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

Jackie Cassell, Julie Dodds, Claudia Estcourt, Carrie Llewellyn, Stefania Lanza, John Richens, Helen Smith, Merle Symonds, Andrew Copas, T. E. Roberts, Kate Walters, Peter White, Catherine Lowndes, Hema Mistry, Melcoir Rossello-Roig, Hilary Smith, Greta Rait

Research output: Contribution to journalArticle

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.
Original languageEnglish
Pages (from-to)1-145
Number of pages145
JournalNIHR
Volume19
Issue number5
DOIs
Publication statusPublished - Jan 2015

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Contact Tracing
Sexually Transmitted Diseases
Cost-Benefit Analysis
Primary Health Care
General Practice
Referral and Consultation
Chlamydia
Contracts
Pelvic Inflammatory Disease
Urethritis
Gonorrhea
Sexual Partners
Reproductive Health
Research
England
Health Services
Randomized Controlled Trials
Outcome Assessment (Health Care)
Costs and Cost Analysis

Keywords

  • partner notification
  • STI
  • sexual health
  • ehealth
  • cluster randomised trial

Cite this

Cassell, Jackie ; Dodds, Julie ; Estcourt, Claudia ; Llewellyn, Carrie ; Lanza, Stefania ; Richens, John ; Smith, Helen ; Symonds, Merle ; Copas, Andrew ; Roberts, T. E. ; Walters, Kate ; White, Peter ; Lowndes, Catherine ; Mistry, Hema ; Rossello-Roig, Melcoir ; Smith, Hilary ; Rait, Greta. / 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. In: NIHR. 2015 ; Vol. 19, No. 5. pp. 1-145.
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Cassell, J, Dodds, J, Estcourt, C, Llewellyn, C, Lanza, S, Richens, J, Smith, H, Symonds, M, Copas, A, Roberts, TE, Walters, K, White, P, Lowndes, C, Mistry, H, Rossello-Roig, M, Smith, H & 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', NIHR, vol. 19, no. 5, pp. 1-145. https://doi.org/10.3310/hta19050

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. / Cassell, Jackie; Dodds, Julie; Estcourt, Claudia; Llewellyn, Carrie; Lanza, Stefania; Richens, John; Smith, Helen; Symonds, Merle; Copas, Andrew; Roberts, T. E. ; Walters, Kate; White, Peter ; Lowndes, Catherine; Mistry, Hema; Rossello-Roig, Melcoir; Smith, Hilary ; Rait, Greta.

In: NIHR, Vol. 19, No. 5, 01.2015, p. 1-145.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

AU - Cassell, Jackie

AU - Dodds, Julie

AU - Estcourt, Claudia

AU - Llewellyn, Carrie

AU - Lanza, Stefania

AU - Richens, John

AU - Smith, Helen

AU - Symonds, Merle

AU - Copas, Andrew

AU - Roberts, T. E.

AU - Walters, Kate

AU - White, Peter

AU - Lowndes, Catherine

AU - Mistry, Hema

AU - Rossello-Roig, Melcoir

AU - Smith, Hilary

AU - Rait, Greta

PY - 2015/1

Y1 - 2015/1

N2 - 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.

AB - 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.

KW - partner notification

KW - STI

KW - sexual health

KW - ehealth

KW - cluster randomised trial

U2 - 10.3310/hta19050

DO - 10.3310/hta19050

M3 - Article

VL - 19

SP - 1

EP - 145

IS - 5

ER -