A survey of contact tracing practice for sexually transmitted diseases in GUM clinics in England and Wales

Is everyone treated equally? Management of genital Chlamydia trachomatis infection in New Zealand

Health disparities often reflect inequitable access to appropriate health care. This study aimed to establish if cases of genital chlamydia infection were managed equitably by age, gender and ethnicity in a region of New Zealand with high rates of chlamydia infection (858 per 100,000 population). Clinical records of 415 genital chlamydia cases from 19 different health-care sites, including general practice and community settings, were reviewed. Data were analysed by demographic variables. For those treated, men were treated more quickly than women (median 3 days versus 6 days, P < 0.001), but there was no difference by ethnicity. Cases without documented treatment were more likely to be women (8.2% versus 2.1%, P = 0.037) and more likely to be Māori than non-Māori (13.6% versus 4.8%, P = 0.036). Overall, the most notable issue was the lack of effective partner notification across all demographic variables. Ongoing efforts are required to ensure equitable access to timely treatment and to ensure that more effective partner notification strategies are implemented.

Is Accelerated Partner Therapy partner notification for sexually transmissible infections acceptable and feasible in general practice?

Background: Partner notification in primary care is problematic and of limited effectiveness despite enthusiasm from primary care providers to engage with sexually transmissible infection (STI) management. Innovative partner notification strategies must be relevant to the primary care context. The aim of the present study was to explore the opinions of general practitioners (GP) and practice nurses on the acceptability and feasibility of a new form of partner notification developed in the specialist setting known as Accelerated Partner Therapy (APT), for sex partners of those diagnosed with a bacterial STI in general practice. APT is defined as partner notification strategies that reduce time for sex partners to be treated, and include partner assessment by appropriately qualified health care professionals and here involve telephone and community pharmacy assessment. Methods: Semi-structured qualitative interviews were conducted with a purposive sample of GP and practice nurses in East London, UK. Results: All participants appreciated the importance of partner notification in STI management and felt that APT would improve their practice. They supported prioritising antibiotic provision for the sex partners with provision for future comprehensive STI screening. Although both models were acceptable and feasible, the majority preferred the sexual health clinic telephone assessment over the pharmacy model. Conclusions: GP and practice nurses welcome new strategies for partner notification and believe APT could provide rapid and convenient treatment of sex partners in general practice. This supports further evaluation of APT models as a partner notification strategy in primary care.

Contact heterogeneity and phylodynamics: how contact networks shape parasite evolutionary trees

The inference of population dynamics from molecular sequence data is becoming an important new method for the surveillance of infectious diseases. Here, we examine how heterogeneity in contact shapes the genealogies of parasitic agents. Using extensive simulations, we find that contact heterogeneity can have a strong effect on how the structure of genealogies reflects epidemiologically relevant quantities such as the proportion of a population that is infected. Comparing the simulations to BEAST reconstructions, we also find that contact heterogeneity can increase the number of sequence isolates required to estimate these quantities over the course of an epidemic. Our results suggest that data about contact-network structure will be required in addition to sequence data for accurate estimation of a parasitic agent's genealogy. We conclude that network models will be important for progress in this area.

Contact tracing for sexually transmitted infections in New South Wales, Australia

Background: Contact tracing is an important strategy in the control of sexually transmitted infections (STI) because it encourages individuals who may be unaware they have been exposed to an infection to be tested and treated. The aim of this study was to review STI contact tracing procedures in NSW by sexual health clinics (SHC), public health units (PHU) and general practitioners (GP). Methods: A questionnaire study carried out in 2004–2005 of SHC, PHU and a random sample of GP in NSW. SHC and PHU participated in structured interviews and GP completed questionnaires at educational workshops or through a mail-out. Interviews and questionnaires addressed current contact tracing practice and methods of improving the service. Results: All 35 SHC, 6/18 (33%) PHU and 172/212 (81%) of the GP who responded to the survey undertook contact tracing for STI. Chlamydia was the STI most commonly traced by SHC (34/35, 97%) and GP (165/172, 96%). HIV was the STI most commonly traced by PHU (5/6, 83%). Only 23/172 (13%) GP were familiar with the ‘Australasian contact tracing manual’. The commonest barriers to tracing for SHC and GP included patient reluctance (SHC 60%, GP 71%), and the lack of contact details for partners (SHC 46%, GP 60%). GP identified the availability of information for patients (82%) and more training (55%) as necessary resources for optimal contact tracing. Conclusions: SHC and GP frequently undertook contact tracing for some STI; PHU do so less frequently. Barriers to contact tracing are similar for all health-care providers. For GP, there is a need for increased training and the development of written policies and agreed pathways for referral.

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

OBJECTIVE

To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of 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 vulval swab specimen.

INTERVENTIONS

Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic.

MAIN OUTCOME MEASURES

Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for chlamydia six weeks after treatment, and the cost of each strategy in 2003 sterling prices.

RESULTS

65.3% (47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9% (39/68) of those referred to a genitourinary medicine 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 32.55 pounds sterling for the practice nurse led strategy and 32.62 pounds sterling for the specialist referral strategy.

CONCLUSION

Practice based partner notification by trained nurses with telephone follow up by health advisers is at least as effective as referral to a specialist health adviser at a genitourinary medicine clinic, and costs the same. Trial registration Clinical trials: NCT00112255.

The transformation of partner notification

Since 1996, several traditional epidemiological studies of program efficacy have done little to alter the fixed opinions of promoters or detractors of partner notification. Modeling studies have appeared that confirm the value of the contact-tracing approach in locating and treating persons who may be important in transmission. These provide a theoretical base for a number of empirical studies that have applied social network methods to classical partner-notification approaches, which have demonstrated the dense networks and geographic clustering of persons involved in sexually transmitted disease transmission and have provided justification for focusing efforts on small groups that may be critical to epidemicity or its maintenance. These initial studies would appear to warrant a broad-based inclusion of network concepts into programmatic activities, with careful monitoring and analysis of the impact they have on both the traditional indices of partner notification as well as the larger effect on disease transmission.

A survey of patients with Chlamydia trachomatis infection: sexual behaviour and perceptions about contact tracing

The aim of this study was to evaluate how patients with Chlamydia trachomatis infection perceived the legal enforcement of partner notification and to seek their views on legislation impinging on their own sexual behaviour. The investigation was performed at STD clinics in Stockholm, Sweden in 1997. Consecutive patients (n=192) answered a questionnaire about sexual behaviour and contact tracing. More men (40%) than women (21%) had had sexual intercourse during the past 6 months with an occasional partner. The mean number (6 months prior to this) was 2.3 partners (1-15) for men and 2.2 partners (1-21) for women. Eighteen per cent admitted to having avoided disclosing the name of their partner(s). Ninety per cent considered it beneficial that chlamydial infection was regulated and that a named partner could be forced to undergo STD testing. Partly based on this report, the government has recommended police enforcement to be removed from the legislation as a tool for contact tracing in chlamydial infections.