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Hall JA, Harris RJ, Zaidi A, Dabrera G, Dunbar JK. Risk of hospitalisation or death in households with a case of COVID-19 in England: an analysis using the HOSTED data set. Public Health 2022; 211:85-87. [PMID: 36058199 PMCID: PMC9359490 DOI: 10.1016/j.puhe.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
Abstract
Objective To determine whether household contacts of confirmed cases of COVID-19 have an increased risk of hospitalisation or death. Methods We used the HOSTED data set of index cases of COVID-19 in England between June and November 2020, linked to Secondary Uses Service data on hospital episodes and Office for National Statistics’ mortality data. Multivariable logistic regression models of the odds of household contacts being hospitalised or dying within six weeks of an index case, adjusted for case type, age, sex and calendar month were calculated. Excess risk was determined by comparing the first six weeks after the index case with 6–12 weeks after the index case in a survival analysis framework. Results Index cases were more likely to be hospitalised or die than either secondary cases or non-cases, having adjusted for age and sex. There was an increased risk of hospitalisation for non-cases (adjusted hazard ratio (aHR) 1.10; 95% confidence interval (CI) 1.04, 1.16) and of death (aHR 1.57; 95% CI 1.14, 2.16) in the first six weeks after an index case, compared to 6–12 weeks after. Conclusion Risks of hospitalisation and mortality are predictably higher in cases compared to non-cases. The short-term increase in risks for non-case contacts following diagnosis of the index case may suggest incomplete case ascertainment among contacts, although this was relatively small.
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Affiliation(s)
- J A Hall
- UK Health Security Agency, London, UK
| | | | - A Zaidi
- UK Health Security Agency, London, UK
| | - G Dabrera
- UK Health Security Agency, London, UK
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Affiliation(s)
| | - Jennifer A Hall
- University College London Institute for Women's Health, London, United Kingdom
| | - Asad Zaidi
- Public Health England, London, United Kingdom
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Hall JA, Harris RJ, Zaidi A, Woodhall SC, Dabrera G, Dunbar JK. HOSTED-England's Household Transmission Evaluation Dataset: preliminary findings from a novel passive surveillance system of COVID-19. Int J Epidemiol 2021; 50:743-752. [PMID: 33837417 PMCID: PMC8083300 DOI: 10.1093/ije/dyab057] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Household transmission of SARS-CoV-2 is an important component of the community spread of the pandemic. Little is known about the factors associated with household transmission, at the level of the case, contact or household, or how these have varied over the course of the pandemic. METHODS The Household Transmission Evaluation Dataset (HOSTED) is a passive surveillance system linking laboratory-confirmed COVID-19 cases to individuals living in the same household in England. We explored the risk of household transmission according to: age of case and contact, sex, region, deprivation, month and household composition between April and September 2020, building a multivariate model. RESULTS In the period studied, on average, 5.5% of household contacts in England were diagnosed as cases. Household transmission was most common between adult cases and contacts of a similar age. There was some evidence of lower transmission rates to under-16s [adjusted odds ratios (aOR) 0.70, 95% confidence interval (CI) 0.66-0.74). There were clear regional differences, with higher rates of household transmission in the north of England and the Midlands. Less deprived areas had a lower risk of household transmission. After controlling for region, there was no effect of deprivation, but houses of multiple occupancy had lower rates of household transmission [aOR 0.74 (0.66-0.83)]. CONCLUSIONS Children are less likely to acquire SARS-CoV-2 via household transmission, and consequently there was no difference in the risk of transmission in households with children. Households in which cases could isolate effectively, such as houses of multiple occupancy, had lower rates of household transmission. Policies to support the effective isolation of cases from their household contacts could lower the level of household transmission.
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Affiliation(s)
- J A Hall
- COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
- UCL Institute for Women’s Health, London, United Kingdom
| | - R J Harris
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - A Zaidi
- COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
| | - S C Woodhall
- COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
| | - G Dabrera
- COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
| | - J K Dunbar
- COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
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Harb AK, Town K, Callan E, Furegato M, Connor N, Dunbar JK. Who is coming back for more chlamydia testing within non-specialist health services and where do they go? England, 2013-2016. Public Health 2019; 180:136-140. [PMID: 31901574 DOI: 10.1016/j.puhe.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/16/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate patient demographics and venue type preferences within community settings associated with re-attendance for chlamydia testing. STUDY DESIGN Data used for this analysis were obtained from the English National Chlamydia Screening Programme (NCSP) which focuses on prevention, control and treatment of chlamydia in sexually active under-25 year olds. A greater understanding of how young adults attend services helps to inform commissioners regarding where to focus resources within community settings. METHODS Data from the Chlamydia surveillance system (CTAD) were used to count patient attendances at non-specialist sexual health services (SHSs) among 15-24-year-olds and monitor re-attendance for chlamydia testing within and between community services between 6 and 18 months of their first visit. RESULTS From January 2013 to December 2016, 866,847 young people underwent 1,041,245 tests for chlamydia. Re-attendance for chlamydia testing was 20.1% (174,398/866,847). Re-attendance rate was 28.5% after a positive test and 19.5% after a negative test. For re-attenders, 64.2% used the same venue type for both visits. General practice (GP) and sexual and reproductive health services (SRH) were the most commonly re-attended services (31.0% and 30.6% respectively). CONCLUSIONS Only one in five re-attended for chlamydia testing. Re-attendance was associated with having a positive result, accessibility and convenience. Patients are likely to return for testing to services they know. This should be considered by commissioners implementing new re-attendance guidance based on the NCSP.
