Developing a model of sexual healthcare provision for substance-misusing women

OBJECTIVES: This project sought to define a model of sexual healthcare provision for substance-misusing women (SMW), as they are known to experiencedisproportionate sexual health morbidities. METHOD: Model development followed the first stage of the MRC Framework for developing and evaluatingcomplex interventions. The model was developed in four sequential steps. Firstly a survey and qualitative interview study were conducted with SMW to determine sexual health needs and barriers to service use. Secondly these data were used to informally model services by determining critical service components and how they would inter-relate.Next, guidance on sexual health service standards and supporting at-risk and disenfranchised populations were reviewed to ensure the draft model was congruent with recommended policy and service delivery. Finally expert panel consultations were convened to 'trouble shoot' problematic elements of the model and to identifyfeasibility issues; before finalising the model in a commissioning framework format to facilitate uptake. RESULTS: The finalised model comprises: 1. Opportunistic fast-track single-site access to a range of sexual health interventions through CASH and GUM services, walk-in centres and GP surgeries where certain criteria are met. 2. Training in sexual health discussion and sign-posting, to drug workers and other non-sexual health providers who regularly engage with substance misusing women 3. Sexual health role expansion for drug workers and other non-sexual health providers who regularly engage with substance misusing women 4. Training for sexual healthcare providers in specific issues and barriers to sexual healthcare engagement affecting substance misusing women 5. Outreach sexual health (female) nurse services (including administration of contraception and pregnancy testing) to substance misusing women 6. Targeted and sustained advertisement of sexual health services and promotion messages through poster campaigns and ‘Women's Health cards' 7. Travel reimbursement for substance misusing women attending sexual health services and Sexual Assault Referral Centres (SARCs) 8. Provision and advertisement of washing facilities at sites where genital examination may be required CONCLUSIONS: The model carries a strong policy and evidence base, with clear actions and anticipated outcomes. The model highlights the importance of joined-up provision and skill sharing by substance misuse and sexual health service providers and practitioners; and the importance of emotional and practical support in enabling access to sexual health services for SMW.Further researchto test the effectiveness of model provision should investigate which model components carry specific effects in improving service uptake and health outcomes; and explore the potential value of extending the intervention to other disenfranchised populations.