The NHSG Opportunistic Chlamydia Testing Pilot Study

Overview

•Need to increase CT testing rates especially in males <25

•Need to decrease pool of chlamydia infection

•NAATs simplified testing / less invasive

•Choice of less medicalised model (common/ treatable)

•Promote individual responsibility for sexual health

•Need to engage with young people

•English opportunistic screening programme underway

•Approach devolved to individual Boards in Scotland

NHSG Sexual Health Strategy

From objectives :• reduce the incidence and prevalence of sexually transmitted

infections (STIs) • improve accessibility/integration of sexual health services,

ensuring all sexually active people in Grampian have access to quality sexual health advice and services

• meet the needs of ‘hard to reach’ groups• strengthen monitoring, surveillance and research to support

future planning of sexual health services/interventions• encourage fulfilled, respectful and responsible relationships• reduce the rates of unintended pregnancy

STI diagnoses in Grampian

0

500

1000

1500

2000

2500

1999 2000 2001 2002 2003 2004 2005 2006

nu

mb

er

of

dia

gn

os

es

Chlamydia Gonorrhoea Trichomoniasis Syphilis HIV

Chlamydia diagnoses Grampian 1999-2006

0

500

1000

1500

2000

2500

1999 2000 2001 2002 2003 2004 2005 2006

GUM

Hospital

GP

FP

Rates of genital chlamydial infection by age-group UK 1996 to 2005

Data sources: KC60 and STIS/ISD(D)5 returns from GUM clinics.

Routine GUM clinic returns

Proportion of Chlamydia tests which were positive in Grampian 1999-2006

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

1999 2000 2001 2002 2003 2004 2005 2006

FP

GP

Hospital

GUM

Opportunistic screening

• Targeted screening for genital chlamydia – reduces prevalence in women – reduces PID

• SIGN recommends opportunistic screening for genital chlamydia should be undertaken for:– Women aged <25 years who are sexually active;– Women aged >25 years with >2 sexual partners in the

last year or a change of partner in the last year;– All symptomatic women and men.

Chlamydia tests performed in Grampian 1999-2006

0

5000

10000

15000

20000

25000

30000

1999 2000 2001 2002 2003 2004 2005 2006

GUM

Hospital

GP

FP

Percentage of 15-25yr olds tested in Grampian in 2005

Project Design

• Men and women 16-24 years inclusive• Non-sexual health specialist health care facilities e.g.

community pharmacies• Young people’s projects, universities/colleges, MIB,

Caledonia Youth, etc• Offer of test regardless of reason for attendance

Method

• 12-month, multi-centre, opportunistic screening study (28/08/07 – 28/08/08)

• 31 sites – General practices (n=10)– Community pharmacies (n=10)– Family Planning and Genito-urinary Medicine

clinics (n=2)– Other health sites– Community sites

Method

• Urine and SOLV kits available for self-selection in non-pharmacy sites, and for issue by pharmacist following brief consultation in community pharmacy sites.

Results

• 2553 clients screened in 12 months– 68.3% female (n=1744)

• 93% female clients used SOLVs• 10.0% (n=254) positive tests obtained• late results still coming in for kits picked

up during pilot

Type of site where kit obtained

• General practice 39.5%• Sq 13 (S&R Health / FP) 38.3%• Pharmacy 4.0%• GUM 2.2%• Community 5.4%• Other health 1.2%• Other 8.5%

Positiven (%)

Non-conforming

n

Equivocaln

Invalidn

Total

General practice 89(9.9)

62 2 18 901

Pharmacy 10 (10.9)

5 0 1 92

GUM 7 (12.3)

3 0 1 57

Sq13 S&R Health (FP)

95 (10.7)

67 1 12 885

Other health 4 (14.3) 2 0 4 28

Other 18 (9.3) 19 0 2 194

Chlamydia tests performed in Grampian 1999-2007

0

5000

10000

15000

20000

25000

30000

1999 2000 2001 2002 2003 2004 2005 2006 2007

self-test pilotGUMHospitalGPFP

• Ongoing evaluation• Economic evaluation• Qualitative research strand• Dissemmination meeting for results planned Feb

09 / report for Board / publication and other meetings

• Analysis will feed into NHSG Development of Community STI testing working group

Next steps

Phase 3 Community STI / HIV testing short life task group issues to address

• Improving partner notification• Integration of dual CT/GC testing• Increasing low risk asymptomatic community based

STI / BBV testing (simplify request form)• Support introduction of PH SH Pharmacy contract• Develop an infrastructure to support all of above with

agreed local care pathways

Next steps

Opportunistic Chlamydia Screening Study Strategy Group Members • Susan Webb*, Deputy Director of Public Health/Sexual Health Executive

Lead

• Dr Gillian Flett, Consultant & Service lead S&R Health /Clinical Lead, SH for NHSG

• Janet Bruce*, Sexual Health Improvement Co-ordinator

• Dr Margaret Watson*, Public Health Pharmacist

• Dr Mayada AbuAffan*, Specialist Registrar

• Dr Steve Baguley, Consultant & Service lead, Department of Genito-Urinary Medicine (GUM)

• Shona Crocker, Health Advisor, GUM

* Public Health Unit, NHSG