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Affiliation(s)
- A K Harb
- Blood Safety, Hepatitis, STI & HIV Division, National Infection Service, Public Health England, London, UK.
| | - K Town
- Blood Safety, Hepatitis, STI & HIV Division, National Infection Service, Public Health England, London, UK
| | - E Callan
- Blood Safety, Hepatitis, STI & HIV Division, National Infection Service, Public Health England, London, UK
| | - M Furegato
- Blood Safety, Hepatitis, STI & HIV Division, National Infection Service, Public Health England, London, UK; Applied Diagnostic Research & Evaluation Unit, St George's, University of London, London, UK
| | - N Connor
- Blood Safety, Hepatitis, STI & HIV Division, National Infection Service, Public Health England, London, UK
| | - J K Dunbar
- Blood Safety, Hepatitis, STI & HIV Division, National Infection Service, Public Health England, London, UK
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Blomquist PB, Migchelsen SJ, Wills G, McClure E, Ades AE, Kounali D, Dunbar JK, McClure MO, Soldan K, Woodhall SC, Horner P. Correction: Sera selected from national STI surveillance system shows Chlamydia trachomatis PgP3 antibody correlates with time since infection and number of previous infections. PLoS One 2019; 14:e0216193. [PMID: 31017980 PMCID: PMC6481860 DOI: 10.1371/journal.pone.0216193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Soldan K, Dunbar JK, Gill ON. Estimating chlamydia prevalence: more difficult than modelling suggests. Lancet Public Health 2019; 3:e416. [PMID: 30193695 DOI: 10.1016/s2468-2667(18)30166-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/22/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Kate Soldan
- National Chlamydia Screening Programme, HIV & STI Department, National Infection Service, Public Health England.
| | - J Kevin Dunbar
- National Chlamydia Screening Programme, HIV & STI Department, National Infection Service, Public Health England
| | - O Noel Gill
- National Chlamydia Screening Programme, HIV & STI Department, National Infection Service, Public Health England
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Blomquist PB, Mighelsen SJ, Wills G, McClure E, Ades AE, Kounali D, Dunbar JK, McClure MO, Soldan K, Woodhall SC, Horner P. Sera selected from national STI surveillance system shows Chlamydia trachomatis PgP3 antibody correlates with time since infection and number of previous infections. PLoS One 2018; 13:e0208652. [PMID: 30557408 PMCID: PMC6296657 DOI: 10.1371/journal.pone.0208652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/20/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Seroprevalence surveys of Chlamydia trachomatis (CT) antibodies are promising for estimating age-specific CT cumulative incidence, however accurate estimates require improved understanding of antibody response to CT infection. METHODS We used GUMCAD, England's national sexually transmitted infection (STI) surveillance system, to select sera taken from female STI clinic attendees on the day of or after a chlamydia diagnosis. Serum specimens were collected from laboratories and tested anonymously on an indirect and a double-antigen ELISA, both of which are based on the CT-specific Pgp3 antigen. We used cross-sectional and longitudinal descriptive analyses to explore the relationship between seropositivity and a) cumulative number of chlamydia diagnoses and b) time since most recent chlamydia diagnosis. RESULTS 919 samples were obtained from visits when chlamydia was diagnosed and 812 during subsequent follow-up visits. Pgp3 seropositivity using the indirect ELISA increased from 57.1% (95% confidence interval: 53.2-60.7) on the day of a first-recorded chlamydia diagnosis to 89.6% (95%CI: 79.3-95.0) on the day of a third or higher documented diagnosis. With the double-antigen ELISA, the increase was from 61.1% (95%CI: 53.2-60.7) to 97.0% (95%CI: 88.5-99.3). Seropositivity decreased with time since CT diagnosis on only the indirect assay, to 49.3% (95%CI: 40.9-57.7) two or more years after a first diagnosis and 51.9% (95%CI: 33.2-70.0) after a repeat diagnosis. CONCLUSION Seropositivity increased with cumulative number of infections, and decreased over time after diagnosis on the indirect ELISA, but not on the double-antigen ELISA. This is the first study to demonstrate the combined impact of number of chlamydia diagnoses, time since diagnosis, and specific ELISA on Pgp3 seropositivity. Our findings are being used to inform models estimating age-specific chlamydia incidence over time using serial population-representative serum sample collections, to enable accurate public health monitoring of chlamydia.
