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

Abstract

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 for the practice nurse led strategy and £32.62 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.

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

“…A justification for this was not usually presented, but likely assumptions are that young women are most likely to access health services and that male partners would be picked up by partner notification programmes or develop symptoms and seek treatment. It is now known, however, that partner notification reaches only 50-60% of partners 136 and that asymptomatic chlamydia is as common in men as in women. 97 Thus, the focus on women only in screening programmes risks leaving a pool of infected men in the community who can continue to spread the disease.…”

“…The costs of partner notification done by a practice nurse at the general practice are reported, because this was as effective as referring patients to a health adviser at a genitourinary medicine clinic (see Table 23, p. 56). 136 The antibiotic costs were included for partners, who were all treated epidemiologically, but costs for chlamydia testing for partners were excluded, as this was defined as a separate screening episode.…”

Meeting the Sexual and Reproductive Health Needs of People Living with HIV: Challenges for Health Care Providers

“…With regard to partner notification for chlamydia, for example, every country in Europe has a different policy and guideline 30 and this also holds true for other STIs and HIV, as well as other countries and regions. Service delivery for stigmatised conditions such as HIV also implies that guidelines must be reviewed for cultural sensitivities and norms, including gender norms.…”

Traditional and Web-Based Technologies to Improve Partner Notification Following Syphilis Diagnosis Among Men Who Have Sex With Men in Lima, Peru: Pilot Randomized Controlled Trial (Preprint)

“…However, evidence of the impact of referral cards in developing country settings is limited, and their use within MSM partnerships has not, to our knowledge, been evaluated in any previous randomized controlled trials (RCTs) (21)(22)(23).…”