Female sexual and reproductive health clinic in an addiction clinic- can it be done?

Author: Lina Hijazi

Theme: Models of Care Year: 2023

Background: Women who use drugs (WHUD) have increased risk of sexually transmitted infections (STI), unplanned pregnancy and untreated menopausal symptoms and face multiple barriers to attending other clinics including conflicting responsibilities, fear of discrimination and difficulty finding health care professionals who understand addiction medicine and its complications.
As a large multidisciplinary inner-city private addictions clinic providing opiate antagonist treatment (OAT), we have long provided injectable long-acting contraception for free and encouraged the WHUD to attend Gynaecology services and were aware that only a small proportion of WHUD attended.

Description of model of care/intervention: In June 2022 we started a sexual and reproductive health (SRH) service within the addiction clinic, provided by doctors trained in both SRH and addiction medicine, aiming to improve access for WHUD. Attendance followed either referral by the addiction doctor or self-referral. The services provided include contraceptive advice and provision; STI screening and management; Papanikolau (Pap) smear; follow up during pregnancy and menopause diagnosis and management.

Effectiveness: 40 patients were referred and 35 were seen in this service: 11 (31%) for PAP smear, 8 (23%) female check-up, 6 (17%) contraception. The average age was 40.7 years (18-61 year). 14 (40%) attended at the first appointment and 7 (20%) returned out of their own volition. Although only 31% attended for the PAP smear, a PAP smear was done on 22 (63%) with an average of 4.6 years (1-19 years) after their last smear, for 2 women this was the first ever smear. All smears were normal.
The 5 women did not attend despite being given 5 appointments and were referred back.

Conclusion: These data show that provision of specialist and addiction services under-one-roof is feasible and is a service that women choose to return to for their ongoing SRH needs, so improving access for this group of women.

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