"Bacterial infection rates were rising before PrEP, but PrEP may have helped accelerate them. Most of this is fueled by changing social norms, particularly for women as they are increasing the number of partners they have," she told Contagion
The Dean Street Express Clinic (www.deanstreetexpress.nhs.uk
) at 34 Dean Street in Soho in central London, sponsored by the City of Westminster and the National Health Service (NIH), opened in September 2014 and it was immediately fully booked.
"The drop-in center has come from two pressures," Dr. McCormack told Contagion
. "One, we knew that we had to increase throughput, and two, we had no clear increase in our budget to do this. And we were diagnosing so much HIV in our patients. It's about location, location, location. We were right in the middle of a massive gay scene and we could not cope with the HIV that we were seeing and treating in the clinic along with the asymptomatics. So we had to move what we could from the clinic to another venue."
"Moving out self-screening was the obvious choice. You don't need a doctor to do this. You don't really even need a nurse. People can do this themselves very well. And they really like it," she said.
The providers were also under pressure to make visiting the busy sexual health testing and treatment clinic acceptable, and they created an efficient yet attractive relaxing space. The façade has no signage advertising it as a sexual health clinic. "We want to make the educational facts fun and acceptable, and people love it. It doesn't feel like going to sexual health clinic," Dr. McCormack told Contagion
. "One person said, 'I really thought that a waiter was going to come with cocktails and canapés.'"
Dean Street Express offers free confidential routine sexual health screening tests for STI/STD and HIV six days a week to people who without symptoms. Clients reserve a time slot online, provide a cellphone number, receive an SMS text message confirmation, and show that message to a staff member when they arrive at the clinic. They check themselves in on an iPad to avoid transcription errors; and messages, including lab tests, are texted to the phone.
A video (https://www.youtube.com/watch?v=q0X9QpWyRkA
) shows them how to take a throat, vaginal or anal swab, to urinate into a container, and they send their samples through a pneumatic tube to the lab. Most results are processed in about an hour and most people receive all their results within 6 hours.
A blood test for HIV provides results in 60 seconds and is the one interaction with a trained health care provider who has seen the person's history and can provide information and advice about safe sex and clean needles and provide condoms. Some labs take about six hours to come back and those results are also texted to the cellphone.
"The person receives results for syphilis, hepatitis, gonorrhea, and chlamydia," Dr. McCormack said.