Identifying opportunities for sexually transmitted infection prevention: analysis of critical points in the care pathways of patients with gonorrhoea

Abstract

We applied the principles of Hazard Analysis and Critical Control Points (HACCP) to systematically analyse the care pathway of patients diagnosed with gonorrhoea to identify potential intervention opportunities for preventive action. Data were collected on individuals with culture-positive gonococcal infection during 27 February 2003 to 08 January 2004. Qualitative data were gathered within individual semi-structured interviews. Two hundred and twenty-three gonorrhoea patient episodes were evaluated. The median interval between presentation and treatment was significantly longer in females and men having sex with men (MSM), compared with heterosexual men (P = 0.002). Females were significantly more likely to be in regular relationships at the timepoint of perceived infection acquisition than heterosexuals or MSM (P < 0.0001). Four major themes emerged from the interviews: life-stage and infection risk, determinants of risk perception around sexual encounters, attitudes to preventing re-infection and condom use. These informed three potential 'critical control points': health-related attitudes/behaviours preceding infection; access to appropriate care and optimizing health promotion to prevent further infection.

Asking about condom use: a key to individualized care when screening for chlamydia

“…We cannot, however, comment on the reasons for inconsistent condom use. Others have found it to be attributed to alcohol use; key life stages; negative affective status; increased number of sexual partners; not considering oneself at risk of infection; and not wanting the partner to believe that they do not trust them/think they have CT. 21–23…”

Evaluating health systems’ preparedness for emerging infectious diseases: A novel conceptual and analytic framework

“…HACCP is concerned with identifying possible hazards before they occur [23]. Recently, the method has been more widely applied in medicine and public health, for instance in the assessment of hospital infection control programmes and clinical care pathways of patients [24,25]. It has also been applied to national infectious disease policy programmes, such as assessing the interplay in European outbreak response and evaluating generic pandemic preparedness plan [26,27].…”