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Affiliation(s)
- Paula B Blomquist
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, Public Health England, London, United Kingdom.,Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Health Protection Research Unit in Evaluation of Interventions at University of Bristol in partnership with Public Health England, Bristol, United Kingdom
| | - Stephanie J Mighelsen
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, Public Health England, London, United Kingdom.,Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Health Protection Research Unit in Evaluation of Interventions at University of Bristol in partnership with Public Health England, Bristol, United Kingdom
| | - Gillian Wills
- Jefferiss Research Trust Laboratories, Section of Infectious Diseases, Wright-Fleming Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Eleanor McClure
- Jefferiss Research Trust Laboratories, Section of Infectious Diseases, Wright-Fleming Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Anthony E Ades
- Health Protection Research Unit in Evaluation of Interventions at University of Bristol in partnership with Public Health England, Bristol, United Kingdom.,Population Health Science Institute, University of Bristol, Bristol, United Kingdom
| | - Daphne Kounali
- Health Protection Research Unit in Evaluation of Interventions at University of Bristol in partnership with Public Health England, Bristol, United Kingdom.,Population Health Science Institute, University of Bristol, Bristol, United Kingdom
| | - J Kevin Dunbar
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, Public Health England, London, United Kingdom.,Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Health Protection Research Unit in Evaluation of Interventions at University of Bristol in partnership with Public Health England, Bristol, United Kingdom
| | - Myra O McClure
- Jefferiss Research Trust Laboratories, Section of Infectious Diseases, Wright-Fleming Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Kate Soldan
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, Public Health England, London, United Kingdom.,Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Health Protection Research Unit in Evaluation of Interventions at University of Bristol in partnership with Public Health England, Bristol, United Kingdom
| | - Sarah C Woodhall
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, Public Health England, London, United Kingdom.,Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Health Protection Research Unit in Evaluation of Interventions at University of Bristol in partnership with Public Health England, Bristol, United Kingdom
| | - Patrick Horner
- Health Protection Research Unit in Evaluation of Interventions at University of Bristol in partnership with Public Health England, Bristol, United Kingdom.,Population Health Science Institute, University of Bristol, Bristol, United Kingdom
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Chandra NL, Broad C, Folkard K, Town K, Harding-Esch EM, Woodhall SC, Saunders JM, Sadiq ST, Dunbar JK. Detection of Chlamydia trachomatis in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis. Sex Transm Infect 2018; 94:320-326. [PMID: 29431148 DOI: 10.1136/sextrans-2017-053161] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 12/07/2017] [Accepted: 01/15/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Chlamydia trachomatis is the most commonly diagnosed bacterial STI. Lack of prevalence and risk factor data for rectal chlamydia in women has testing and treatment implications, as azithromycin (a first-line urogenital chlamydia treatment) may be less effective for rectal chlamydia. We conducted a systematic review of studies on women in high-income countries to estimate rectal chlamydia prevalence, concurrency with urogenital chlamydia and associations with reported anal intercourse (AI). DESIGN Systematic review and four meta-analyses conducted using random-effects modelling. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Cochrane Database were searched for articles published between January 1997 and October 2017. ELIGIBILITY CRITERIA Studies reporting rectal chlamydia positivity in heterosexual women aged ≥15 years old in high-income countries were included. Studies must have used nucleic acid amplification tests and reported both the total number of women tested for rectal chlamydia and the number of rectal chlamydia infections detected. Conference abstracts, case reports and studies with self-reported diagnoses were excluded. Data extracted included setting, rectal and urogenital chlamydia testing results, AI history, and demographics. RESULTS Fourteen eligible studies were identified, all among diverse populations attending sexual health services. Among routine clinic-attending women, summary rectal chlamydia positivity was 6.0% (95% CI 3.2% to 8.9%); summary concurrent rectal chlamydia infection was 68.1% in those who tested positive for urogenital chlamydia (95% CI 56.6% to 79.6%); and of those who tested negative for urogenital chlamydia, 2.2% (95% CI 0% to 5.2%) were positive for rectal chlamydia. Reported AI was not associated with rectal chlamydia (summary risk ratio 0.90; 95% CI 0.75 to 1.10). CONCLUSIONS High levels of rectal chlamydia infection have been shown in women with urogenital chlamydia infection. The absence of association between reported AI and rectal chlamydia suggests AI is not an adequate indicator for rectal testing. Further work is needed to determine policy and practice for routine rectal testing in women.
