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Mercer CH, Clifton S, Riddell J, Tanton C, Freeman L, Copas AJ, Dema E, Bosó Pérez R, Gibbs J, Macdowall W, Menezes D, Ridge MC, Bonell C, Sonnenberg P, Field N, Mitchell KR. Impacts of COVID-19 on sexual behaviour in Britain: findings from a large, quasi-representative survey (Natsal-COVID). Sex Transm Infect 2022; 98:469-477. [PMID: 34916335 PMCID: PMC8687784 DOI: 10.1136/sextrans-2021-055210] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Physical restrictions imposed to combat COVID-19 dramatically altered sexual lifestyles but the specific impacts on sexual behaviour are still emerging. We investigated physical and virtual sexual activities, sexual frequency and satisfaction in the 4 months following lockdown in Britain in March 2020 and compared with pre-lockdown. METHODS Weighted analyses of web panel survey data collected July/August 2020 from a quota-based sample of 6654 people aged 18-59 years in Britain. Multivariable regression took account of participants' opportunity for partnered sex, gender and age, to examine their independent associations with perceived changes in sexual frequency and satisfaction. RESULTS Most participants (86.7%) reported some form of sex following lockdown with physical activities more commonly reported than virtual activities (83.7% vs 52.6%). Altogether, 63.2% reported sex with someone ('partnered sex') since lockdown, three-quarters of whom were in steady cohabiting relationships. With decreasing relationship formality, partnered sex was less frequently reported, while masturbation, sex toy use and virtual activities were more frequently reported. Around half of all participants perceived no change in partnered sex frequency compared with the 3 months pre-lockdown, but this was only one-third among those not cohabiting, who were more likely to report increases in non-partnered activities than those cohabiting. Two-thirds of participants perceived no change in sexual satisfaction; declines were more common among those not cohabiting. Relationship informality and younger age were independently associated with perceiving change, often declines, in sexual frequency and satisfaction. CONCLUSIONS Our quasi-representative study of the British population found a substantial minority reported significant shifts in sexual repertoires, frequency and satisfaction following the introduction of COVID-19 restrictions. However, these negative changes were perceived by some more than others; predominantly those not cohabiting and the young. As these groups are most likely to experience adverse sexual health, it is important to monitor behaviour as restrictions ease to understand the longer term consequences, including for health services.
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Affiliation(s)
| | - Soazig Clifton
- Institute for Global Health, University College London, London, UK
- NatCen Social Research, London, UK
| | - Julie Riddell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Clare Tanton
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lily Freeman
- Institute for Global Health, University College London, London, UK
| | - Andrew J Copas
- Institute for Global Health, University College London, London, UK
| | - Emily Dema
- Institute for Global Health, University College London, London, UK
| | - Raquel Bosó Pérez
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Wendy Macdowall
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Dee Menezes
- Institute for Health Informatics, University College London, London, UK
| | - Mary-Clare Ridge
- Institute for Global Health, University College London, London, UK
| | - Chris Bonell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
| | - Kirstin R Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Accelerated partner therapy contact tracing for people with chlamydia (LUSTRUM): a crossover cluster-randomised controlled trial. THE LANCET PUBLIC HEALTH 2022; 7:e853-e865. [DOI: 10.1016/s2468-2667(22)00204-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023] Open
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Wayal S, Estcourt CS, Mercer CH, Saunders J, Low N, McKinnon T, Symonds M, Cassell JA. Optimising partner notification outcomes for bacterial sexually transmitted infections: a deliberative process and consensus, United Kingdom, 2019. Euro Surveill 2022; 27. [PMID: 35057899 PMCID: PMC8804665 DOI: 10.2807/1560-7917.es.2022.27.3.2001895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Partner notification (PN) is an essential element of sexually transmitted infection (STI) control. It enables identification, treatment and advice for sexual contacts who may benefit from additional preventive interventions such as HIV pre- and post-exposure prophylaxis. PN is most effective in reducing STI transmission when it reaches individuals who are most likely to have an STI and to engage in sexual behaviour that facilitates STI transmission, including having multiple and/or new sex partners. Outcomes of PN practice need to be measurable in order to inform standards. They need to address all five stages in the cascade of care: elicitation of partners, establishing contactable partners, notification, testing and treatment. In the United Kingdom, established outcome measures cover only the first three stages and do not take into account the type of sexual partnership. We report an evidence-based process to develop new PN outcomes and inform standards of care. We undertook a systematic literature review, evaluation of published information on types of sexual partnership and a modified Delphi process to reach consensus. We propose six new PN outcome measures at five stages of the cascade, including stratification by sex partnership type. Our framework for PN outcome measurement has potential to contribute in other domains, including Covid-19 contact tracing.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London, London, United Kingdom
| | - Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Catherine H Mercer
- Institute for Global Health, University College London, London, United Kingdom
| | - John Saunders
- Institute for Global Health, University College London, London, United Kingdom
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tamsin McKinnon
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Merle Symonds
- Western Sussex Hospitals NHS Foundation Trust, Worthing, West Sussex, United Kingdom
| | - Jackie A Cassell
- Brighton and Sussex Medical School, Falmer, East Sussex, United Kingdom
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Estcourt CS, Flowers P, Cassell JA, Pothoulaki M, Vojt G, Mapp F, Woode-Owusu M, Low N, Saunders J, Symonds M, Howarth A, Wayal S, Nandwani R, Brice S, Comer A, Johnson AM, Mercer CH. Going beyond 'regular and casual': development of a classification of sexual partner types to enhance partner notification for STIs. Sex Transm Infect 2021; 98:108-114. [PMID: 33927009 PMCID: PMC8862076 DOI: 10.1136/sextrans-2020-054846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/03/2021] [Accepted: 02/27/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives To develop a classification of sexual partner types for use in partner notification (PN) for STIs. Methods A four-step process: (1) an iterative synthesis of five sources of evidence: scoping review of social and health sciences literature on partner types; analysis of relationship types in dating apps; systematic review of PN intervention content; and review of PN guidelines; qualitative interviews with public, patients and health professionals to generate an initial comprehensive classification; (2) multidisciplinary clinical expert consultation to revise the classification; (3) piloting of the revised classification in sexual health clinics during a randomised controlled trial of PN; (4) application of the Theoretical Domains Framework (TDF) to identify index patients’ willingness to engage in PN for each partner type. Results Five main partner types emerged from the evidence synthesis and consultation: ‘established partner’, ‘new partner’, ‘occasional partner’, ‘one-off partner’ and ‘sex worker’. The types differed across several dimensions, including likely perceptions of sexual exclusivity, likelihood of sex reoccurring between index patient and sex partner. Sexual health professionals found the classification easy to operationalise. During the trial, they assigned all 3288 partners described by 2223 index patients to a category. The TDF analysis suggested that the partner types might be associated with different risks of STI reinfection, onward transmission and index patients’ engagement with PN. Conclusions We developed an evidence-informed, useable classification of five sexual partner types to underpin PN practice and other STI prevention interventions. Analysis of biomedical, psychological and social factors that distinguish different partner types shows how each could warrant a tailored PN approach. This classification could facilitate the use of partner-centred outcomes. Additional studies are needed to determine the utility of the classification to improve measurement of the impact of PN strategies and help focus resources.
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Affiliation(s)
- Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Jackie A Cassell
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
| | - Maria Pothoulaki
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Gabriele Vojt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Mapp
- Institute for Global Health, University College London, London, UK
| | | | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - John Saunders
- Institute for Global Health, University College London, London, UK
- Blood Safety, Hepatitis, STI & HIV Division, Public Health England, London, UK
| | - Merle Symonds
- Department of Sexual Health, West Sussex Health and Social Care NHS Trust, Worthing, West Sussex, UK
| | - Alison Howarth
- Institute for Global Health, University College London, London, UK
| | | | - Rak Nandwani
- Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Alex Comer
- Central and North West London NHS Foundation Trust, London, UK
| | - Anne M Johnson
- Department of Infection & Population Health, University College London, London, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, University College London, London, UK
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Parda N, Stępień M, Zakrzewska K, Madaliński K, Kołakowska A, Godzik P, Rosińska M. What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland. BMJ Open 2016; 6:e013359. [PMID: 27927665 PMCID: PMC5168657 DOI: 10.1136/bmjopen-2016-013359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare. DESIGN Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate. SETTING This study was conducted in primary care units in selected provinces in Poland. PARTICIPANTS A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected. RESULTS Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect. CONCLUSIONS Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed.
