5C 1 Can Accelerated Partner Therapy (APT) Improve Outcomes of Partner Notification for Women Diagnosed with Genital Chlamydia in Primary Care Settings: A Pilot Randomised Controlled Trial in General Practice and Community Sexual Health Services

Thursday, June 12, 2014: 8:00 AM
Grand Ballroom A/B/C/D1
Claudia Estcourt, MBBS, MD1, Lorna Sutcliffe, MSc2, Cath Mercer, BSc, MSc, PhD3, Andrew Copas, BA, MSc, PhD4, Pamela Muniia, MSc5, Greta Rait, MSc, MD5, Merle Symonds, Dip HE6, Laura Greaves, BSC, MSc7, Kazeem Aderogba, MBChB8, Donal Traynor, Esq8, Tracy Roberts, PhD9, Louise Jackson, PhD9, Anne Johnson, MBBS, MD10, Sarah Creighton, MBBS BSc11, Geoff Huckle, Esq11 and Jackie Cassell, BMBCh, MSc, MD, BA (Philosophy)12, 1Centre for Immunology & Infectious Disease Blizard Institute Barts & The London School of Medicine & Dentistry, Queen Mary University of London & Barts Health NHS Trust, London, United Kingdom, 2Queen Mary University of London, 3Department of Infection and Population Health, University College London, London, United Kingdom, 4Department of Infection and Population Health, Centre for Sexual Health and HIV Research, London, United Kingdom, 5University College London, 6Infection & Immunity, Barts Health NHS Trust, LONDON, United Kingdom, 7Barts Health NHS Trust, 8East Sussex Healthcare Trust, 9University of Birmingham, 10Research Department of Infection and Population Health, University College London, London, United Kingdom, 11Homerton University Hospital NHS Foundation Trust, 12Brighton & Sussex Medical School

Background: APT is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings.

Methods: 3-arm pilot individual RCT of 2 APT interventions: APTHotline (telephone assessment of partner(s)) and APTPharmacy (community pharmacist assessment of partner), vs routine care (patient referral). Participants were women diagnosed with genital Chlamydia trachomatis infection (indexes) in 10 general practices and 2 community contraception and sexual health services in London and the south coast of England, 1 Sept 2011-31 July 2013. The primary outcome was the proportion of contactable partners considered treated ≤6 weeks of index diagnosis.

Results: 199 women described 339 male partners, of whom 313 were described by the index as contactable. Index follow-up rates varied significantly by intervention arm: APTHotline: 50/68 (74%); APTPharmacy 42/65 (65%); Standard 54/66 (82%). Proportion of contactable partners considered treated ≤6 weeks of index diagnosis by arm were: APTHotline 41/111 (37%); APTPharmacy 38/110 (35%) and Standard patient referral 46/102 (45%). Excluding from the denominators partners who could not be followed-up, these proportions were: 49%; 60%, and 58%, respectively

Conclusions: The proportion of partners treated was lower than that achieved by APT in specialist services and uptake of interventions was low.  Poorer outcomes in these community settings may reflect index randomisation, removing the opportunity for the women to choose a PN approach, which has been shown to contribute to successful PN. Also the ability to follow-up indexes to ascertain PN outcomes varied by arm, and thus the extent of difference between arms depends on the denominator used. Nonetheless, overall outcomes were superior to previously-reported PN measures in similar settings and so further work is required to optimise uptake of APT outside specialist services.