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Affiliation(s)
- Nastassya L Chandra
- HIV and STI Department, Public Health England, London, UK
- Field Epidemiology Service, Public Health England, London, UK
| | - Claire Broad
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Kate Folkard
- HIV and STI Department, Public Health England, London, UK
| | - Katy Town
- HIV and STI Department, Public Health England, London, UK
| | - Emma M Harding-Esch
- HIV and STI Department, Public Health England, London, UK
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
- Research Department of Infection and Population Health, St George's University of London, London, UK
| | | | | | - S Tariq Sadiq
- HIV and STI Department, Public Health England, London, UK
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Kevin Dunbar
- HIV and STI Department, Public Health England, London, UK
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Woodhall SC, Gorwitz RJ, Migchelsen SJ, Gottlieb SL, Horner PJ, Geisler WM, Winstanley C, Hufnagel K, Waterboer T, Martin DL, Huston WM, Gaydos CA, Deal C, Unemo M, Dunbar JK, Bernstein K. Advancing the public health applications of Chlamydia trachomatis serology. Lancet Infect Dis 2018; 18:e399-e407. [PMID: 29983342 DOI: 10.1016/s1473-3099(18)30159-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 02/04/2018] [Accepted: 02/09/2018] [Indexed: 12/22/2022]
Abstract
Genital Chlamydia trachomatis infection is the most commonly diagnosed sexually transmitted infection. Trachoma is caused by ocular infection with C trachomatis and is the leading infectious cause of blindness worldwide. New serological assays for C trachomatis could facilitate improved understanding of C trachomatis epidemiology and prevention. C trachomatis serology offers a means of investigating the incidence of chlamydia infection and might be developed as a biomarker of scarring sequelae, such as pelvic inflammatory disease. Therefore, serological assays have potential as epidemiological tools to quantify unmet need, inform service planning, evaluate interventions including screening and treatment, and to assess new vaccine candidates. However, questions about the performance characteristics and interpretation of C trachomatis serological assays remain, which must be addressed to advance development within this field. In this Personal View, we explore the available information about C trachomatis serology and propose several priority actions. These actions involve development of target product profiles to guide assay selection and assessment across multiple applications and populations, establishment of a serum bank to facilitate assay development and evaluation, and development of technical and statistical methods for assay evaluation and analysis of serological findings. The field of C trachomatis serology will benefit from collaboration across the public health community to align technological developments with their potential applications.
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Affiliation(s)
- Sarah C Woodhall
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK.
| | - Rachel J Gorwitz
- Division of STD Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie J Migchelsen
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, UK; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Patrick J Horner
- National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK
| | - William M Geisler
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Katrin Hufnagel
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wilhelmina M Huston
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Örebro University, Örebro, Sweden
| | - J Kevin Dunbar
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Kyle Bernstein
- Division of STD Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Harding-Esch EM, Fuller SS, Chow SLC, Nori AV, Harrison MA, Parker M, Piepenburg O, Forrest MS, Brooks DG, Patel R, Hay PE, Fearnley N, Pond MJ, Dunbar JK, Butcher PD, Planche T, Lowndes CM, Sadiq ST. Diagnostic accuracy of a prototype rapid chlamydia and gonorrhoea recombinase polymerase amplification assay: a multicentre cross-sectional preclinical evaluation. Clin Microbiol Infect 2018; 25:380.e1-380.e7. [PMID: 29906594 PMCID: PMC6420679 DOI: 10.1016/j.cmi.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 11/27/2022]
Abstract
Objectives Rapid and accurate sexually transmitted infection diagnosis can reduce onward transmission and improve treatment efficacy. We evaluated the accuracy of a 15-minute run-time recombinase polymerase amplification–based prototype point-of-care test (TwistDx) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Methods Prospective, multicentre study of symptomatic and asymptomatic patients attending three English sexual health clinics. Research samples provided were additional self-collected vulvovaginal swab (SCVS) (female participants) and first-catch urine (FCU) aliquot (female and male participants). Samples were processed blind to the comparator (routine clinic CT/NG nucleic acid amplification test (NAAT)) results. Discrepancies were resolved using Cepheid CT/NG GeneXpert. Results Both recombinase polymerase amplification and routine clinic NAAT results were available for 392 male and 395 female participants. CT positivity was 8.9% (35/392) (male FCU), 7.3% (29/395) (female FCU) and 7.1% (28/395) (SCVS). Corresponding NG positivity was 3.1% (12/392), 0.8% (3/395) and 0.8% (3/395). Specificity and positive predictive values were 100% for all sample types and both organisms, except male CT FCU (99.7% specificity (95% confidence interval (CI) 98.4–100.0; 356/357), 97.1% positive predictive value (95% CI 84.7–99.9; 33/34)). For CT, sensitivity was ≥94.3% for FCU and SCVS. CT sensitivity for female FCU was higher (100%; 95% CI, 88.1–100; 29/29) than for SCVS (96.4%; 95% CI, 81.7–99.9; 27/28). NG sensitivity and negative predictive values were 100% in FCU (male and female). Conclusions This prototype test has excellent performance characteristics, comparable to currently used NAATs, and fulfils several World Health Organization ASSURED criteria. Its rapidity without loss of performance suggests that once further developed and commercialized, this test could positively affect clinical practice and public health.
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Affiliation(s)
- E M Harding-Esch
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - S S Fuller
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - S-L C Chow
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK
| | - A V Nori
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
| | - M A Harrison
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK
| | | | | | | | | | - R Patel
- Department of Sexual Health, University of Southampton, Southampton, UK
| | - P E Hay
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - N Fearnley
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - M J Pond
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK
| | - J K Dunbar
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - P D Butcher
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK
| | - T Planche
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
| | - C M Lowndes
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - S T Sadiq
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK.
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Mohammed H, Blomquist P, Ogaz D, Duffell S, Furegato M, Checchi M, Irvine N, Wallace LA, Thomas DR, Nardone A, Dunbar JK, Hughes G. 100 years of STIs in the UK: a review of national surveillance data. Sex Transm Infect 2018; 94:553-558. [DOI: 10.1136/sextrans-2017-053273] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/02/2018] [Accepted: 03/24/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectivesThe 1916 Royal Commission on Venereal Diseases was established in response to epidemics of syphilis and gonorrhoea in the UK. In the 100 years since the Venereal Diseases Act (1917), the UK has experienced substantial scientific, economic and demographic changes. We describe historical and recent trends in STIs in the UK.MethodsWe analysed surveillance data derived from STI clinics’ statistical returns from 1917 to 2016.ResultsSince 1918, gonorrhoea and syphilis diagnoses have fluctuated, reflecting social, economic and technological trends. Following spikes after World Wars I and II, rates declined before re-emerging during the 1960s. At that time, syphilis was more common in men, suggestive of transmission within the men who have sex with men (MSM) population. Behaviour change following the emergence of HIV/AIDS in the 1980s is thought to have facilitated a precipitous decline in diagnoses of both STIs in the mid-1980s. Since the early 2000s, gonorrhoea and syphilis have re-emerged as major public health concerns due to increased transmission among MSM and the spread of antimicrobial-resistant gonorrhoea. Chlamydia and genital warts are now the most commonly diagnosed STIs in the UK and have been the focus of public health interventions, including the national human papillomavirus vaccination programme, which has led to substantial declines in genital warts in young people, and the National Chlamydia Screening Programme in England. Since the 1980s, MSM, black ethnic minorities and young people have experienced the highest STI rates.ConclusionAlthough diagnoses have fluctuated over the last century, STIs continue to be an important public health concern, often affecting more marginalised groups in society. Prevention must remain a public health priority and, as we enter a new era of sexual healthcare provision including online services, priority must be placed on maintaining prompt access for those at greatest risk of STIs.
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Clifton S, Town K, Furegato M, Cole M, Mohammed H, Woodhall SC, Kevin Dunbar J, Fifer H, Hughes G. Is previous azithromycin treatment associated with azithromycin resistance in Neisseria gonorrhoeae? A cross-sectional study using national surveillance data in England. Sex Transm Infect 2018; 94:421-426. [PMID: 29511067 DOI: 10.1136/sextrans-2017-053461] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES It has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance in Neisseria gonorrhoeae (NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectal Chlamydia trachomatis (CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin. METHODS Azithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013-2015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013-2016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012-2016). Descriptive and regression analyses were conducted to examine associations between history of previous CT/NGU/NG and subsequent susceptibility of NG to azithromycin. RESULTS Modal azithromycin minimum inhibitory concentration (MIC) was 0.25 mg/L (one dilution below the resistance breakpoint) in those with and without history of previous CT/NGU/NG (previous 1 month/6 months). There were no differences in MIC distribution by history of CT/NGU (P=0.98) or NG (P=0.85) in the previous 1 month/6 months or in the odds of having an elevated azithromycin MIC (>0.25 mg/L) (Adjusted OR for CT/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT/NGU/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients. CONCLUSIONS We found no evidence of an association between previous treatment for CT/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions.
