Miss Natasha Ratna Public Health England

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Gabriella Edwards
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1 Miss Natasha Ratna Public Health England

2 A quantitative evaluation of the London Come Correct Condom Card (C-Card) scheme: Does it serve those in Natasha Ratna 1, Meroe Bleasdille 1, Anthony Nardone 1, Andrew Roberts 2, Kate Folkard 1 1. Public Health England, UK 2. THERAPY AUDIT Limited, UK

3 C-Card scheme 2008 Come Correct C-Card scheme by Primary Care Trusts (PCTs) in London (commissioned by 24/33 boroughs in 2016) Come Correct Scheme a) CONVENIENT to register and access free condom from any outlet b) HOLISTIC approach discusses sexual behavior / rights / consent, condom demonstration, signposting to other services c) IT INFRASTRUCTURE supported by THERAPY AUDIT Limited Each London Borough retains autonomy variation in service delivery (eg. registration models, no. of outlets, outlet type, resources, funding) 3

4 Why evaluate London Come Correct C-Card schemes? First London-wide evaluation (Only local evaluations to date). Come Correct promotes condom use among young people (aged <25 years) with highest STI rates. 4

5 Aims To better understand how the scheme is accessed by local population and to inform service delivery Objectives Population coverage: How do C-Card users compare to the demographics of London residents in 2016? User retention: Determine demographic and service delivery factors associated with repeat use in

6 Analyses Objective Method Inclusion criteria Descriptive Population coverage, 2016 Compare C-Card users vs London resident population. User: Anyone who used the scheme in 2016, regardless of year of registration Analytical User retention, (i.e. repeat users) Multivariate logistic regression Repeat user: Anyone who registered between Jan2013 June2016 AND returned to use the scheme between Jan2013 Dec2016 6

7 Data sources Come Correct activity data by THERAPY AUDIT Limited 2013 to 2016 disaggregated data of C-Card registration and repeat attendance. Population Estimates by Office of National Statistics (ONS) for London by Gender and Age (15-24 years) in 2016 Ethnicity (15-24 years) in 2011 Index of Multiple Deprivation (IMD) (all ages) in

Rate of C-Card users, by London borough of residence, London 2016

8 Rate of C-Card users, by London borough of residence, London per 1,000 London resident population aged years

9 Population coverage among year olds gender, ,069 C-Card users in London (3.2% of London residents aged years) Approximately equal gender distribution among C-Card users London residents Male Female C-Card users 49% 51% 47% 53% 9

10 C-Card users aged year olds age & gender, 2016 Scheme Users: years- More young men years- More young women. Female Male Age group (years) ,000 10,000 5, ,000 10,000 15,000 Number of C-Card users aged years 10

11 Population coverage among year olds age group, 2016 Age group (years) ONS population estimate C-Card users % 29% % 63% 15 9% 9% 0% 20% 40% 60% 80% Percentage 11

12 Population coverage Ethnicity 60% 50% 40% 47% 52% 2016 C-Card users ONS estimates* 30% 20% 10% 0% 28% 19% 15% 11% 10% 7% 6% 4% white black asian mixed other *2011 population estimates by ethnicity for London residents aged years, Office of National Statistics (ONS) 12

13 Population coverage by Index of Multiple Deprivation (IMD) 50% 45% 40% C-Card users 2016 Population 2015* 44% 35% 30% 30% 31% 28% 25% 20% 19% 15% 10% 9% 6% 7% 13% 12% 5% 0% Least deprived 2nd least deprived 3rd least deprived 4th least deprived Levels of index of multiple deprivation (IMD) Most deprived *2015 Official National Statistics (ONS) Population estimates for index of multiple deprivation for all ages and gender 13

14 Likelihood of user retention Of 98,319 registered users between , 30% (29,902) repeat users (median between registration and subsequent visit 3 months) Female Male age at reg: yrs age at reg: yrs age at reg: yrs (base) (base) 1.6 Increased likelihood of repeat user Least deprived quintile Most deprived quintile 1.0 (base) 1.2 White Asian Black Mixed Other (base) 1.0 Registration model (no Card) Registration model (Card provided) 1.0 (base) 5.4 Sexual Health Clinic including outreach Pharmacy Health & Social Care Education and Youth Advisory Services Other (inc internet & unknown) GP (base) small scale (<30 outlets) medium-scale (31-55 outlets) large-scale (>55 outlets) 1.0 (base) Adjusted Odds Ratio (AOR) 14

15 Limitations Data limitations Recommendations Duplicate registrations Ward of residence, differently formatted postcodes Analysis Limitations Regional IT function to prevent duplicate registrations LSOA codes Population coverage- descriptive analysis only as not controlled for scheme variation in different boroughs 15

16 Summary The scheme successfully reached key vulnerable groups of young people: Aged years Of Black and Mixed ethnicity Living in deprived areas Factors associated with repeat use Demographics: White;; Male;; Aged years at registration;; Living in deprived areas. Service delivery factors: Registration models that issue a card at registration;; Outlet types (esp. pharmacy);; Large-scale schemes. 16

17 Conclusion Condom schemes are key, easy-access, sexual health service able to engage high risk population of young people. Lessons could be learned from service delivery components that influence repeat use to improve service delivery. Continued scheme evaluation is necessary to ensure optimal service delivery and dissemination of best practice. 17

18 Acknowledgement PHE team from the HIV and STI Department : Meroe Bleasdille, former Sexual Health Facilitator, London Catherine Lowndes, Consultant Epidemiologist Anthony Nardone, Consultant Epidemiologist Kate Folkard, NCSP Programme Manager We would like to thank the following for providing the data: THERAPY AUDIT Limited Office for National Statistics (ONS) We would also like to thank the following for their input into content and design: Emma Hollis, Senior Scientist HIV and STI Department Robbie Currie, Sexual Health Programme Lead, London Borough of Bexley Susan Otiti, Assistant Director of Public Health, London Borough of Haringey Andrew Roberts,Product Manager THERAPY AUDIT Limited 18

Stockport (Local Authority)

Stockport (Local Authority) Population Brinnington & Central (Ward) All Usual Residents (Count) 14999 Area (Hectares) (Count) 527 Females (Count) 7316 Females (Percentage) 48.8 Males (Count) 7683 Males (Percentage) 51.2 Dataset: