Partner Notification Outcomes Research Articles

Treatment and Partner Notification Outcomes for Clients Diagnosed With Chlamydia and Gonorrhea Through GetCheckedOnline Compared With Sexually Transmitted Infection Clinics in British Columbia, Canada.

A study comparing treatment and partner notification outcomes for people diagnosed with chlamydia or gonorrhea found no differences between clients of Internet-based and clinic-based testing services. Background Whether treatment, engagement in partner notification (PN), and PN outcomes differ between clients of Internet-based and clinic-based testing services is poorly understood. We compared these outcomes between people diagnosed with chlamydia and/or gonorrhea (CT/GC) through a sexually transmitted infection (STI) clinic service and GetCheckedOnline (GCO), an Internet-based testing service in British Columbia. Methods We conducted a retrospective matched cohort study among CT/GC cases where each case diagnosed through GCO in 2016 to 2017 was matched to 2 STI clinic cases by diagnosis, sex, age group, and specimen collection date. Data were collected through chart review, with outcomes compared using appropriate statistical tests. Results Of 257 GCO and 514 matched clinic cases, case treatment was high and did not differ between GCO (254 of 257 [98.9%]) and clinic (513 of 514 [99.8%]) cases, as was engagement in PN (250 of 257 [97.2%] vs. 496 of 514 [96.5%]). There was no difference in the proportion of notified partners between GCO (159 of 270 [58.9%]) and clinic (253 of 435 [58.2%]) cases, although a greater proportion of partners reported by clinic cases were notified by STI nurses (43 of 435 [9.9%]) versus GCO cases (6 of 270 [2.2%]). Conclusions GetCheckedOnline clients diagnosed with CT/GC demonstrated similar treatment uptake and engagement in PN to clinic clients, and PN outcomes did not differ. The greater reliance on STI clinic nurses for PN among clinic clients may be related to having had an initial in-person testing visit.

Optimising partner notification outcomes for bacterial sexually transmitted infections: a deliberative process and consensus, United Kingdom, 2019.

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.

Population-Level Outcomes of Partner Notification Among Gay, Bisexual, and Other Men Who Report Sex With Men Diagnosed With Infectious Syphilis in British Columbia, Canada.

Syphilis testing, treatment, and partner notification (PN) are centrally coordinated in British Columbia (BC), Canada. Public health (PH) nurses (PHNs) contact almost all syphilis patients and either notify partners of syphilis exposure (PH-initiated PN) or support patients to notify their own partners (patient-initiated PN). In the context of an ongoing syphilis epidemic among gay, bisexual, and other men who report sex with men (gbMSM), we measured population-level yields and compared PN approaches to inform prevention and control efforts. All gbMSM diagnosed with infectious syphilis in 2016 in BC were included. We calculated indicators of engagement with PN among patients and PN outcomes among notifiable partners using a cascade-of-care framework. χ2 Tests compared indicators between PN approaches. Of the 759 syphilis diagnoses, 85.4% (648/759) were among gbMSM and 94.7% (614/648) were treated within 30 days of testing (mean [SD], 5.5 [5.2] days). Among patients, 87.7% (568/648) discussed PN with PHNs and 49.5% (281/568) named at least 1 notifiable partner, for a total of 1094 partners (mean [SD], 3.9 [5.5] partners/patient). Compared with PH-initiated PN, patient-initiated PN resulted in a greater proportion of partners notified (70.1% [573/817] vs. 89.8% [211/235]; P = 1.88 × 10-9), but there was no difference in the proportion of partners tested and/or treated (90.2% [517/573] vs. 86.7% [183/211]; P = 0.203), and diagnosed (12.8% [66/517] vs. 16.4% [30/183]; P > 0.271). Public health- and patient-initiated PN had similarly high yields of partners tested and/or treated, and diagnosed, demonstrating that gbMSM can contribute to syphilis PN when supported by resource-equipped PHNs.

Partner notification and treatment outcomes among South African adolescents and young adults diagnosed with a sexually transmitted infection via laboratory-based screening.