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Affiliation(s)
- Soazig Clifton
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, UK
| | - Katy Town
- National Infection Service, Public Health England, London, UK
| | | | - Michelle Cole
- National Infection Service, Public Health England, London, UK
| | - Hamish Mohammed
- National Infection Service, Public Health England, London, UK
| | | | - J Kevin Dunbar
- National Infection Service, Public Health England, London, UK
| | - Helen Fifer
- National Infection Service, Public Health England, London, UK
| | - Gwenda Hughes
- National Infection Service, Public Health England, London, UK
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Allison R, Lecky DM, Town K, Rugman C, Ricketts EJ, Ockendon-Powell N, Folkard KA, Dunbar JK, McNulty CAM. Exploring why a complex intervention piloted in general practices did not result in an increase in chlamydia screening and diagnosis: a qualitative evaluation using the fidelity of implementation model. BMC Fam Pract 2017; 18:43. [PMID: 28327096 PMCID: PMC5361828 DOI: 10.1186/s12875-017-0618-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15-24 year olds regardless of the type of consultation. However, when the 3Cs (chlamydia screening, signposting to contraceptive services, free condoms) and HIV was offered to a large number of general practitioner (GP) surgeries across England, chlamydia screening was not significantly increased. This qualitative evaluation addresses the following aims: a) Explore why the modified intervention did not increase screening across all general practices. b) Suggest recommendations for future intervention implementation. METHODS Phone interviews were carried out with 26 practice staff, at least 5 months after their initial educational workshop, exploring their opinions on the workshop and intervention implementation in the real world setting. Interview transcripts were thematically analysed and further examined using the fidelity of implementation model. RESULTS Participants who attended had a positive attitude towards the workshops, but attendee numbers were low. Often, the intervention content, as detailed in the educational workshops, was not adhered to: practice staff were unaware of any on-going trainer support; computer prompts were only added to the female contraception template; patients were not encouraged to complete the test immediately; complete chlamydia kits were not always readily available to the clinicians; and videos and posters were not utilised. Staff reported that financial incentives, themselves, were not a motivator; competing priorities and time were identified as major barriers. CONCLUSION Not adhering to the exact intervention model may explain the lack of significant increases in chlamydia screening. To increase fidelity of implementation outside of Randomised Controlled Trial (RCT) conditions, and consequently, improve likelihood of increased screening, future public health interventions in general practices need to have: more specific action planning within the educational workshop; computer prompts added to systems and used; all staff attending the workshop; and on-going practice staff support with feedback of progress on screening and diagnosis rates fed back to all staff.
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Affiliation(s)
- R Allison
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK.
| | - D M Lecky
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | - K Town
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - C Rugman
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, GL1 3NN, UK
| | - E J Ricketts
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, now Derriford Hospital, Derriford Road, Plymouth, UK
| | - N Ockendon-Powell
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, now Biotechnology and Biological Sciences Research Council (BBSRC), Polaris House, North Star Avenue, Swindon, UK
| | - K A Folkard
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - J K Dunbar
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - C A M McNulty
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
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Dunbar JK, Hughes G, Fenton K. In a challenging environment, intelligent use of surveillance data can help guide sexual health commissioners’ choices to maximise public health benefit. Sex Transm Infect 2016; 93:151-152. [DOI: 10.1136/sextrans-2016-052696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/28/2016] [Accepted: 10/29/2016] [Indexed: 11/03/2022] Open
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Town K, McNulty CAM, Ricketts EJ, Hartney T, Nardone A, Folkard KA, Charlett A, Dunbar JK. Service evaluation of an educational intervention to improve sexual health services in primary care implemented using a step-wedge design: analysis of chlamydia testing and diagnosis rate changes. BMC Public Health 2016; 16:686. [PMID: 27484823 PMCID: PMC4969638 DOI: 10.1186/s12889-016-3343-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Providing sexual health services in primary care is an essential step towards universal provision. However they are not offered consistently. We conducted a national pilot of an educational intervention to improve staff’s skills and confidence to increase chlamydia testing rates and provide condoms with contraceptive information plus HIV testing according to national guidelines, known as 3Cs&HIV. The effectiveness of the pilot on chlamydia testing and diagnosis rates in general practice was evaluated. Methods The pilot was implemented using a step-wedge design over three phases during 2013 and 2014 in England. The intervention combined educational workshops with posters, testing performance feedback and continuous support. Chlamydia testing and diagnosis rates in participating general practices during the control and intervention periods were compared adjusting for seasonal trends in chlamydia testing and differences in practice size. Intervention effect modification was assessed for the following general practice characteristics: chlamydia testing rate compared to national median, number of general practice staff employed, payment for chlamydia screening, practice urban/rurality classification, and proximity to sexual health clinics. Results The 460 participating practices conducted 26,021 tests in the control period and 18,797 tests during the intervention period. Intention-to-treat analysis showed no change in the unadjusted median tests and diagnoses per month per practice after receiving training: 2.7 vs 2.7; 0.1 vs 0.1. Multivariable negative binomial regression analysis found no significant change in overall testing or diagnoses post-intervention (incidence rate ratio (IRR) 1.01, 95 % confidence interval (CI) 0.96–1.07, P = 0.72; 0.98 CI 0.84–1.15, P = 0.84, respectively). Stratified analysis showed testing increased significantly in practices where payments were in place prior to the intervention (IRR 2.12 CI 1.41–3.18, P < 0.001) and in practices with 6–15 staff (6–10 GPs IRR 1.35 (1.07–1.71), P = 0.012; 11–15 GPs IRR 1.37 (1.09–1.73), P = 0.007). Conclusion This national pilot of short educational training sessions found no overall effect on chlamydia testing in primary care. However, in certain sub-groups chlamydia testing rates increased due to the intervention. This demonstrates the importance of piloting and evaluating any service improvement intervention to assess the impact before widespread implementation, and the need for detailed understanding of local services in order to select effective interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3343-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katy Town
- HIV/STI Department, National Infection Service, Public Health England, London, UK.
