Jackie A Cassell1, Julie Dodds2, Claudia Estcourt3, Carrie Llewellyn1, Stefania Lanza1, John Richens4, Helen Smith1, Merle Symonds3, Andrew Copas4, Tracy Roberts5, Kate Walters4, Peter White6, Catherine Lowndes7, Hema Mistry5, Melcior Rossello-Roig5, Hilary Smith1, Greta Rait2. 1. Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK. 2. Medical Research Council, General Practice Research Framework, London, UK. 3. BICMS, Barts and The London School of Medicine and Dentistry, Queen Mary College, University of London, London, UK. 4. Research Department of Primary Care and Population Health, UCL and Medical Research Council General Practice Research Framework, London, UK. 5. Health Economics Unit, School of Health and Population Science, University of Birmingham, , UK. 6. MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK. 7. STI Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
Abstract
BACKGROUND: Partner notification is the process of providing support for, informing and treating sexual partners of individuals who have been diagnosed with sexually transmitted infections (STIs). It is traditionally undertaken by specialist sexual health services, and may involve informing a partner on a patient's behalf, with consent. With an increasing proportion of STIs diagnosed in general practice and other community settings, there is a growing need to understand the best way to provide partner notification for people diagnosed with a STI in this setting using a web-based referral system. OBJECTIVE: We aimed to compare three different approaches to partner notification for people diagnosed with chlamydia within general practice. DESIGN: Cluster randomised controlled trial. SETTING: General practices in England and, within these, patients tested for and diagnosed with genital chlamydia or other bacterial STIs in that setting using a web-based referral system. INTERVENTIONS: Three different approaches to partner notification: patient referral alone, or the additional offer of either provider referral or contract referral. MAIN OUTCOME MEASURES: (1) Number of main partners per index patient treated for chlamydia and/or gonorrhoea/non-specific urethritis/pelvic inflammatory disease; and (2) proportion of index patients testing negative for the relevant STI at 3 months. RESULTS: As testing rates for chlamydia were far lower than expected, we were unable to scale up the trial, which was concluded at pilot stage. We are not able to answer the original research question. We present the results of the work undertaken to improve recruitment to similar studies requiring opportunistic recruitment of young people in general practice. We were unable to standardise provider and contract referral separately; however, we also present results of qualitative work aimed at optimising these interventions. CONCLUSIONS: External recruitment may be required to facilitate the recruitment of young people to research in general practice, especially in sensitive areas, because of specific barriers experienced by general practice staff. Costs need to be taken into account together with feasibility considerations. Partner notification interventions for bacterial STIs may not be clearly separable into the three categories of patient, provider and contract referral. Future research is needed to operationalise the approaches of provider and contract partner notification if future trials are to provide generalisable information. TRIAL REGISTRATION: Current Controlled Trials ISRCTN24160819. FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 5. See the NIHR Journals Library website for further project information.
BACKGROUND: Partner notification is the process of providing support for, informing and treating sexual partners of individuals who have been diagnosed with sexually transmitted infections (STIs). It is traditionally undertaken by specialist sexual health services, and may involve informing a partner on a patient's behalf, with consent. With an increasing proportion of STIs diagnosed in general practice and other community settings, there is a growing need to understand the best way to provide partner notification for people diagnosed with a STI in this setting using a web-based referral system. OBJECTIVE: We aimed to compare three different approaches to partner notification for people diagnosed with chlamydia within general practice. DESIGN: Cluster randomised controlled trial. SETTING: General practices in England and, within these, patients tested for and diagnosed with genital chlamydia or other bacterial STIs in that setting using a web-based referral system. INTERVENTIONS: Three different approaches to partner notification: patient referral alone, or the additional offer of either provider referral or contract referral. MAIN OUTCOME MEASURES: (1) Number of main partners per index patient treated for chlamydia and/or gonorrhoea/non-specific urethritis/pelvic inflammatory disease; and (2) proportion of index patients testing negative for the relevant STI at 3 months. RESULTS: As testing rates for chlamydia were far lower than expected, we were unable to scale up the trial, which was concluded at pilot stage. We are not able to answer the original research question. We present the results of the work undertaken to improve recruitment to similar studies requiring opportunistic recruitment of young people in general practice. We were unable to standardise provider and contract referral separately; however, we also present results of qualitative work aimed at optimising these interventions. CONCLUSIONS: External recruitment may be required to facilitate the recruitment of young people to research in general practice, especially in sensitive areas, because of specific barriers experienced by general practice staff. Costs need to be taken into account together with feasibility considerations. Partner notification interventions for bacterial STIs may not be clearly separable into the three categories of patient, provider and contract referral. Future research is needed to operationalise the approaches of provider and contract partner notification if future trials are to provide generalisable information. TRIAL REGISTRATION: Current Controlled Trials ISRCTN24160819. FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 5. See the NIHR Journals Library website for further project information.
Authors: Louise J Jackson; Tracy E Roberts; Sebastian S Fuller; Lorna J Sutcliffe; John M Saunders; Andrew J Copas; Catherine H Mercer; Jackie A Cassell; Claudia S Estcourt Journal: Sex Transm Infect Date: 2014-12-15 Impact factor: 3.519
Authors: Katy Town; Cliodna A M McNulty; Ellie J Ricketts; Thomas Hartney; Anthony Nardone; Kate A Folkard; Andre Charlett; J Kevin Dunbar Journal: BMC Public Health Date: 2016-08-02 Impact factor: 3.295
Authors: Claudia S Estcourt; Lorna J Sutcliffe; Andrew Copas; Catherine H Mercer; Tracy E Roberts; Louise J Jackson; Merle Symonds; Laura Tickle; Pamela Muniina; Greta Rait; Anne M Johnson; Kazeem Aderogba; Sarah Creighton; Jackie A Cassell Journal: Sex Transm Infect Date: 2015-05-27 Impact factor: 3.519