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

doi:10.1136/bmj.38678.405370.7C

BMJ, doi: 10.1136/bmj.38678.405370.7C, (Published 15 December 2005)

PRIMARY CARE

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

Nicola Low ¹^*, Anne McCarthy ¹, Tracy E Roberts ², Mia Huengsberg ³, Emma Sanford ¹, Jonathan A C Sterne ¹, John Macleod ⁴, Chris Salisbury ⁵, Karl Pye ⁶, Aisha Holloway ⁴, Andrea Morcom ⁴, Rita Patel ⁵, Suzanne M Robinson ², Paddy Horner ⁶, Pelham M Barton ², Matthias Egger ⁷, for the Chlamydia Screening Studies (ClaSS) Project Group

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 General Practice and Primary Care, University of Birmingham
⁵ Academic Unit of Primary Health Care, University of Bristol, Bristol BS6 6JL
⁶ Department of Genitourinary Medicine, United Bristol Healthcare Trust, Milne Centre for Sexual Health, Bristol BS2 8EE
⁷ Department of Social Medicine, University of Bristol, Bristol BS8 2PR; Department of Social and Preventive Medicine, University of Berne, CH-3012, Switzerland

^* Correspondence to: low{at}ispm.unibe.ch.

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

Design Randomised controlledtrial.

Setting 27 general practices in the Bristol and Birminghamareas.

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 generalpractice immediately after diagnosis by trained practice nurses,with telephone follow up by a health adviser; or referral toa specialist health adviser at a genitourinary medicine clinic.

Mainoutcome measures Primary outcome was the proportion of indexcases with at least one treated sexual partner. Specified secondaryoutcomes included the number of sexual contacts elicited duringa sexual history, positive test result for chlamydia six weeksafter treatment, and the cost of each strategy in 2003 sterlingprices.

Results 65.3% (47/72) of participants receiving practicenurse led partner notification had at least one partner treatedcompared with 52.9% (39/68) of those referred to a genitourinarymedicine clinic (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 £32.55for the practice nurse led strategy and £32.62 for thespecialist referral strategy.

Conclusion Practice based partnernotification by trained nurses with telephone follow up by healthadvisers is at least as effective as referral to a specialisthealth adviser at a genitourinary medicine clinic, and coststhe same.

Trial registration Clinical trials: NCT00112255.

(Accepted 1 November 2005)

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