| | - Cliodna A M McNulty
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK
| | - Ellie J Ricketts
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK
| | - Thomas Hartney
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Anthony Nardone
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Kate A Folkard
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, NW9 5EQ, London, UK
| | - J Kevin Dunbar
- HIV/STI Department, National Infection Service, Public Health England, London, UK
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Ong KJ, Soldan K, Jit M, Dunbar JK, Woodhall SC. Chlamydia sequelae cost estimates used in current economic evaluations: does one-size-fit-all? Sex Transm Infect 2016; 93:18-24. [PMID: 27288417 DOI: 10.1136/sextrans-2016-052597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/22/2016] [Accepted: 05/22/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark). METHODS From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values. RESULTS Sequelae management costs ranged from £171 to £3635 (pelvic inflammatory disease); £953 to £3615 (ectopic pregnancy); £546 to £6752 (tubal factor infertility); £159 to £3341 (chronic pelvic pain); £22 to £1008 (epididymitis); £11 to £1459 (neonatal conjunctivitis) and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412. CONCLUSIONS There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context.
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Affiliation(s)
- Koh Jun Ong
- HIV/STI Department, National Infection Service, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Kate Soldan
- Modelling and Economics Unit, National Infection Service, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Mark Jit
- Modelling and Economics Unit, National Infection Service, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - J Kevin Dunbar
- HIV/STI Department, National Infection Service, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Sarah C Woodhall
- HIV/STI Department, National Infection Service, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Town K, Ricketts EJ, Hartney T, Nardone A, Folkard KA, Rugman C, Ockendon N, Charlett A, McNulty CAM, Dunbar JK. P13.09 Evaluation of a pilot to improve primary care sexual health services in england: analysis of chlamydia testing and diagnosis rate changes. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Town K, Ricketts EJ, Hartney T, Dunbar JK, Nardone A, Folkard KA, Charlett A, McNulty CAM. Supporting general practices to provide sexual and reproductive health services: protocol for the 3Cs & HIV programme. Public Health 2015; 129:1244-50. [PMID: 26278476 DOI: 10.1016/j.puhe.2015.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/02/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Sexually transmitted infections, HIV and unplanned pregnancies continue to be a major public health problem in England, especially in young adults. Strengthening the provision of free condoms, HIV testing, chlamydia screening and contraception within primary care will contribute to reducing poor sexual and reproductive health outcomes. Recent research demonstrated the benefit for general practices of educational support visits based on behaviour change theory. Public Health England (PHE) has piloted an educational training programme to improve the delivery of sexual health services and HIV testing within general practice. STUDY DESIGN & METHODS The 3Cs & HIV programme used practice based workshops to improve staffs' awareness and skills in order to increase opportunistic offers of chlamydia testing, provision of contraceptive service information and free condoms (the '3Cs') to 15-24 year olds and HIV testing according to national guidelines. The programme was based on the theory of planned behaviour and has been implemented using a stepped wedge design. Process evaluation, testing and diagnosis data, plus qualitative interviews were all used in the evaluation. The primary outcome measures were chlamydia testing and diagnosis rates. Secondary outcome measures were HIV testing and diagnoses rates within each practice and rates of consultations where long acting reversible contraceptives had been discussed. CONCLUSION A key strength of the 3Cs & HIV programme has been the evidence base underpinning the development of the resources and the formal process evaluation of its implementation. The programme was designed to encourage sustainable relationships between general practice staff and local sexual health services as well as the knowledge, awareness and behaviours cultivated during the programme.
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Affiliation(s)
- K Town
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK.
| | - E J Ricketts
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, UK
| | - T Hartney
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - J K Dunbar
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - A Nardone
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - K A Folkard
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - A Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - C A M McNulty
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, UK
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Bhopal R, Smith C, Smith J, Craig P, Sans S, Littlejohn C, Donnelly P, Gruer L, Crombie I, Dunbar JK. World Congress of Epidemiology 2011: themes and highlights. Public Health 2012; 126:179-184. [PMID: 22317946 DOI: 10.1016/j.puhe.2011.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/17/2022]
Abstract
Modern-day epidemiologists are confronted with huge changes, such as the rise in the global population due to reduced mortality, migration within and across countries, massive shifts in economic standing and lifestyles, and environmental degradation. With over 1000 posters, more than 100 oral presentations, 16 workshops, four lunchtime symposia, many exhibitions and immeasurable discussions, the task of capturing all highlights of the International Epidemiology Association (IEA) World Congress of Epidemiology 2011 is impossible, but this article has provided a sample. Many presenters showed that the challenges facing global health are complex, changing and in demand of measurement, and they demonstrated the central role of epidemiology. The cutting-edge methodologies theme promised the emergence of a more transparent, better balanced, but also more critical approach to dealing with bias. Preceding the United Nations high-level meeting on non-communicable diseases (New York, 19th-20th September 2011), the Congress's chronic diseases stream was especially timely. The neglected conditions theme illustrated inspiring work battling against apathy, inertia and ignorance; perhaps the special challenge of the 'neglected conditions epidemiologist'. Translating epidemiology's insights into effective policies and programmes to prevent diseases or reduce their impact is not easy. Speakers highlighted the common failure of epidemiologists to contribute actively to improving the health of the populations they serve, especially the poor and disadvantaged, but also provided many examples where they had done so. The 'other' theme ensured that important studies were not lost from the programme just because they did not fit easily into the specific themes. The studies focused on identified risk factors throughout the life course. A variety of methods were used to identify factors that altered the rate of birth, disease and death. Ongoing epidemiology is not only broad but is also deep, and ever more so as collaborative pooling of expertise, data, populations and ideas has emerged, accelerated by modern-day communication technologies. Epidemiology, and epidemiologists, seem poised for tomorrow's world.
