COVID-19: Sexual Health, HIV and Pregnancy Advisory Service Guide

May 2020

Scope

This information provides guidance on the management of Sexual Health, HIV and Pregnancy Advisory Service (PAS) patients in Northern Devon, South Devon & Torbay and Eastern Devon provided by Devon Sexual health service during the COVID-19 pandemic. The information is based on national guidance from the BASHH, BHIVA and FRSH which includes regularly updated resources for patients and health care professionals.

The team at Devon Sexual Health have now enacted a service model to provide this across their clinics at Exeter, Barnstaple and Torquay. Please note that currently all of the outreach services at Tiverton, Exmouth, Ilfracombe, Holsworthy, Bideford, Okehampton, Newton Abbot and Paignton are shut for the duration of the pandemic.

Key Referral Information

Devon Sexual Health website

Patients

Can self-refer for advice on Sexual Health using the telephone number: 0300 303 3989, choosing the appropriate option

Clinicians

Can ask for advice on Sexual Health, Human Immunodeficiency Virus (HIV) or Pregnancy Advisory Service (PAS)

Monday-Friday 09:00 -17:00;

  • Barnstaple: Telephone – 01271 341562
  • Exeter: Telephone – 01392 284966
  • Torbay: Telephone – 01803 656500
Out of hours HIV advice:

By contacting the on-call HIV consultant via Derriford hospital switchboard 01752 202082

Pregnancy Advisory Service:
  • via GP or patient self-referral; 0300 303 3989

or

  • by GP or patient self-referral to Marie Stopes UK using the telephone number: One Call 0345 300 8090 – day or night, 7 days a week

National guidance

Conditions with specific guidance

HIV
  1. People with a CD4 count less than 50 or opportunistic illness in last 6 months: follow shielding advice for extremely vulnerable;
  2. People with CD4 less than 200, detectable viral load or not on ART: follow social distancing advice stringently;
  3. People with CD4 less than 200 and undetectable on ART: follow general population advice (i.e. social distancing)
    • New HIV cases, should still be referred urgently as normal
Contraception
  • Helpful advice from the Faculty of Sexual and Reproductive Health (FSRH) is available on Long Acting Reversible Contraceptives (LARC) use at this time. This includes reassuring information for people who already have a Long Acting Reversible Contraceptives LARC inserted that is due to, or has, expired.

There is good evidence that extended use of:

  • Nexplanon implants for 4 years
  • 10-year lifespan copper IUDs for 12 years
  • 5-year lifespan copper IUDs for 6 years
  • 52mg LNG-IUS (Mirena/Levosert) for 6 years

is safe with arrangements made for removal/replacement after the COVID-19 crisis is over. Women can leave the Long Acting Reversible Contraceptives (LARC)in place and add a progestogen-only pill (POP) on top if they are worried, but the risk of pregnancy is likely to be small.

  • Encourage 12-month prescription for existing cop/pop users - electronic prescriptions straight to pharmacies if available
  • QuickStart and Bridge with progestogen-only pill POP (no need for face to face) for anyone with new request for contraception
  • Switch Depot users to Sayana Press (provided available) if they have successfully used this method before. Give them 4x (12-month supply)

Pregnancy Advisory Service (PAS)

  • via GP or patient self-referral using the telephone number: 0300 303 3989

or

  • by GP or patient self-referral to Marie Stopes UK using the telephone number: One Call 0345 450 3964 –day or night, 7 days a week.
  • A full list of our clinic locations can be found here: Marie Stopes UK
  • Home Medical Termination of Pregnancy (MTOP) available for those suitable after telephone assessment and short clinic visit for US scan if required
  • Local anaesthetic and general anaesthetic Termination of Pregnancy (TOP) currently still available but may be subject to restrictions during COVID-19

​Urgent Sexual Health Advice

The FRSH, BASHH and BHIVA has given clear guidance on the shape of a core service for essential sexual health needs during this pandemic.

Urgent referrals, including new HIV cases, should still be referred urgently as normal

The team at Devon Sexual Health have now enacted a service model to provide this across their clinics at Exeter, Barnstaple and Torquay. This encompasses the provision of:

  • emergency contraception, including the provision of PCIUDs
  • supply of contraceptive pills (for collection from the service)
  • complications arising from LARCs – e.g. significant coil pain, implant pain, missing LARCs
  • advice and referral for TOP care, as well as pregnancy advisory service (Torquay only)
  • face-to-face management of symptomatic sexually transmitted infections (STIs)
  • management of diagnosed STIs
  • partner notification, testing and treatment
  • HIV Pre-exposure prophylaxis (PrEP)
  • HIV Post-Exposure Prophylaxis following Sexual Exposure (PEPSE)
  • advice and referral for the management of sexual assault (please note that referral to Sexual Assualt Referral Centre (SARC) is via the SARC website
  • HIV treatment and care
  • clinical advice to health care professionals on the above
  • free condom supplies
Patients

Can self-refer using the telephone number: 0300 303 3989, choosing the appropriate option

Clinicians

Can ask for advice on Sexual Health, HIV or PAS Monday - Friday 09:00-17:00;

  • Barnstaple: Telephone – 01271 341562
  • Exeter: Telephone – 01392 28496
  • Torbay: Telephone – 01803 656500

Risk factors for face-to-face review will be decided on case by case basis.

Out of hours HIV advice

By contacting the on-call HIV consultant via Derriford hospital switchboard 01752 202082

Routine referrals

New routine Sexual Health referrals will not be booked during the COVID-19 pandemic. All routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Urgent referrals, including new HIV cases, should still be referred urgently as normal (see details above)

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate.

Patients can self-refer using the telephone number: 0300 303 3989, choosing the appropriate option

​Advice & Guidance/Telephone services

  • Advice and Guidance / telephone consultation services aim to maintain operation for non-urgent patients
    • Mobile messaging is routinely used
    • Patients will be assessed by telephone and managed with home testing/sampling as needed
    • Need for face-to-face review will be decided on case by case basis
    • Royal Mail or pick up service for medication
  • Patients will be encouraged to attend pharmacies for guided self-management where appropriate
  • News articles are updated on the website (Devon Sexual Health) to summarise patient and professional advice as it comes available.
    • Current information available includes:
      • Information on the provision of routine contraception during this pandemic is here
      • Information on sexual contact during a time of social distancing can be found here
      • Specific advice on coronavirus is available for people living with HIV here, and for pregnant women here

​Contact information

Devon Sexual Health website

Patients

Can self-refer for advice on Sexual Health using the telephone number: 0300 303 3989, choosing the appropriate option

Clinicians

Can ask for advice on Sexual Health, HIV or PAS Monday-Friday 09:00 -17:00;

  • Barnstaple: Telephone – 01271 341562
  • Exeter: Telephone – 01392 284966
  • Torbay: Telephone – 01803 656500
Out of hours HIV advice:
  • By contacting the on-call HIV consultant via Derriford hospital switchboard 01752 202082
Pregnancy Advisory Service:
  • via GP or patient self-referral; 0300 303 3989

or

  • by GP or patient self-referral to Marie Stopes UK using the telephone number: One Call 0345 450 3964 –day or night, 7 days a week

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 15-05-2020

 

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