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The relative clinical and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections (STIs) : a cluster randomised trial in primary care

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Cassell, J. A., Dodds, J., Estcourt, C., Llewellyn, C., Lanza, S., Richens, J., Smith, H., Symonds, M., Copas, A., Roberts, T. (Timothy), Walters, Kate, White, P., Lowndes, C., Mistry, Hema, Rossello, M. R., Smith, H. and Rait, G. (2015) The relative clinical and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections (STIs) : a cluster randomised trial in primary care. Health Technology Assessment, Volume 19 (Number 5). pp. 1-115. doi:10.3310/hta19050 ISSN 1366-5278.

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Official URL: http://dx.doi.org/10.3310/hta19050

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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.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Sexually transmitted diseases -- Prevention, Sexual health, Hospitals -- Medical staff -- Training of , Community health services , Medical centers
Journal or Publication Title: Health Technology Assessment
Publisher: NIHR Health Technology Assessment programme
ISSN: 1366-5278
Official Date: January 2015
Dates:
DateEvent
January 2015Published
Volume: Volume 19
Number: Number 5
Page Range: pp. 1-115
DOI: 10.3310/hta19050
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Funder: National Institute for Health Research (Great Britain) (NIHR)

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