The NHSG Opportunistic Chlamydia Testing Pilot Study

Overview Need to increase CT testing rates especially in males <25 Need to decrease pool of chlamydia infection NAATs simplified testing / less invasive Choice of less medicalised model (common/ treatable) Promote individual responsibility for sexual health Need to engage with young people English opportunistic screening programme underway Approach devolved to individual Boards in Scotland

NHSG Sexual Health Strategy From objectives : reduce the incidence and prevalence of sexually transmitted infections (STIs) improve accessibility/integration of sexual health services, ensuring all sexually active people in Grampian have access to quality sexual health advice and services meet the needs of ‘hard to reach’ groups strengthen monitoring, surveillance and research to support future planning of sexual health services/interventions encourage fulfilled, respectful and responsible relationships reduce the rates of unintended pregnancy

Rates of genital chlamydial infection by age-group UK 1996 to 2005 Data sources: KC60 and STIS/ISD(D)5 returns from GUM clinics. Routine GUM clinic returns

Opportunistic screening Targeted screening for genital chlamydia –reduces prevalence in women –reduces PID SIGN recommends opportunistic screening for genital chlamydia should be undertaken for: –Women aged <25 years who are sexually active; –Women aged >25 years with >2 sexual partners in the last year or a change of partner in the last year; –All symptomatic women and men.

Percentage of yr olds tested in Grampian in 2005

Project Design Men and women years inclusive Non-sexual health specialist health care facilities e.g. community pharmacies Young people’s projects, universities/colleges, MIB, Caledonia Youth, etc Offer of test regardless of reason for attendance

Method 12-month, multi-centre, opportunistic screening study (28/08/07 – 28/08/08) 31 sites –General practices (n=10) –Community pharmacies (n=10) –Family Planning and Genito-urinary Medicine clinics (n=2) –Other health sites –Community sites

Method Urine and SOLV kits available for self- selection in non-pharmacy sites, and for issue by pharmacist following brief consultation in community pharmacy sites.

Results 2553 clients screened in 12 months –68.3% female (n=1744) 93% female clients used SOLVs 10.0% (n=254) positive tests obtained late results still coming in for kits picked up during pilot

Type of site where kit obtained General practice 39.5% Sq 13 (S&R Health / FP) 38.3% Pharmacy 4.0% GUM 2.2% Community 5.4% Other health 1.2% Other 8.5%

Positive n (%) Non- conforming n Equivocal n Invalid n Total General practice 89 (9.9) Pharmacy 10 (10.9) GUM 7 (12.3) Sq13 S&R Health (FP) 95 (10.7) Other health 4 (14.3)20428 Other 18 (9.3)

Ongoing evaluation Economic evaluation Qualitative research strand Dissemmination meeting for results planned Feb 09 / report for Board / publication and other meetings Analysis will feed into NHSG Development of Community STI testing working group Next steps

Phase 3 Community STI / HIV testing short life task group issues to address Improving partner notification Integration of dual CT/GC testing Increasing low risk asymptomatic community based STI / BBV testing (simplify request form) Support introduction of PH SH Pharmacy contract Develop an infrastructure to support all of above with agreed local care pathways Next steps

Opportunistic Chlamydia Screening Study Strategy Group Members Susan Webb*, Deputy Director of Public Health/Sexual Health Executive Lead Dr Gillian Flett, Consultant & Service lead S&R Health /Clinical Lead, SH for NHSG Janet Bruce*, Sexual Health Improvement Co-ordinator Dr Margaret Watson*, Public Health Pharmacist Dr Mayada AbuAffan*, Specialist Registrar Dr Steve Baguley, Consultant & Service lead, Department of Genito- Urinary Medicine (GUM) Shona Crocker, Health Advisor, GUM * Public Health Unit, NHSG