Community pharmacies can provide important sexual health services and make their presence felt in the prevention agenda, says Andrew Dawson, a pharmacist at Well…
Pharmacies are incredibly well placed to deliver effective sexual health services to the communities we serve. Still the only method of preventing both sexually transmitted infections and pregnancy, condoms remain a vital product for all pharmacies to provide.
But with changes in how sexual health services are delivered, there is a growing opportunity for pharmacy to provide more comprehensive sexual health services. The starting point for any successful service is knowing what needs to be delivered. Public Health England has three key priority areas for sexual health:
1. Chlamydia screening in people aged 15-24.
2. Preventing conceptions in people younger than 18.
3. Preventing late diagnosis of HIV.
Community pharmacy is now delivering services mapped against at least two of these outcomes in most of the country, with some areas delivering against all three.
Chlamydia screening programme
A familiar pharmacy service now, we can offer a chlamydia testing kit to those in the target age group. By having the kits available in pharmacy, access is greatly improved to young people who otherwise may not attend a sexual health clinic, particularly as many patients with chlamydia are asymptomatic.
Although there is a range of online kit ordering sites across the UK, there are still groups of people who are not able to receive the kits at home. Some pharmacies can deliver antibiotic treatment for chlamydia (Azithromycin) via PGDs if the result comes back positive, furthering the work of community pharmacy beyond just screening to intervening to reduce the spread of infection.
Reducing under-18 conceptions
The role of the condom should not be forgotten as an easy to use, highly effective intervention, and pharmacy teams can educate young people in the community on the use of these.
However, in cases where condoms have not been used successfully, emergency hormonal contraception (EHC) is a key element in preventing unwanted pregnancies.
Delivery of both free and purchased emergency contraception to young people can help to reduce the risk of pregnancy after unprotected sex.
PGDs vary across the country, but where robust safeguarding training exists, emergency contraception can be delivered to under 18s. Recent changes from the Faculty of Sexual and Reproductive Healthcare have meant reviewing under which circumstances ulipristal acetate is more appropriate than using levonorgestrel, a drug we are all very familiar with.
A key role that pharmacies can play is to make sure their staff are correctly trained to make the experience of accessing contraception as free from embarrassment or judgement as possible for the younger person.
Preventing late diagnosis of HIV
There are currently two schemes across England and Wales, in the West Midlands and Cumbria, where pharmacists are trained to use HIV point of care testing kits to deliver screening and counsel patients in the community pharmacy.
By providing walk-in access within a safe space to these kits, pharmacies are making a real and innovative contribution to achieving this public health goal.
I am based in Cumbria and in our scheme, we can provide a full package of sexual health screening and prevention including tests for HIV, syphilis, chlamydia and gonorrhoea, and the provision of free condoms. This marks a real step forward in screening in the community.
Concerned patients receive an HIV/syphilis test result within minutes in the pharmacy, often leading to fast-track referral so medical treatment can commence immediately.
It also alleviates some of the anxiety that comes with long wait times for results. Late HIV diagnosis leads to higher patient mortality and therefore early medical intervention can have a significant impact on the patient’s long-term health.
Providing such a complete sexual health service is immensely rewarding, knowing that we are contributing to Public Health England’s key priorities in a measurable manner.
Such robust services working in synergy can only be offered when working in partnership with local authorities. The LPC has an enormous role to play as an advocate for community pharmacy, enabling pharmacy teams to extend their services to support the wider health service.
In the case of HIV/syphilis testing, the relationships with the local sexual health clinic must be strong too, so that pharmacy teams feel confident to deliver this specialist service, knowing that they have the support and expertise of the sexual health clinic teams.