Partner notification and treatment are essential components of sexually transmitted infection (STI) management, but little is known about such practices among adolescents and young adults. Using data from a prospective cohort study (AYAZAZI) of youth aged 16-24 years in Durban, South Africa, we assessed the STI care cascade across participant diagnosis, STI treatment, partner notification, and partner treatment; index recurrent STI and associated factors; and reasons for not notifying partner of STI. Participants completed laboratory-based STI screening (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis) at enrollment and at 12 months. Of the 37/216 participants with STI (17%), 27/37 (73%) were women and 10/37 (27%) were men. Median age was 19 years (IQR: 18-20). Of the participants with STI, 23/37 (62%) completed a Treatment and Partner Tracing Survey within 6 months of diagnosis. All survey participants reported completing STI treatment (100%), 17/23 (74%) notified a partner, and 6/23 (35%) reported partner treatment. Overall, 4/23 (11%) participants had 12-month recurrent C. trachomatis infection, with no association with partner notification or treatment. Stigma and lack of STI knowledge were reasons for not notifying partner of STI. STI partner notification and treatment is a challenge among youth. Novel strategies are needed to overcome barriers along the STI care cascade.

Characteristics of Gay, Bisexual and Other Men Who Have Sex With Men With Multiple Diagnoses of Infectious Syphilis in British Columbia, Canada, 2005-2014.

Infectious syphilis has increased substantially over the past decade. Targeting limited public health resources toward subpopulations with multiple reinfections may have a large impact in reducing onward transmission within a community. A chart review was conducted for individuals with 4 or more infectious syphilis diagnoses between 2005 and 2014 (the top 1% of all syphilis diagnoses in British Columbia, Canada). We characterized the sociodemographics, partner notification outcomes and social network. Between 2005 and 2014, there were 30 individuals with 4 or more syphilis diagnoses, accounting for 139 diagnoses. All were men who have sex with men and 29 (96%) were human immunodeficiency virus-positive. Of the 139 diagnoses, 65% occurred in the early latent stage of infection, 22% in the secondary stage, and 14% in the primary stage. The median number of sexual partners per diagnosis was 5 (range, 1-50). Among the 838 partners reported, 79% were notifiable, 53% were notified, and 23% were reported to be tested or treated. Sexual network mapping showed that almost half of the members of this group could be linked to one another either directly or indirectly via partners over 10 years. Social network mapping demonstrated high connectivity, with 4 venues associated with almost two thirds of the study population. The connectivity and recurrent diagnoses in this study population suggest potential benefits of targeted interventions to individuals with multiple diagnoses and their partners. Our study highlights the need for enhanced care, increased syphilis testing frequency, and exploring alternative preventative methods among individuals with syphilis rediagnoses to reduce syphilis incidence.

Spatial clusters of gonorrhoea in England with particular reference to the outcome of partner notification: 2012 and 2013.

BackgroundThis study explored spatial-temporal variation in diagnoses of gonorrhoea to identify and quantify endemic areas and clusters in relation to patient characteristics and outcomes of partner notification (PN) across England, UK.MethodsEndemic areas and clusters were identified using a two-stage analysis with Kulldorff’s scan statistics (SaTScan).ResultsOf 2,571,838 tests, 53,547 diagnoses were gonorrhoea positive (positivity = 2.08%). The proportion of diagnoses in heterosexual males was 1.5 times that in heterosexual females. Among index cases, men who have sex with men (MSM) were 8 times more likely to be diagnosed with gonorrhoea than heterosexual males (p<0.0001). After controlling for age, gender, ethnicity and deprivation rank, 4 endemic areas were identified including 11,047 diagnoses, 86% of which occurred in London. 33 clusters included 17,629 diagnoses (34% of total diagnoses in 2012 and 2013) and spanned 21 locations, some of which were dominated by heterosexually acquired infection, whilst others were MSM focused. Of the 53,547 diagnoses, 14.5% (7,775) were the result of PN. The proportion of patients who attended services as a result of PN varied from 0% to 61% within different age, gender and sexual orientation cohorts. A third of tests resulting from PN were positive for gonorrhoea. 25% of Local Authorities (n = 81, 95% CI: 20.2, 29.5) had a higher than expected proportion for female PN diagnoses as compared to 16% for males (n = 52, 95% CI: 12.0, 19.9).ConclusionsThe English gonorrhoea epidemic is characterised by spatial-temporal variation. PN success varied between endemic areas and clusters. Greater emphasis should be placed on the role of PN in the control of gonorrhoea to reduce the risk of onward transmission, re-infection, and complications of infection.

