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Partner notification for chlamydia by postal kit: pilot study results

Explore partner notification methods and outcomes for chlamydia control, including postal kits and expedited therapy options. Analyze cost, benefits, and challenges in implementing postal kits in sexual health services.

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Partner notification for chlamydia by postal kit: pilot study results

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

  2. Background • Partner notification for chlamydia • High DNA rate (30 %) for notified contacts (Internal provider referral audit 2004-8) • 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

  3. 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

  4. 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

  5. Postal kit appearance

  6. Postal kit contents – male

  7. Postal kit contents – female

  8. Results • Provider referrals 28 (26 males) • Traced 26 (incl I already att) • Kits offered 20 (all males) • Kits requested 13 (65%) • Urine tested 11 • Positive 3

  9. Comparison of outcomes for postal kit v GUM appt

  10. Comparison of provider referral outcomes for chlamydia

  11. Costs per postal kit

  12. Financial balance • Face to face PbR rate £133.00 • Telephone consultation rate (from April 2011) £ 58.00 • Cost of service per case £ 39.78 Service costs covered Potential loss of income Off-set by higher proportion receiving care??

  13. 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

  14. 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

  15. 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

  16. Provider referral for chlamydia outcomes 1.3.11 – 12.9.11

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

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