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Affiliation(s)
- Natalia Parda
- Department of Epidemiology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Małgorzata Stępień
- Department of Epidemiology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Karolina Zakrzewska
- Department of Virology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
- Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Madaliński
- Department of Virology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Agnieszka Kołakowska
- Department of Virology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Paulina Godzik
- Department of Virology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Magdalena Rosińska
- Department of Epidemiology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
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Mercer CH, Jones KG, Johnson AM, Lewis R, Mitchell KR, Gravningen K, Clifton S, Tanton C, Sonnenberg P, Wellings K, Cassell JA, Estcourt CS. How can we objectively categorise partnership type? A novel classification of population survey data to inform epidemiological research and clinical practice. Sex Transm Infect 2016; 93:129-136. [PMID: 27535765 PMCID: PMC5339562 DOI: 10.1136/sextrans-2016-052646] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/27/2016] [Accepted: 07/17/2016] [Indexed: 11/16/2022] Open
Abstract
Background Partnership type is a determinant of STI risk; yet, it is poorly and inconsistently recorded in clinical practice and research. We identify a novel, empirical-based categorisation of partnership type, and examine whether reporting STI diagnoses varies by the resulting typologies. Methods Analyses of probability survey data collected from 15 162 people aged 16–74 who participated in Britain's third National Survey of Sexual Attitudes and Lifestyles were undertaken during 2010–2012. Computer-assisted self-interviews asked about participants' ≤3 most recent partners (N=14 322 partners/past year). Analysis of variance and regression tested for differences in partnership duration and perceived likelihood of sex again across 21 ‘partnership progression types’ (PPTs) derived from relationship status at first and most recent sex. Multivariable regression examined the association between reporting STI diagnoses and partnership type(s) net of age and reported partner numbers (all past year). Results The 21 PPTs were grouped into four summary types: ‘cohabiting’, ‘now steady’, ‘casual’ and ‘ex-steady’ according to the average duration and likelihood of sex again. 11 combinations of these summary types accounted for 94.5% of all men; 13 combinations accounted for 96.9% of all women. Reporting STI diagnoses varied by partnership-type combination, including after adjusting for age and partner numbers, for example, adjusted OR: 6.03 (95% CI 2.01 to 18.1) for men with two ‘casual’ and one ‘now steady’ partners versus men with one ‘cohabiting’ partner. Conclusions This typology provides an objective method for measuring partnership type and demonstrates its importance in understanding STI risk, net of partner numbers. Epidemiological research and clinical practice should use these methods and results to maximise individual and public health benefit.
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Affiliation(s)
- C H Mercer
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, University College London, London, UK
| | - K G Jones
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, University College London, London, UK
| | - A M Johnson
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, University College London, London, UK
| | - R Lewis
- Department of Social and Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK.,Department of Sociology, University of the Pacific, Stockton, USA
| | - K R Mitchell
- Department of Social and Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK.,MRC/CSO Social and Public Health Sciences Unit, Institute of Wellbeing, University of Glasgow, Glasgow, UK
| | - K Gravningen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - S Clifton
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, University College London, London, UK
| | - C Tanton
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, University College London, London, UK
| | - P Sonnenberg
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, University College London, London, UK
| | - K Wellings
- Department of Social and Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - J A Cassell
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | - C S Estcourt
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.,Barts Sexual Health Centre, St Bartholomew's Hospital, London, UK
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7
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Estcourt CS, Sutcliffe LJ, Copas A, Mercer CH, Roberts TE, Jackson LJ, Symonds M, Tickle L, Muniina P, Rait G, Johnson AM, Aderogba K, Creighton S, Cassell JA. Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial. Sex Transm Infect 2015; 91:548-54. [PMID: 26019232 PMCID: PMC4680194 DOI: 10.1136/sextrans-2014-051994] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/05/2015] [Indexed: 11/07/2022] Open
Abstract
Background Accelerated partner therapy (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 Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. Results 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. Conclusions The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation. Trial registration number Registered UK Clinical Research Network Study Portfolio id number 10123.