Partner notification outcomes after integration of an on-site disease intervention specialist at a sexually transmitted disease clinic.

BackgroundPartner notification services (PNS) are highly effective in reducing transmission of sexually transmitted diseases (STDs). We assessed outcomes of PNS before and after integration of an on-site disease intervention specialist (DIS) at a publicly-funded STD clinic.MethodsFrom August 2014 to December 2015, patients testing positive for infectious syphilis or gonorrhea at the Rhode Island STD Clinic were referred to on-site DIS for partner notification. Data on PNS outcomes were reviewed for eight months before integration of DIS at the clinic and compared to eight months after.ResultsOf the 145 index patients referred for PNS during the study period (n = 58 before DIS integration, n = 87 after), 86% were interviewed. DIS integration resulted in a significantly greater proportion of index patients interviewed overall (92% versus 76%, p<0.01), on the day of diagnosis (85% versus 61%; p<0.01), and in person at the STD clinic (64% versus 11%; p<0.01). However, there was no significant difference in number of sexual partners named or treated.ConclusionsIntegrating DIS at a publicly-funded STD clinic resulted in a greater number of index cases interviewed, a greater number interviewed in person, and a greater number interviewed on the day of diagnosis. Challenges remain in identifying and engaging partners for treatment.

Partner notification and retesting for Chlamydia trachomatis and Neisseria gonorrhoeae: a case-note review in New Zealand primary care.

INTRODUCTION Bacterial sexually transmitted infections (STIs) contribute to a significant burden of ill-health despite being easy to diagnose and treat. STI management guidelines provide clinicians with evidence-based guidance on best-practice case management. AIM To determine the extent of adherence to STI management guidelines for partner notification, follow up and testing for reinfection following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae. METHODS Retrospective review of electronic patient records for individuals diagnosed with chlamydia or gonorrhoea in eight primary care clinics in Wellington, New Zealand. At each clinic, 40 clinical records were reviewed (320 in total). Outcome measures were: overall numbers (%) of cases with documented evidence of reason for testing, sexual history, treatment, advice, partner notification and follow up. Partner notification outcomes were: n (%) with evidence of partner notification discussion and n (%) with partners advised, tested and treated. Proportions retested between 6 weeks and 6 months and n (%) positive on retesting were also determined. RESULTS Presenting features and treatment were generally well documented. Recent sexual history including number of partners was documented for half of cases reviewed (159/320). Partner notification discussion was documented for 74% (237/320) of cases, but only 24.4% (78/320) had documentation on numbers of partners notified and 17% (54/320) on numbers of partners treated. Testing for reinfection between 6 weeks and 6 months occurred for 24.7% (79/320), of whom 19% (15/79) re-tested positive. CONCLUSIONS This research suggests there are gaps in important aspects of patient care following bacterial STI diagnosis - a factor that may be perpetuating our high rates of infection. A more systematic approach will be needed to ensure people diagnosed with an STI receive the full cycle of care in line with best practice guidelines.

Individual and partnership factors associated with anticipated versus actual partner notification following STI diagnosis among men who have sex with men and/or with transgender women in Lima, Peru

ObjectivesA detailed understanding of intentions and practices related to partner notification (PN) following STI diagnosis can improve control strategies. We assessed participant-level and partner-level factors guiding notification behaviour among men...

