Partner notification of chlamydia infection in primary care: randomised controlled trial and analysis of resource use

doi:10.1136/bmj.38678.405370.7C

BMJ 2006;332:14-19 (7 January), doi:10.1136/bmj.38678.405370.7C (published 15 December 2005)

Research

Partner notification of chlamydia infection in primary care: randomised controlled trial and analysis of resource use

Nicola Low, senior lecturer in epidemiology and public health¹, Anne McCarthy, research fellow¹, Tracy E Roberts, senior lecturer in health economics², Mia Huengsberg, consultant³, Emma Sanford, research associate¹, Jonathan A C Sterne, reader in medical statistics and epidemiology¹, John Macleod, senior lecturer in primary care⁵, Chris Salisbury, professor⁶, Karl Pye, research health adviser⁴, Aisha Holloway, research fellow⁵, Andrea Morcom, research assistant⁵, Rita Patel, research assistant⁶, Suzanne M Robinson, lecturer in health economics², Paddy Horner, consultant⁴, Pelham M Barton, lecturer in mathematical modelling², Matthias Egger, professor of epidemiology¹^,7

¹ Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ² Health Services Management Centre, University of Birmingham, Birmingham B15 2TT, ³ Department of Genitourinary Medicine, Heart of Birmingham Teaching Primary Care Trust, Whittall Street Clinic, Birmingham B4 6DH, ⁴ Department of Genitourinary Medicine, United Bristol Healthcare Trust, Milne Centre for Sexual Health, Bristol BS2 8EE, ⁵ Department of General Practice and Primary Care, University of Birmingham, ⁶ Academic Unit of Primary Health Care, University of Bristol, Bristol BS6 6JL, ⁷ Department of Social and Preventive Medicine, University of Berne, CH-3012, Switzerland

Correspondence to: Dr N Low, Department of Social and Preventive Medicine, University of Berne, Finkenhubelweg 11, Berne, CH-3012, Switzerland low{at}ispm.unibe.ch

Abstract

Objective To evaluate the effectiveness of a practice nurseled strategy to improve the notification and treatment of partnersof people with chlamydia infection.

Design Randomised controlled trial.

Setting 27 general practices in the Bristol and Birmingham areas.

Participants 140 men and women with chlamydia (index cases)diagnosed by screening of a home collected urine sample or vulvalswab specimen.

Interventions Partner notification at the general practice immediatelyafter diagnosis by trained practice nurses, with telephone followup by a health adviser; or referral to a specialist health adviserat a genitourinary medicine clinic.

Main outcome measures Primary outcome was the proportion ofindex cases with at least one treated sexual partner. Specifiedsecondary outcomes included the number of sexual contacts elicitedduring a sexual history, positive test result for chlamydiasix weeks after treatment, and the cost of each strategy in2003 sterling prices.

Results 65.3% (47/72) of participants receiving practice nurseled partner notification had at least one partner treated comparedwith 52.9% (39/68) of those referred to a genitourinary medicineclinic (risk difference 12.4%, 95% confidence interval -1.8%to 26.5%). Of 68 participants referred to the clinic, 21 (31%)did not attend. The costs per index case were £32.55 forthe practice nurse led strategy and £32.62 for the specialistreferral strategy.

Conclusion Practice based partner notification by trained nurseswith telephone follow up by health advisers is at least as effectiveas referral to a specialist health adviser at a genitourinarymedicine clinic, and costs the same.

Trial registration Clinical trials: NCT00112255 [ClinicalTrials.gov] .

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