Background/introduction: Commercial Sex Workers (CSW) are at increased risk of STIs including Hepatitis B virus (HBV) and, for some, Hepatitis C virus (HCV) and sexual assault. These risks can be reduced by vaccination, post-exposure prophylaxis (PEP) awareness and condoms.

Aim(s)/objectives: To audit management against clinic policy with respect to documentation of: HBV status; offering vaccination (vacc.) to HBV negative; HCV test; HIV test; PEP information/awareness and offer of condoms. Additional data was collected on new/prior STIs, recreational drugs, and same sex contact.

Methods: Casenotes of all attenders between 01/01/12 and 30/09/15 with a SW code were reviewed and additional data collected regarding vaccine uptake.

Results: 56 (7 males (12.5%), 49 females (87.5%)) individuals with a total of 243 episodes, with a median of 3 (1-17) visits, were identified. Median age of 30 (range 18-63) with 51 (91%) of white British ethnicity. 38 (67.9%) reported an STI diagnosis prior to the period audited and 13 (23.2%) had ≥1 new STI during this period, median 1 (1-3). 21 (37.5%) reported current/recent use of recreational drugs and 31/54 (57.4%) documented same sex contact, (including MSM contact for females). PEPSE was issued at 2/243 (0.8%) of episodes.
	                                       Test offered	 Test accepted	   Tested positive
HBV at first visit (n=56)	55 (98.2%)	    55 (98.2%)	           1 (eAb + sAg)
HCV test (episode, n=243) 193 (79.4%)	    176 (91%)	                        0
HIV test (episode, n=243)	239 (98.4%)	  222 (92.9%)                 	0
	
HBV status (episode, 243)	documented: 239 (98.4%)	

HBV status at first visit (n=56):
1 past infection (1.8%)
1 chronic HBV (1.8%)
20 immune post vac (35.7%)
1 not tested (1.8%)
33 status unknown (58.9%):

Outcome of those with unknown status at first visit (n=33)
4 immune (12.1%)
7 undergoing vacc. (21.2%)
10 vacc. at first visit (30.3%)
7 vacc. at later visit (21.2%)
3 declined vacc, (9.1%)
2 did not attend vacc. (6.1%)
	                                                              Documented	Not documented	
PEPSE info/awareness (episode, 243)	111 (45.7%)	    132 (54.3%)	
Offered condoms (episode, 243)	         174 (71.6%)	      69 (28.4%)	

Discussion/conclusion: The main limitation of the audit was dependence on SW code. Performance was good (>95%) for HBV documentation at first/subsequent visits, offer of HIV test, whilst HCV testing and documentation re. condoms and PEPSE awareness were suboptimal (45-80%). None were IVDU, and policy re. HCV testing in CSW will be reviewed given the low positivity rate.

An audit of bloodborne virus screening and safer sex advice for sex workers