P017 Managing mycoplasma genitalium in clinic: don’t forget the partners

IntroductionThere is increasing UK interest in Mycoplasma genitalium(MG) testing of clinic attendees where indicated. Partner notification(PN) is a crucial part of STI management but as yet no national performance standards specific to MG have been defined.MethodsCase note review of all MG cases at our clinic from December 2015 to November 2016. Data collected on the four PN outcomes outlined in the 2012 BASHH statement on PN for STIs.Results114 cases were identified. Mean age 28.5, 82(71.9%) male of whom 36(43.9%) MSM. The proportion of cases with a PN discussion documented (83.3% [95% CI 75.2–89.6]) and the proportion of cases with an outcome of agreed contact action(s) documented (78.1% [95% CI 69.4–85.3]) were both lower than the national standard of 97.0% (p&lt;0.0001).There were 0.22 (95% CI 0.17–0.28) contacts per index case whose attendance at a sexual health service for treatment was reported by the index case and 0.19 (95% CI 0.14–0.24) contacts per index case in which a healthcare worker verified treatment. Performance was lower than the national standard of 0.60(p&lt;0.0001), and inferior to local chlamydial and gonorrhoeal PN data, 0.6 and 0.5 contacts per index case reported treated respectively. Performance across all PN outcomes was worse for men than for women.DiscussionPN for MG at our clinic falls below local and national standards for other STIs. Contributory factors may include poor documentation, absence of national guidance for MG PN performance standards and lack of patients’ appreciation of the importance of MG as an STI.

P209 What makes expedited partner therapy (EPT) and accelerated partner therapy (APT) work for partner notification for bacterial stis? a systematic review of interventions

IntroductionExpedited Partner Therapy (EPT) treats the sex partners of persons with STIs without prior clinical evaluation. These interventions have been shown to reduce rates of re-infection and treat a higher...

P196 The cost to find one case of syphilis

IntroductionCost effectiveness is an important consideration especially in the context of constrained budgets. For the National Chlamydia Screening Programme, doubling Partner Notification (PN) was modelled to reduce the cost per diagnosis by £60 and improves gender equity (Turner et al, BMJ. 2011; 342:c7250. doi: 10.1136/bmj.c7250); however, it is not known how PN impacts on a less common but growing Syphilis epidemic. We therefore looked at the impact of PN for patients with Syphilis using a new PN tool.MethodsThe Syphilis diagnoses and testing for one year from February 2016-2017 were determined for two clinics, prices for testing and PN were derived from the integrated sexual health tariff (www.pathwayanalytics.com) and PN data was obtained from SXT (www.sxt.org.uk).ResultsThe Syphilis incidence was 257/30,641 and the cost of a full screen £75; consequently, the cost per Syphilis diagnosis was £8,941. Ten percent of patients coded as partners were found to be infected with Syphilis. The PN outcomes of 248 (96%) patients with early infectious Syphilis were known: 132 partners were verified as seen and tested (KPI=0.53), representing 13 new diagnoses. The cost to deliver PN was £4903 [248*(£17.33 tariff &amp; £2.40 SXT)] and ten partners need to test at £750 [10*£75] to diagnose one case, making the overall cost per Syphilis diagnosis £5,653. PN initiated testing was estimated to reduce the cost per syphilis diagnosis by £3,288.DiscussionPN services reduce the cost to diagnose Syphilis and support case finding. More work is required to target testing and improve PN.

