BASHH Conference, Oxford 2016 Evaluation of a pilot of internet requested Chlamydia test kits in 25 to 34 year olds Deborah Shaw1, Jo Keal2, Sarah Woodhall1, Emma Hollis1, John Saunders1 1Public Health England, 2Lincolnshire County Council Other authors as per abstract? Sara Brine? Michele Presbury? BASHH Conference, Oxford 2016

Background Natsal 3: Chlamydia trachomatis most prevalent in those aged 16-24 years 1.5% of women and 1.0% of men aged 25-34 years are estimated to be infected Outreach and internet testing frequently offered to younger age groups Part of Local National Chlamydia Screening Programme Overcome barriers to testing In the UK, Chlamydia is most prevalent in those aged 16-24 years. However, 1.5% of women and 1.0% of men aged 25-34 years are estimated to be infected. Attending healthcare venues may be challenging in rural settings and internet- requested tests may help individuals to access testing. We report results from a pilot of internet-requested testing among 25 to 34 year-olds resident in a rural region of England. We report results from a pilot of internet-requested testing among 25-34 year-olds resident in Lincolnshire BASHH Annual Conference 2016

Lincolnshire Population ~700,000 83,881 15-24 year olds 80,780 25-34 year olds Outreach workers frequently approached by those aged over 25 years Lincolnshire is a largely rural county in the east of England of just over 700,000 residents. ONS 2015 15-24 = 83,881; 25-34 = 80,780 It borders Norfolk to the south east, Cambridgeshire to the south, Rutland to the south west, Leicestershire and Nottinghamshire to the West, South Yorkshire to the northwest and the East Riding of Yorkshire to the north. It also borders Northamptonshire to the south for 18 metres, England’s shortest county boundary. A large numbers of residents are employed in work, particularly agricultural occupations adding to the difficulty in accessing services. BASHH Annual Conference 2016

Aim Pilot of internet-requested testing among 25-34 year olds resident in Lincolnshire Demand (number of tests requested) Positivity and costs BASHH Annual Conference 2016

Methods 1st April 2015 to 30th June 2016 Internet requested chlamydia test kits made available to 25-34 year olds through a dedicated website Variables monitored and compared between younger (15-24) and older (25-34) groups: Test requests Return rates Test positivity (positive tests / number tested) Cost per test and per positive BASHH Annual Conference 2016

Results: Test requests and return by age group 71% 73% During the pilot period more than 4 and a half thousand test kits were requested with just under 900 of these by the older 25-34 year age group The return rate was high in both groups There was no statistically difference in return rates between the younger and older age groups i.e. the older group were no more or less likely to return test kits BASHH Annual Conference 2016

Results: Tests returned by age and gender Although there were fewer test kits requested and returned by the older group, proportionally, a greater number were returned by men in the older group compared to the younger group (37% versus 29%, respectively) BASHH Annual Conference 2016

Results: Positivity between age groups 15 to 24 years 25 to 34 years Suitable specimen returned for testing: 2,720 644 Total specimen tested Specimen from women Specimen from men 2,713 1,921 792  643 406 237 In the younger age group, 9.8% of all samples tested were positive for chlamydia compared to 7.2% in the older group. This was a statistically significant difference in an unadjusted analysis although the confidence interval is wide and the upper limit approaches 1 (i.e. only just statistically significant) There was no statistical difference when comparing positivity by gender between age groups BASHH Annual Conference 2016

Results: Positivity between age groups 15 to 24 years 25 to 34 years Suitable specimen returned for testing: 2,720 644 Total specimen tested Specimen from women Specimen from men 2,713 1,921 792  643 406 237 15 to 24 years 25 to 34 years Test positive for chlamydia:  n % n unadj OR (95%CI) p value Total positive Positivity in women Positivity in men 265 168 97 9.8% 8.7% 12.2% 46 24 22 7.2% 5.9% 9.3% 0.71 (0.50 to 0.99) 0.66 (0.40 to 1.03) 0.73 (0.43 to 1.21) 0.04 0.06 0.21 In the younger age group, 9.8% of all samples tested were positive for chlamydia compared to 7.2% in the older group. This was a statistically significant difference in an unadjusted analysis although the confidence interval is wide and the upper limit approaches 1 (i.e. only just statistically significant) There was no statistical difference when comparing positivity by gender between age groups BASHH Annual Conference 2016

Results: Positivity within age groups Women Men unadj OR (95%CI) p value 15 to 24 years Suitable specimen returned for testing 1,921 792 Test positive for chlamydia 168 97 Positivity 8.7% 12.2% 1.46 (1.11 to 1.91)  0.01 Women Men unadj OR (95%CI) p value 25 to 34 years Suitable specimen returned for testing 406 237 Test positive for chlamydia 24 22   Positivity 5.9%   9.3% 1.63 (0.85 to 3.12) 0.12 (re-orientate the audience as the table has changed slightly): When looking at positivity within age groups, positivity among 15-24 year old men was significant higher than women of the same age There was no significant difference in positivity between men and women in the older age group BASHH Annual Conference 2016

Results: Spend and cost per positive 15 to 24 years 25 to 34 years Total spend (includes test kits, lab costs; excludes management of positives) £61,096 £14,305 Cost per test £22.51 £22.25 Cost per positive £230.55 £310.98 Total spend for tests requested during the 5 quarters for the service for the younger group and older group was £61,096 and £14,305 respectively, including all kit, postage and laboratory costs (excluding management of positives). Based on the above, the average cost per test and per positive was £22.51 and £230.55, respectively, in the younger group and £22.25 and £310.98 for the older group. BASHH Annual Conference 2016

Summary Good return rates in both groups with no significant difference in return rates Positivity in the older group was lower than in the younger group (7.2% vs. 9.8%) although upper confidence interval was 0.99 and this difference was not seen when comparing by gender Significantly higher positivity in 15-24 year old men compared to women in the same age range whereas no difference in positivity between men and women in older age range BASHH Annual Conference 2016

Discussion Internet testing was accessed (and returned) by an older age group with high chlamydia positivity May be attractive to older men and those in rural areas Unknown impact on capacity in physical services or whether reaching groups who were not previously testing Service continues to be commissioned in Lincoln and findings reviewed quarterly Plan to compare positivity with internet testing in CTAD for 25-34 year olds BASHH Annual Conference 2016

Acknowledgements Michele Presbury Sara Brine Freetest Acknowledgements Michele Presbury Sara Brine Freetest.me, Online Sexual Health Screening, Preventx BASHH Annual Conference 2016