Partner notification for chlamydia by postal kit: pilot study results Gill Bell Nurse Consultant Sexual Health Adviser

Background Partner notification for chlamydia –High DNA rate (30 %) for notified contacts (Internal provider referral audit ) How to improve partner testing / treatment rate? PN studies : Expedited Partner Services (EPS) –Patient delivered partner treatment (PDPT) Kissinger et al 2008; Shillinger et al 2003 –Expedited partner therapy (EPT) Golden et al 2005; 2007 –Accelerated partner therapy (APT) Estcourt et al 2009 ISSTDR presentation –Patient delivered partner screening (PDPS) Ostergaard et al 2003

Postal kits feasible? Partner testing by postal kit – feasible and acceptable in other PN studies. (Ostergaard et al 2003; Estcourt 2009) Medication by post –available via internet prescribed by UK Drs (Dr Thom) –Prescribing via telephone consultation/ PGD permissible under GMC Guidelines 2008 Funding –Potential loss of income GUM

Postal kit pilot Chlamydia contacts notified by health adviser offered choice of postal kit or GUM appt Exclusions: symptomatic; h/o PID; allergic microclides; MSM, < 16, pregnant; HIV + Telephone follow – up: result; medication; PN (if pos); GUM appt offered for TOC / bloods June – August 2010

Postal kit appearance

Postal kit contents – male

Postal kit contents – female

Results Provider referrals 28 (26 males) Traced 26 (incl I already att) Kits offered 20 (all males) Kits requested13 (65%) Urine tested11 Positive3

Comparison of outcomes for postal kit v GUM appt Postal kitsGUM appt Number requested1310 Treatment received138 (2 DNA’d) Tested chlamydia118 Tested HIV08 Chlamydia positive3/116/8 Partners screened4/56/8 Chlamydia TOC0/31/6

Comparison of provider referral outcomes for chlamydia Postal kit pilot June – Aug 2010 Provider referral audit Notified partners verified accessed treatment 21/26 (81%) 841/1194 (70%)

Costs per postal kit UnitAverage per client Staff time (HA & Admin) £21.77 Testing / treatment materials £15.22 Postal costs£ 2.79 Total39.78

Financial balance Face to face PbR rate£ Telephone consultation rate (from April 2011) £ Cost of service per case£ Service costs covered Potential loss of income Off-set by higher proportion receiving care??

Discussion Pros of postal kits –More convenient for service users –Partners more likely to get treated –Patients at less risk of re-infection –More cost effective use of NHS resources Could appeal to commissioners / increase referrals for PN from primary care –Reduction in GUM DNA rate

Discussion cont’d Cons of postal kits –Partners not tested for HIV or syphilis –Partners not examined –Loss of income for GUM –PN discussions more difficult by phone

PN Postal kit policy April 2011 All chlamydia contacts to be offered GUM appt initially Postal kits to be offered if partner has difficulty attending, or has DNA’d. (from April 2011) Postal kits being considered for chlamydia TOCs, and HIV contacts

Provider referral for chlamydia outcomes – Initiated 93 Attended 68 Failed to attend 13 Postal kit accepted 2 Unable to re-contact 2 Missed 1 Not involved 4 Not eligible for Postal kit 4 Untraced 12

Other postal kit pilots Test of cure for chlamydia HIV home sampling for contacts of HIV who decline clinic attendance