An observational study to evaluate three pilot programmes of retesting chlamydia-positive individuals within 6†months in the South West of England.

OBJECTIVES: To evaluate 3 pilot chlamydia retesting programmes in South West England which were initiated prior to the release of new National Chlamydia Screening Programme (NCSP) guidelines recommending retesting in 2014. METHODS: Individuals testing positive between August 2012 and July 2013 in Bristol (n=346), Cornwall (n=252) and Dorset (n=180) programmes were eligible for inclusion in the retesting pilots. The primary outcomes were retest within 6 months (yes/no) and repeat diagnosis at retest (yes/no), adjusted for area, age and gender. RESULTS: Overall 303/778 (39.0%) of participants were retested within 6 months and 31/299 (10.4%) were positive at retest. Females were more likely to retest than males and Dorset had higher retesting rates than the other areas. CONCLUSIONS: More than a third of those eligible were retested within the time frame of the study. Chlamydia retesting programmes appear feasible within the context of current programmes to identify individuals at continued risk of infection with relatively low resource and time input.

Could a peer-led intervention increase uptake of chlamydia screening? A proof of principle pilot study.

BACKGROUND: Uptake of the English National Chlamydia Screening Programme is lower than predicted necessary to result in a rapid fall in chlamydia prevalence. Peer-led approaches may increase screening uptake but their feasibility and acceptability to young people is not known. METHODS: Focus groups and interviews with young women and men. Following interview, chlamydia postal kits were introduced to participants and their opinions on giving these out to their peers sought. Participants were asked for their views and experiences of discussing chlamydia screening and distributing kits to their friends 4-8 weeks after the focus group/interview. All kits returned to the laboratory over a 9-month period were recorded. RESULTS: Six men (mean age 19 years) and six women (mean age 20 years) were recruited. In total 45 kits were distributed, 33 (73%) to female participants. 22 (67%) and 3 (25%) of kits given to females and males, respectively, were given to peers. Ten kits (22%; seven female, three male) all of which had been given out by females, were returned for testing. Participants generally felt positive about the idea of peer-led screening (PLS) using postal kits. However, embarrassment was a key theme, particularly among men. Generally women but not men were able to discuss PLS among their close friends. Both sexes felt PLS would be easier if kits were readily available in multiple sites, and chlamydia screening was more widely promoted. CONCLUSION: Female PLS but not male PLS was successful in recruiting peers to participate in chlamydia screening. An evaluation of the acceptability and cost-effectiveness of PLS is now indicated.

Partner notification of chlamydia infection in primary care: randomised controlled trial and analysis of resource use.

OBJECTIVE: To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of people with chlamydia infection. DESIGN: Randomised controlled trial. SETTING: 27 general practices in the Bristol and Birmingham areas. PARTICIPANTS: 140 men and women with chlamydia (index cases) diagnosed by screening of a home collected urine sample or vulval swab specimen. INTERVENTIONS: Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic. MAIN OUTCOME MEASURES: Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for chlamydia six weeks after treatment, and the cost of each strategy in 2003 sterling prices. RESULTS: 65.3% (47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9% (39/68) of those referred to a genitourinary medicine clinic (risk difference 12.4%, 95% confidence interval -1.8% to 26.5%). Of 68 participants referred to the clinic, 21 (31%) did not attend. The costs per index case were 32.55 pounds sterling for the practice nurse led strategy and 32.62 pounds sterling for the specialist referral strategy. CONCLUSION: Practice based partner notification by trained nurses with telephone follow up by health advisers is at least as effective as referral to a specialist health adviser at a genitourinary medicine clinic, and costs the same. Trial registration Clinical trials: NCT00112255.