Real-time partner notification Dr Anatole S Menon-Johansson SXT Health CIC (www.sxt.org.uk) SSHA Annual Conference London, 10th September 2016

SXT real-time dashboard of clients

Top SXT searches

Providers chosen by SXT clients

Burden of Sexually Transmitted Infections (STIs) in the UK PHE Fingertips Burden of Sexually Transmitted Infections (STIs) in the UK An example of some of the data on this website http://fingertips.phe.org.uk/profile/sexualhealth

17% p.a. increase of new Gonorrhoea diagnoses between 2012 and 2014 The case for improved partner notification STIs are a growing source of concern for the national health system: bacterial diagnoses have increased and in European comparisons the UK is falling behind Chlamydia Gonorrhoea Syphilis HIV 17% p.a. increase of new Gonorrhoea diagnoses between 2012 and 2014 21% p.a. Increase of new Syphilis diagnoses between 2012 and 2014 3.7% p.a. Increase of HIV prevalence between 2013 and 2014 Chlamydia accounts for 47% of all newly diagnosed STIs 8.0 per 100,000 population (2014) An estimated 18,100 (17%) PLWH are unaware of their diagnosis & transmission risk (2014) 19% 5.5 per 100,000 population (2012) 41% HIV prevalence rates higher across Europe, at 5.9/100,000 population compared to 1.9/100,000 in the UK The UK has the third highest rate of Chlamydia per 100,000 population in the EU (after Denmark & Iceland) At an average rate of 55.8 per 100,000 population (2012-2014), the UK has one of the highest prevalence rates in Europe. Syphilis rates have been increasing across Europe since 2010, particularly among men which account for >90% of cases in England. *Please note that data for new STI diagnoses cannot be compared from 2012 onwards due to new reporting standards for Chlamydia.

Disproportionate burden of STIs amongst MSM MSM & STIs Disproportionate burden of STIs amongst MSM Inequalities in sexual health: Update on HIV and STIs in men who have sex with men in London – February 2016 http://bit.ly/29en37C

SXT has the solution: the interactive digital Contact Slip The toughest problem to solve in sexual health Partner notification reduces the risk of transmitting infections. However, up until today, health service providers face logistical challenges: Challenges Consequences Lack of an effective monitoring solution Difficulty to capture correct information Time and capacity constraints of Health Care Workers to follow up on partner notification Emotional barriers for index patients Fewer patients inform their partners No clear account of current PN effectiveness Partners are not notified and new STI diagnoses keep increases SXT has the solution: the interactive digital Contact Slip

Provider and patient delivered PN The idCS provides anonymous partner notification and allows sexual health service providers to track effectiveness and individual performance Partner notification Partner verification

What the partner receives from SXT Supporting partners to get tested What the partner receives from SXT Explanation that their name has been given as a sexual contact of someone who has recently been diagnosed with a treatable STI How it works video Click on the link Blue button directs partner to a local clinic for testing and possible treatment Mobile number or email address is not stored by SXT

Understanding where each step of PN is working … we have data to show that information technology enables effective partner notification The idCS pilot launched on 27 January 2016 1,313 2,156 declared Index Patients Contactable Partners 40% of contactable partners were notified using the tool 54% of those notified opened the link Partners declared Contactable partners Partners contacted Partners opening the link Partners verified in clinic 32% of those who opened the link were seen by a Health Care Worker Based on the data collected between 27/01/2016 - 02/07/2016

Not all STIs are equal in partner notification behaviour Analysis of idCS up to 30th August 2016 Not all STIs are equal in partner notification behaviour Based on the data collected between 27/01/2016 - 30/08/2016

Follow up tool & dashboard Supporting health advisors to deliver PN Follow up tool & dashboard http://bit.ly/SXT_PN

