Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial

Abstract

IntroductionThe sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis.Methods and analysisMoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12–18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice.Ethics and disseminationEthics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.

Chlamydia retesting remains low among young women in Australia: an observational study using sentinel surveillance data, 2018–2022

“…Interventions aiming to increase chlamydia retesting, including patient text message reminders and postal home collection kits, have been shown to increase retesting rates within 1-4 months of a chlamydia diagnosis. 22,23 Studies such as the Management of Chlamydia Cases in Australia trial 24 are underway to ascertain how best to implement such strategies within the complex and competing priorities of the primary care environment, where many STIs are diagnosed and managed. 19 In addition to increasing retesting, a greater understanding of what women perceive as the risks and consequences of re-infection is required, as part of a multipronged approach to reducing the health impacts from chlamydia acquisition.…”

Chlamydia: The Secret Enemy from the Past to Present, and Future

“…These results might be used to characterize antibodies specific to detect different stages of infection. [35].…”

Investigating possibilities for surveillance of long term chlamydia complications in the Netherlands: A qualitative study

“…focussing more on reducing harms from untreated chlamydia infection rather than onward transmission [ 13 ]. Australia replaced its focus from testing uptake to strengthening management of diagnosed infections, which involves improving retesting, partner management and PID diagnosis [ 14 ].…”