title: Audit of HIV testing frequency and behavioural interventions for men who have sex with men: policy and practice in sexual health clinics in England.
abstract: BACKGROUND
  National guidance recommends targeted behavioural interventions and frequent HIV testing for men who have sex with men (MSM). We reviewed current policy and practice for HIV testing and behavioural interventions (BI) in England to determine adherence to guidance.
  
  
  METHODS
  25 sexual health clinics were surveyed using a semistructured audit asking about risk ascertainment for MSM, HIV testing and behavioural intervention policies. Practice was assessed by reviewing the notes of the first 40 HIV-negative MSM aged over 16 who attended from 1 June 2010, in a subset of 15 clinics.
  
  
  RESULTS
  24 clinics completed the survey: 18 (75%) defined risk for MSM and 17 used unprotected anal intercourse (UAI) as an indication of high risk. 21 (88%) offered one or more structured BI. Of 598 notes reviewed, 199 (33%) MSM reported any UAI. BI, including safer sex advice, was offered to and accepted by 251/598 (42%) men. A low proportion of all MSM (52/251: 21%) accepted a structured one-to-one BI as recommended by national guidance and uptake was still low among higher risk MSM (29/107: 27%). 92% (552/598) of men had one or more HIV test over a 1-year period.
  
  
  CONCLUSIONS
  In 2010, the number of HIV tests performed met the national minimum standard but structured behavioural interventions were being offered to and accepted by only a small proportion of MSM, including those at a higher risk of infection. Reasons for not offering behavioural interventions to higher risk MSM, whether due to patient choice, a lack of staff training or resource shortage, need to be investigated and addressed.
authors.affiliation: HIV & STI Department, Health Protection Agency, London, UK. desai.monica@gmail.com
authors.forename: Monica
authors.initials: M
authors.lastname: Desai
authors.forename: Sarika
authors.initials: S
authors.lastname: Desai
authors.forename: Ann Kathleen
authors.initials: AK
authors.lastname: Sullivan
authors.forename: Malika
authors.initials: M
authors.lastname: Mohabeer
authors.forename: Danielle
authors.initials: D
authors.lastname: Mercey
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Kingston
authors.forename: Caroline
authors.initials: C
authors.lastname: Thng
authors.forename: Sheena
authors.initials: S
authors.lastname: McCormack
authors.forename: O Noel
authors.initials: ON
authors.lastname: Gill
authors.forename: Anthony
authors.initials: A
authors.lastname: Nardone
mesh_terms: D054869:Clinical Audit; D004739:England; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006291:Health Policy; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D060728:Reproductive Health / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D011795:Surveys and Questionnaires
keywords: Behavioural Interventions; HIV; Prevention