94 94 Syphilis & Trichomoniasis sub- analysis A novel partner notification tool highlights differences in sexual network adoption A novel partner notification tool, the interactive digital Contact Slip (idCS), has been developed by SXT Health CIC. The idCS enables the anonymous notification of partners via text or email and supports them to find a local clinic for testing and possible treatment. The partner notification data collected by SXT Health CIC allows us to show differences in sexual network adoption. Two different sexually transmitted infections (STIs) have been chosen to show how the adoption and performance of the interactive digital Contact Slip (idCS) varies by the patient group diagnosed. Since 27/01/2016, 94 index patients across 6 clinics were diagnosed with Syphilis Since 27/01/2016, 94 index patients across 6 clinics were diagnosed with Trichomonas Vaginalis (TV) 81% 4% Not recorded 15% 17% 72% Not recorded 11% 74 (79%) were made in men who have sex with men (MSM), 5 (5%) were classified as heterosexual, and 15 (16%) did not have their sexuality captured. Where ethnicity was documented, 7 (7%) diagnoses were made in those with black ethnicity. Three of the MSM were of black ethnicity. 75 (86%) diagnoses were made in heterosexuals, 1 (1%) in a bisexual patient, and 11 (13%) did not have their sexuality captured Where ethnicity was documented, 44 (50%) diagnoses were made in those with black ethnicity Please click Index patients Syphilis # of Index patients 94 % Partners contactable % Partners contacted Index patients TV Syphilis TV 94 BAASH KPI 0.29 BAASH KPI 0.06 % Partners who opened link % Verified partners 1 Data collected in 13 clinics since 27/01/2016

% Partners contactable % Partners who opened link Syphilis & Trichomoniasis sub- analysis II A novel partner notification tool highlights differences in sexual network adoption The idCS is the same for all patient groups; consequently, the differences in performance between those patients diagnosed with syphilis and TV relates to how the health care workers and the patients behave in relation to this tool. The video opposite shows the journey for the index patient and their partner(s). All use of the idCS is healthcare worker initiated and verified. In this analysis it is assumed that all partners of those with both STIs are in position of a smart phone or have a personal email address; however, it is possible that heterosexuals of black ethnicity have less access to smart phones or the internet. There is data showing that household income in lower in those individuals of black ethnicity in the UK and the performance of the idCS in those with TV may simply reflect a lack of access to smart phones or the internet. The data shows that only 25% of contactable partners of index patients of black ethnicity were contacted using the idCS (compared to 33% for the total group). Syphilis Trichomoniasis Please click Syphilis BAASH KPI 0.29 BAASH KPI 0.06 # of Index patients 53% % Partners contactable Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified Syphilis 94 338 178 111 69 23 100% 53% 62% 33% TV 122 82 27 12 5 67% 48% 38% % Partners contacted TV 67% % Partners who opened link % Verified partners 1 Data collected in 13 clinics since 27/01/2016

% Partners contactable % Partners who opened link Syphilis & Trichomoniasis sub- analysis III A novel partner notification tool highlights differences in sexual network adoption There is a steep drop off in the number of contactable contacts who are documented by the system as being told. For those with syphilis 62% of the contactable contacts are told, whilst with TV this is only one third (33%). It is assumed that when a partner is either told in clinic (provider referral) or using their smart phone or computer of the index patient at home (patient referral) that the details they add into SXT are correct. SXT does not store the mobile number or email address; consequently, there is no way to check if the details added were correct within the current configuration of the idCS tool. We had the same number of index patients being diagnosed with Syphilis and TV. However, even though there were two times more contactable contacts we saw four times more partners contacted for Syphilis than for the TV group. Syphilis Trichomoniasis Please click Syphilis BAASH KPI 0.29 BAASH KPI 0.06 # of Index patients 62% % Partners contactable Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified Syphilis 94 338 178 111 69 23 100% 53% 62% 33% TV 122 82 27 12 5 67% 48% 38% % Partners contacted TV 33% % Partners who opened link % Verified partners 1 Data collected in 13 clinics since 27/01/2016

% Partners contactable % Partners who opened link Syphilis & Trichomoniasis sub- analysis IV A novel partner notification tool highlights differences in sexual network adoption When an idCS is sent to a partner by text or email, a link is embedded in the message that takes them to a web page (see opposite) informing the partner that they have been named as a partner of an STI & instructions on what to do. Partners of syphilis are 30% more likely to click on the link in the idCS message and look at the web page. Syphilis Trichomoniasis Please click Syphilis BAASH KPI 0.29 BAASH KPI 0.06 # of Index patients 62% % Partners contactable Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified Syphilis 94 338 178 111 69 23 100% 53% 62% 33% TV 122 82 27 12 5 67% 48% 38% % Partners contacted TV 48% % Partners who opened link % Verified partners 1 Data collected in 13 clinics since 27/01/2016