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Affiliation(s)
- Claudia S Estcourt
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Lorna J Sutcliffe
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Andrew Copas
- Research Department of Infection & Population Health, University College London, London, UK
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, London, UK
| | - Tracy E Roberts
- Health Economics Unit, School of Population and Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, School of Population and Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Merle Symonds
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Laura Tickle
- Barts Sexual Health Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Pamela Muniina
- Research Department of Infection & Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Infection & Population Health, University College London, London, UK
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, London, UK
| | - Kazeem Aderogba
- Department of Sexual Health, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Sarah Creighton
- Homerton Sexual Health Services, Homerton Hospital, London, UK
| | - Jackie A Cassell
- Division of Primary Care & Public Health, Brighton & Sussex Medical School, University of Brighton, Brighton, UK
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8
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Abstract
Partner notification is an essential part of case management for sexually transmitted infections. Done correctly it reduces persistent or recurrent infection in the index patient, identifies previously undiagnosed infections, and may thus contribute to reduced transmission in the population. The effectiveness of patient referral of partners can be enhanced through the provision of written information and easy access to tests and medication. A recent systematic review of partner notification found that enhanced partner therapy (helping get treatment to partners more rapidly) reduced re-infection in the index case by almost 30% compared with simple patient referral. Provider referral, where the healthcare worker contacts partners directly, can also be effective, and provides an important service for patients who are wary of informing partners themselves. Partner notification services should be available for all patients found to have a sexually transmitted infection, whether the diagnosis is made in specialist settings, or in primary or community-based care. For patients with HIV, partner notification should be addressed when the infection is first diagnosed and revisited for subsequent partners. Access to specialist partner notification services is an important part of any sexual healthcare system. The professional competencies required to undertake partner notification have now been clearly defined.
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Affiliation(s)
- Helen Ward
- is a Professor of Public Health, Imperial College London, UK. Competing interests: none declared
| | - Gill Bell
- is a Professor of Public Health, Imperial College London, UK. Competing interests: none declared
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9
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Mercer CH, Aicken CRH, Tanton C, Estcourt CS, Brook MG, Keane F, Cassell JA. Serial monogamy and biologic concurrency: measurement of the gaps between sexual partners to inform targeted strategies. Am J Epidemiol 2013; 178:249-59. [PMID: 23801013 DOI: 10.1093/aje/kws467] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Having multiple sexual partners concurrently increases the risk of transmission of a sexually transmitted infection. Even if partnerships do not overlap, transmission potential exists when the gap between partnerships is shorter than the remaining infectious period. In the present article, we quantify the gap between partners to assess transmission potential using data collected by a cross-sectional survey of 2,203 genitourinary medicine clinic patients in England in 2009. Questionnaires asked about patients' 3 most recent partnerships. Gaps were calculated as time (days) between the last sexual encounter with a former partner and the first sexual encounter with the next partner. Among 1,875 patients who reported 1 or more partners in the previous 3 months, 47.6% of men and 27.7% of women reported 2 or more partners. Forty-two percent of the gaps were negative (i.e., partnerships that were concurrent); the median gaps were -7 and -17 days for men and women, respectively (i.e., overlaps were 7 and 17 days for men and women, respectively). Although half of the gaps were positive (serially monogamous partnerships), many were of short duration; the median gaps were 14 and 24 days for men and women, respectively. In over half of the gaps, condoms were used inconsistently with one or both partners, and in one-quarter, condoms were never used with either partner. There is thus a high potential for sexually transmitted infections, as even if partnerships are not behaviorally concurrent, they may be biologically concurrent. These data have important implications for designing and targeting effective health promotion messages.