The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK

BackgroundSexually transmitted infection (STI) diagnoses are increasing and efforts to reduce transmission have failed. There are major uncertainties in the evidence base surrounding the delivery of STI care for men.AimTo improve the sexual health of young men in the UK by determining optimal strategies for STI testing and careObjectivesTo develop an evidence-based clinical algorithm for STI testing in asymptomatic men; model mathematically the epidemiological and economic impact of removing microscopy from routine STI testing in asymptomatic men; conduct a pilot randomised controlled trial (RCT) of accelerated partner therapy (APT; new models of partner notification to rapidly treat male sex partners of people with STIs) in primary care; explore the acceptability of diverse venues for STI screening in men; and determine optimal models for the delivery of screening.DesignSystematic review of the clinical consequences of asymptomatic non-chlamydial, non-gonococcal urethritis (NCNGU); case–control study of factors associated with NCNGU; mathematical modelling of the epidemiological and economic impact of removing microscopy from asymptomatic screening and cost-effectiveness analysis; pilot RCT of APT for male sex partners of women diagnosed withChlamydia trachomatisinfection in primary care; stratified random probability sample survey of UK young men; qualitative study of men’s views on accessing STI testing; SPORTSMART pilot cluster RCT of two STI screening interventions in amateur football clubs; and anonymous questionnaire survey of STI risk and previous testing behaviour in men in football clubs.SettingsGeneral population, genitourinary medicine clinic attenders, general practice and community contraception and sexual health clinic attenders and amateur football clubs.ParticipantsMen and women.InterventionsPartner notification interventions: APTHotline [telephone assessment of partner(s)] and APTPharmacy [community pharmacist assessment of partner(s)]. SPORTSMART interventions: football captain-led and health adviser-led promotion of urine-based STI screening.Main outcome measuresFor the APT pilot RCT, the primary outcome, determined for each contactable partner, was whether or not they were considered to have been treated within 6 weeks of index diagnosis. For the SPORTSMART pilot RCT, the primary outcome was the proportion of eligible men accepting screening.ResultsNon-chlamydial, non-gonococcal urethritis is not associated with significant clinical consequences for men or their sexual partners but study quality is poor (systematic review). Men with symptomatic and asymptomatic NCNGU and healthy men share similar demographic, behavioural and clinical variables (case–control study). Removal of urethral microscopy from routine asymptomatic screening is likely to lead to a small rise in pelvic inflammatory disease (PID) but could save &gt; £5M over 20 years (mathematical modelling and health economics analysis). In the APT pilot RCT the proportion of partners treated by the APTHotline [39/111 (35%)], APTPharmacy [46/100 (46%)] and standard patient referral [46/102 (45%)] did not meet national standards but exceeded previously reported outcomes in community settings. Men’s reported willingness to access self-sampling kits for STIs and human immunodeficiency virus infection was high. Traditional health-care settings were preferred but sports venues were acceptable to half of men who played sport (random probability sample survey). Men appear to prefer a ‘straightforward’ approach to STI screening, accessible as part of their daily activities (qualitative study). Uptake of STI screening in the SPORTSMART RCT was high, irrespective of arm [captain led 28/56 (50%); health-care professional led 31/46 (67%); poster only 31/51 (61%)], and costs were similar. Men were at risk of STIs but previous testing was common.ConclusionsMen find traditional health-care settings the most acceptable places to access STI screening. Self-sampling kits in football clubs could widen access to screening and offer a public health impact for men with limited local sexual health services. Available evidence does not support an association between asymptomatic NCNGU and significant adverse clinical outcomes for men or their sexual partners but the literature is of poor quality. Similarities in characteristics of men with and without NCNGU precluded development of a meaningful clinical algorithm to guide STI testing in asymptomatic men. The mathematical modelling and cost-effectiveness analysis of removing all asymptomatic urethral microscopy screening suggests that this would result in a small rise in adverse outcomes such as PID but that it would be highly cost-effective. APT appears to improve outcomes of partner notification in community settings but outcomes still fail to meet national standards. Priorities for future work include improving understanding of men’s collective behaviours and how these can be harnessed to improve health outcomes; exploring barriers to and facilitators of opportunistic STI screening for men attending general practice, with development of evidence-based interventions to increase the offer and uptake of screening; further development of APT for community settings; and studies to improve knowledge of factors specific to screening men who have sex with men (MSM) and, in particular, how, with the different epidemiology of STIs in MSM and the current narrow focus on chlamydia, this could negatively impact MSM’s sexual health.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Partner Notification Outcomes for Men Who Have Sex With Men Diagnosed With Syphilis Referred to Partner Notification Officers, Melbourne, Australia.

