1. 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

2. Background
Natsal 3:
Chlamydia trachomatis most prevalent in those aged years
1.5% of women and 1.0% of men aged 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 years. However, 1.5% of women and 1.0% of men aged 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 year-olds resident in Lincolnshire
BASHH Annual Conference 2016

3. Lincolnshire Population ~700,000
83, year olds
80, 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 = 83,881; = 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

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

5. Methods 1st April 2015 to 30th June 2016
Internet requested chlamydia test kits made available to 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

6. 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 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

7. 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

8. 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

9. 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

10. 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 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

11. 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 £ for the older group.
BASHH Annual Conference 2016

12. 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 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

13. 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 year olds
BASHH Annual Conference 2016

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