked collaboratively with partner agencies to develop a suite of resources to support service provision and equitable access during the pandemic response. These resources are available on the Sexual Health, Reproductive Health and HIV K-Hub, the British Association for Sexual Health and HIV (BASHH) website and The Faculty of Sexual and Reproductive Health (FSRH) website.

PHE also supported the Breaking the Chain: Time to Test national campaign, which was founded by 56 Dean Street to encourage people to test for HIV in June 2020. Through the National HIV and Syphilis Self-Sampling Service, PHE provided up to 10,000 free HIV self-sampling kits, including syphilis opt-out testing over June 2020.

PHE also established a National Framework for e-Sexual and Reproductive Healthcare in August 2020 to support local authority commissioners in rapidly providing an internet service for HIV/STI self-sampling, BBV testing, condom provision and a range of contraception options.

SSIs in England: annual report in summary

Public Health England (PHE) has published its latest annual report summarising data submitted to the national Surgical Site Infection Surveillance Service (SSISS) by 201 NHS hospitals, and 8 independent sector NHS treatment centres, in England.

The report, Surveillance of surgical site infections in NHS hospitals in England, April 2019 to March 2020, presents surveillance data submitted in the financial year 2019 to 2020 and covers 134,547 procedures and 1,197 surgical site infections (SSIs) detected during inpatient stay or on readmission to hospital.

NHS trusts performing any of 4 orthopaedic surgical categories (hip replacement, knee replacement, reduction of long bone fracture and repair of neck of femur) are required to undertake surveillance of SSI for a minimum of 1 3-month surveillance period per financial year. Trust-level SSI risk results for these mandatory orthopaedic categories can be found as accompanying supplementary tables; 3 trusts did not comply with the mandate in year 2019 to 2020.

The annual report presents SSI risk benchmarks for each of 17 surgical categories, trends in annual SSI incidence and variation among participating hospitals. It also includes risk-stratified SSI incidence, and characteristics of SSI including microbial aetiology.

Key findings include the following:

• the variation in SSI risk across hospitals participating in all mandatory orthopaedic surveillance continues to decrease however, 6 high outlier notifications were identified (3 for knee replacement, 2 for hip and 1 for repair of neck of femur) in year 2019 to 2020
• 9 of 13 categories assessed saw decreases in SSI risk from the previous year; large bowel surgery decreased to its lowest in 10 years at 7.7%
• the national benchmark for SSI risk following bile duct, liver or pancreatic surgery (9.1%) was higher than large bowel for the first time
• the annual SSI incidence for hip and knee replacement has remained stable at around 0.4% to 0.5% in 2019 to 2020
• Enterobacterales continued to make up the largest proportion of causative organisms across all surgical categories in year 2019 to 2020 for both superficial SSIs (29.8%) and deep or organ/space (26.2%), however S. aureus still contributes to a large proportion of deep or organ space SSIs (24.2%)

Infection reports in this issue

• Laboratory reports of hepatitis A infections in England and Wales: January to March 2020

• Laboratory reports of hepatitis C in England and Wales: January to March 2020

• Acute hepatitis B: national enhanced surveillance report January to March 2020

• Laboratory surveillance of pyogenic and non-pyogenic streptococcal bacteraemia in England: 2019

Childhood vaccination coverage reports

• Quarterly vaccination coverage statistics for children aged up to 5 years in the UK (July to September 2020).

• Impact of COVID-19 on childhood vaccination to week 49 (eighth report).