We examined the extent of partner notification for men who have sex with men (MSM) who were diagnosed with syphilis, and offered referral to a partner notification officer (PNO), to assist them with informing recent sexual partners. Between October 2013 and March 2015, MSM diagnosed with syphilis at the Melbourne Sexual Health Centre were routinely offered a referral to a PNO. The outcomes of this intervention were evaluated including the proportion of men who accepted PNO services and the number of sexual partners informed by the PNO. There were 380 MSM diagnosed with syphilis. Those with primary or secondary syphilis reported a total of 813 partners over 3 months and those with early latent syphilis reported a total of 1400 partners over 12 months. Sixty nine percent of index men (n = 262) had documented discussion of partner notification, 34% (n = 128) accepted PNO referral, and 28% (n = 105) were contacted by the PNO, 58 of whom reported they had already notified partners themselves. Only 14 index men (4%) provided the PNO with contact details for 28 partners, 25 of whom were notified by the PNO. Among those interviewed, the most common barrier to partner notification was the presence of anonymous partners and absence of contact details for partners. Despite offering an effective PNO service in our centre, ultimately only 4% of MSM with syphilis had at least 1 partner notified by the PNO with patients declining the PNO service and anonymous partners posing the major barriers. Alternative patient initiated methods for improving partner notification for syphilis among MSM using newer communication technologies are required.

An effective strategy to diagnose HIV infection: findings from a national audit of HIV partner notification outcomes in sexual health and infectious disease clinics in the UK

ObjectivesPartner notification (PN) is a key public health intervention in the control of STIs. Data regarding its clinical effectiveness in the context of HIV are lacking. We sought to audit...

NH3 Partnership working to achieve successful Health Board-Wide Hepatitis B Partner Notification Outcomes

Background/Introduction The Sandyford Shared Care Support and failsafe (SSCS) service managed by the Sexual Health Advisers provides advice and support to NHS Greater Glasgow and Clyde Health Care Professionals in the management of individuals diagnosed with a sexually transmitted infection or blood borne virus. In relation to Hepatitis B infection their role is to make contact with testing clinicians by telephone to review the case, facilitate timely results giving and onward referral to appropriate specialist services, co-ordinate and assist with public health activities arising from each case, document and audit outcomes. Aims(s)/Objectives To demonstrate the impact of SSCS support to promote partnership working to achieve effective and auditable partner notification outcomes for acute and chronic Hepatitis B cases. Methods Acute or chronic Hepatitis B cases between 1 September 2012 and 31 December 2015 were reviewed. Partner notification outcomes documented for identified sexual partners, family and household contacts requiring testing and vaccination were examined. Results A total of 710 cases of Hepatitis B were reported to SSCS during the audit period (675 chronic and 35 acute). 1278 contacts were identified, and 840 contacts (1.18 per index case) were reported (verified or unverified) to have attended a service for assessment. 656 contacts were vaccinated, 113 had immunity and 62 found to have active infection. Discussion/Conclusion This audit clearly demonstrates the value and importance of partnership working to achieve successful public health outcomes well above targets set by national standards.

P228 Evaluating the use of extra-genital Chlamydia trachomatis (CT) and Neisseria gonorrhoea (GC) nucleic acid amplification tests (NAATs) in non-MSM populations

Background/introduction Our clinic performs routine oral and anal CT and GC NAATs following disclosure during sexual history of oral or receptive anal sex. Specimens are analysed using the Abbott M2000 assay, costing £4.50 per dual NAAT. Aim(s)/objectives We report the findings of this practice, focusing on clinical and partner notification outcomes, and the cost per diagnosis. Methods We included all non-MSM patients with isolated extra-genital CT or GC infection from 1/8/14 to 31/7/15. We excluded contacts of either infection, plus those without GC confirmed by culture or second NAAT platform. Retrospective case note review was performed for identified cases. Results In total 8796 NAATs were processed in non-MSM patients, of which 3813 (43%) were extra-genital. In heterosexual men we identified 3 pharyngeal GC cases and one contact, and one pharyngeal CT case with one contact. In women there were 2 pharyngeal GC cases, one pharyngeal CT case and one rectal CT case with no additional contacts. The spend per pharyngeal diagnosis was £1519 in males and £3138 in women. The spend per rectal diagnosis in women was £1665. Discussion/conclusion Our screening practice has picked up only a small number of cases which would otherwise have been missed. 25% (2/8) of those cases had verified contacts identified. The cost implication of such screening is high, meaning that ongoing routine screening is not viable. In our relatively low-prevalence setting we now intend to target our screening in line with BASHH CEG guidance which will provide significant cost savings.

