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Partner notification for chlamydia by postal kit: pilot study results

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 2004-8)

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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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