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.