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Affiliation(s)
- R Bhopal
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - C Smith
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - J Smith
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - P Craig
- Chief Scientist Office, Scottish Government Health Directorates, Edinburgh, UK
| | - S Sans
- Institute of Health Studies, Barcelona, Spain
| | | | - P Donnelly
- University of St Andrews, St Andrews, Fife, UK
| | - L Gruer
- Public Health Science, NHS Health Scotland, Glasgow, UK
| | - I Crombie
- Division of Clinical and Population Sciences and Education, University of Dundee, Dundee, UK
| | - J K Dunbar
- Division of Clinical and Population Sciences and Education, University of Dundee, Dundee, UK
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Jafferbhoy H, Miller MH, Dunbar JK, Tait J, McLeod S, Dillon JF. Intravenous drug use: not a barrier to achieving a sustained virological response in HCV infection. J Viral Hepat 2012; 19:112-9. [PMID: 22239500 DOI: 10.1111/j.1365-2893.2011.01446.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) is commonly transmitted by intravenous drug use (IDU) but drug users are under represented in many treatment cohorts, this is because of the assumption of lowered treatment success. We assessed HCV treatment outcomes in active intravenous drug users and patients on opiate substitution therapy. The Tayside HCV treatment database was retrospectively analysed for consecutively treated patients based on risk factor for acquisition of HCV. Primary end point was sustained virological response (SVR). Two hundred and ninety-one consecutively treated patients were assessed. The overall SVR rate was 55.3%. The SVR rates by risk factor were; Non-IDU 61.4%, Ex-IDU 54.8% and Active IDU 47.1% (P = n/s). In the groups G1 patients SVR was; Non-IDU 52.7%, Ex-IDU 30.7% and active IDU 35.4% (P = n/s). In the non-G1 patients: non-IDU 65.1%, Ex-IDU 76.7% and active IDU 53.5%. Ex-IDU had a significantly better SVR than active IDU, other differences were not significant. Our results demonstrate that SVR rates in the active drug users and those on opiate substitution therapy can be achieved which are comparable with non-IDU infected individuals. Intravenous drug use in those engaged with treatment services should not be seen as a barrier to treatment of HCV.
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Affiliation(s)
- H Jafferbhoy
- Gut Group, Biomedical Research Institute, University of Dundee, Dundee, UK.
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Dunbar JK, Campbell H. Genetic epidemiology. J R Coll Physicians Edinb 2012; 42:139-41; quiz 142. [DOI: 10.4997/jrcpe.2012.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
OBJECTIVES To quantify the out-of-hours experience obtained by public health trainees in Scotland and to assess whether this is sufficient to meet the Faculty of Public Health guidelines. STUDY DESIGN Prospective survey. METHODS All public health trainees in Scotland were invited to participate in a prospective survey of out-of-hours experience. Data were collected from March 2009 to March 2010. The variation in the experience between trainees was compared according to the size, urban/rural mix, and deprivation of the population for which they were responsible. The variation in the experiences gained were then compared to the requirements of the Faculty of Public Health. RESULTS 18 trainees participated from 6 areas, collecting data on 391 shifts and a total of 276 calls. For every 50 shifts the median number of notifications of probable meningococcus was 3.7 and the median number of chemical incidents and Escherichia coli O157 notifications was 0.0. This variation is difficult to interpret because some trainees collected data for only a short period. The variation between trainees was not significantly related to population size, deprivation or rurality. Pooling the data from all trainees, there was a mean of 2.9 probable meningococcus notifications, 2.4 E coli O157 calls, and 0.3 chemical incident calls per 50 shifts. CONCLUSIONS There is a large and unpredictable degree of variation in the on-call experience of Scottish trainees. The minimum recommended number of on-call shifts may not be adequate to ensure a high proportion of trainees are prepared for unsupervised on-call.
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