% Partners contactable % Partners who opened link Syphilis & Trichomoniasis sub- analysis V A novel partner notification tool highlights differences in sexual network adoption Despite the TV group performing less well at informing partners and their partners being less likely to open the idCS link, the two groups are nearly equivalent when you look at the number of partners who attend a clinic after opening the idCS link and their attendance is verified by a health care worker. For every 100 index patients with syphilis, 29 partners are being verified by a health care worker as being seen and tested within four weeks. The idCS developed by SXT is able to meet half of the BASHH key performance indicator (KPI) without any additional contact of the index patient by health care workers. However in the TV group, for every 100 index patients only six are being verified by a health care worker as being seen and tested within four weeks. Even if the BASHH KPI was met for both infections this would only account for one third of contactable contacts. More work is required to improve PN, the use of the idCS tool across different health care workers, promotion of the idCS tool to clinics as well as marketing to potential partners. Syphilis Trichomoniasis Please click Syphilis BAASH KPI 0.29 BAASH KPI 0.06 # of Index patients 33% % Partners contactable Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified Syphilis 94 338 178 111 69 23 100% 53% 62% 33% TV 122 82 27 12 5 67% 48% 38% % Partners contacted TV 38% % Partners who opened link % Verified partners 1 Data collected in 13 clinics since 27/01/2016

Comparison of PN delivered by a health advisor and over the telephone Provider versus patient notification Comparison of PN delivered by a health advisor and over the telephone Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified Health Advisor 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone results team 167 282 222 76 48 11 79% 63% 23% More partners Identified More partners told 1 Data collected in 15 clinics since 27/01/2016 Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% 1 Data collected in 15 clinics since 27/01/2016

Comparison of PN delivered by a health advisor and over the telephone Provider versus patient notification Comparison of PN delivered by a health advisor and over the telephone Gonorrhoea Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified Health Advisor 200 651 416 178 103 29 100% 64% 43% 58% 28% Telephone results team 50 128 83 19 8 3 65% 23% 42% 38% More partners Identified More partners told 1 Data collected in 15 clinics since 27/01/2016 Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Gonorrhoea Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 200 651 416 178 103 29 100% 64% 43% 58% 28% Telephone 50 128 83 19 8 3 65% 23% 42% 38%

Summary of improved performance with provider delivered PN Provider versus patient notification Summary of improved performance with provider delivered PN Chlamydia Number of partners revealed (% difference) Numbers of partners told (% difference) Numbers of partners seen Health Advisors 2.3 +35% 63/100 +37% 11/100 +57% Telephone results team 1.7 46/100 7/100 Gonorrhoea Number of partners revealed (% difference) Numbers of partners told (% difference) Numbers of partners seen Health Advisors 3.3 +27% 89/100 +34% 14/100 +133% Telephone results team 2.6 38/100 6/100 1 Data collected in 15 clinics since 27/01/2016 Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Gonorrhoea Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 200 651 416 178 103 29 100% 64% 43% 58% 28% Telephone 50 128 83 19 8 3 65% 23% 42% 38%

Summary of improved performance with provider delivered PN Single platform > Powerful data Summary of improved performance with provider delivered PN Accurate sign posting to an appropriate service is essential to match capacity with demand PN is supported by the SXT tool & collects objective data Nearly 200 partners were informed via SXT that were not declared in clinic Patients with syphilis are twice as likely to tell partners and the partners are 50% more likely to open the link than patients with TV All partners, once they open the PN link, are as likely to present for testing Significantly more partners are determined, told and seen for testing when health advisors see the index patient More work is needed to raise awareness & promote the use of this tool 1 Data collected in 15 clinics since 27/01/2016 Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Chlamydia Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 458 1063 792 289 154 52 100% 75% 36% 53% 34% Telephone 167 282 222 76 48 11 79% 63% 23% Gonorrhoea Index patients1 Partners declared Partners contactable Partners contacted Partners opened link Partners verified F2F 200 651 416 178 103 29 100% 64% 43% 58% 28% Telephone 50 128 83 19 8 3 65% 23% 42% 38%

SXT would like to thank: Dr. Anatole Menon-Johansson Clinical lead for Sexual & Reproductive Health at Guy's and St Thomas'  PARTNER NOTIFICATION SXT would like to thank:

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Sources Statistics on STI diagnoses and rates in England Published by Public Health England Last updated: 13 January 2016 Available at: https://www.gov.uk/government/statistics/sexually-transmitted-infections- stis-annual-data-tables Statistics on Sexually transmitted infections in Europe ECDC Surveillance Report 2013 Available at: http://ecdc.europa.eu/en/publications/Publications/sexual-transmitted- infections-europe-surveillance-report-2013.pdf Statistics on SXT website traffic and effectiveness of the idCS: Data collected by SXT Health CIC Available upon request from Dr Anatole Menon-Johansson anatole@sxt.org.uk