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Affiliation(s)
- Catherine H Mercer
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK.
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Clarke J, White KAJ, Turner K. Approximating optimal controls for networks when there are combinations of population-level and targeted measures available: chlamydia infection as a case-study. Bull Math Biol 2013; 75:1747-77. [PMID: 23812958 DOI: 10.1007/s11538-013-9867-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
Using a modified one-dimensional model for the spread of an SIS disease on a network, we show that the behaviour of complex network simulations can be replicated with a simpler model. This model is then used to design optimal controls for use on the network, which would otherwise be unfeasible to obtain, resulting in information about how best to combine a population-level random intervention with one that is more targeted. This technique is used to minimise intervention costs over a short time interval with a target prevalence, and also to minimise prevalence with a specified budget. When applied to chlamydia, we find results consistent with previous work; that is maximising targeted control (contact tracing) is important to using resources effectively, while high-intensity bursts of population control (screening) are more effective than maintaining a high level of coverage.
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Affiliation(s)
- James Clarke
- Centre for Mathematical Biology, University of Bath, Bath, BA2 7AY, UK,
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McClean H, Radcliffe K, Sullivan A, Ahmed-Jushuf I. 2012 BASHH statement on partner notification for sexually transmissible infections. Int J STD AIDS 2013; 24:253-61. [PMID: 23970656 DOI: 10.1177/0956462412472804] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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The epidemiology of gonorrhoea in London: a Bayesian spatial modelling approach. Epidemiol Infect 2013; 142:211-20. [PMID: 23561246 DOI: 10.1017/s0950268813000745] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Data obtained from genitourinary medicine clinics through a comprehensive surveillance system were used in a Bayesian mixed-effects Poisson regression model to explore socio-demographic individual and ecological risk factors for gonorrhoea in London, as well as its spatial clustering. The spatial analysis was performed at the Middle-layer Super Output Area level (median population size 7200). A total of 12452 individuals were diagnosed during the 2-year study period (2009-2010). The study confirmed the presence of 'core areas' of high incidence, and identified 'core' high-risk groups, in particular young adults (16-29 years), males, black Caribbeans and more deprived areas. The individual (age, sex, ethnicity) and area-level (deprivation, teenage pregnancies, students) model covariates accounted for 48% of the variance. Most of the remaining variance was explained by the spatial effect, thus capturing other spatially distributed factors associated with gonorrhoea, such as local sexual networks. These findings will be useful in identifying areas for targeted interventions, such as STI testing and health promotion.
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Althaus CL, Heijne JCM, Herzog SA, Roellin A, Low N. Individual and population level effects of partner notification for Chlamydia trachomatis. PLoS One 2012; 7:e51438. [PMID: 23251534 PMCID: PMC3520891 DOI: 10.1371/journal.pone.0051438] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/31/2012] [Indexed: 01/08/2023] Open
Abstract
Partner notification (PN or contact tracing) is an important aspect of treating bacterial sexually transmitted infections (STIs), such as Chlamydia trachomatis. It facilitates the identification of new infected cases that can be treated through individual case management. PN also acts indirectly by limiting onward transmission in the general population. However, the impact of PN, both at the level of individuals and the population, remains unclear. Since it is difficult to study the effects of PN empirically, mathematical and computational models are useful tools for investigating its potential as a public health intervention. To this end, we developed an individual-based modeling framework called Rstisim. It allows the implementation of different models of STI transmission with various levels of complexity and the reconstruction of the complete dynamic sexual partnership network over any time period. A key feature of this framework is that we can trace an individual's partnership history in detail and investigate the outcome of different PN strategies for C. trachomatis. For individual case management, the results suggest that notifying three or more partners from the preceding 18 months yields substantial numbers of new cases. In contrast, the successful treatment of current partners is most important for preventing re-infection of index cases and reducing further transmission of C. trachomatis at the population level. The findings of this study demonstrate the difference between individual and population level outcomes of public health interventions for STIs.
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Affiliation(s)
- Christian L Althaus
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
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