O040 A Partner Notification Bureau in action: outcomes for centralised management of positive gonorrhoea and chlamydia results from primary care by a sexual health service

Background/introduction Centralised management of positive results by a ‘Partner Notification Bureau’ has been suggested by the National Chlamydia Screening Programme. From September 2014 positive results for chlamydia and gonorrhoea from primary care were reported directly to the sexual health service in a UK city for management. Aim(s)/objectives To evaluate the effectiveness of centralised management of treatment and partner notification (PN) by assessing outcomes for the first year and to estimate impact on health adviser workload. Methods Health adviser records were reviewed retrospectively to assess outcomes in terms of : patients informed of their result, confirmed treated at any service, and offered PN discussion; partners attended. Results Gonorrhoea: between September 2014 and August 2015 there were 46 positives reported (31 female). Forty five were informed, confirmed treated, and had a PN discussion by phone. The number of partners reported or verified attended per case was 0.8 (37/46). Chlamydia: Between September 2014–August 2015, 457 positives were reported (352 female). Of these, 440 (96%) were informed and had PN discussion, and 448 (98%) were confirmed treated. The number of partners reported or verified attended per case was 0.98 (450/457). Outcomes for both exceeded the national PN standard of 0.6 partners attending per case. Partner notification workload increased by approximately 10%. Conclusion Centralised management of gonorrhoea and chlamydia positives from primary care resulted in excellent treatment rates and PN outcomes. However, additional health adviser resources are required to manage the extra workload.

P209 Outcomes of partner notification (PN) for sex partners of people with chlamydia, managed via theOnline Chlamydia Pathway.

Background/introduction Within the eSTI2 consortium, we conducted exploratory studies of an innovative Online Chlamydia Pathway (OCP: results service, automated clinical consultation, electronic prescription via community pharmacy, with telephone helpline support), which included optional online partner management. Aim(s)/objectives To evaluate PN outcomes and sex partner uptake of online management. Methods Participants: untreated GUM clinic attenders (two London services) and people tested through six London NCSP online postal testing areas: 21.07.14–13.3.15. The OCP offered index patients an SMS/email containing a unique code and link to forward to partners permitting them to access online care via OCP (patient referral). Outcomes were captured by OCP and index-reported at telephone follow-up (2 weeks post diagnosis) Results Outcomes: 221 index patients consented to the study and 172 (78%) were followed up by telephone (median age 23, 62% female). These 172 index patients reported 371 partners; 317/371 (85%) were contactable and 256/317 (81%) of these were notified. Index patients reported 120/317 (38%) as treated. Online outcomes: 154 index patients reached PN stage of OCP (some had already been routed to clinic). 94/154 (61%) requested online partner access. They reported 280 partners: 28 went online; 19 received treatment at their chosen pharmacy; and 4 were treated elsewhere. Discussion/conclusion 38% of partners treated compares favourably with outcomes for routine PN within similar studies. Online management of sex partners through patient referral is feasible but uptake was low and most successful PN was achieved offline. Pathway optimisation could include anonymised sex-partner PN messaging and provision of partner STI self-sampling kits.

P032 Developing a Sector Led Improvement Approach to Sexual Health

Background Sector-led improvement (SLI) is an approach where local authorities (LA) help each other to continuously improve. It is replacing more traditional performance frameworks, however, the approach lacks a clear methodology. We developed and piloted an evidence-based SLI approach to drive improvements in sexual health (SH) within LAs. Aim(s) To develop and pilot an evidenced-based SLI toolkit Methods Key components for effective SLI were identified following a review of the published literature. These were embedded within a co-produced, peer-review toolkit which was piloted by SH commissioners and key stakeholders from four local authorities. The pilot focussed on delivery of local chlamydia screening programmes. Results Several key clinical and structural issues were identified through the SLI approach including low coverage, the potential to improve partner notification outcomes, low re-testing rates, threats from a reduction in spend and unclear governance. These have been put into a local action plan to focus and drive quality improvement activities. The impact of the action plans will be the focus of a follow up meeting planned for six months after the final peer review meeting involving wider stakeholders. Discussion The SLI toolkit offers a systematic approach to evaluating complex programme activities. It was well received locally and helped key stakeholders to gain insight, catalyse self-reflection and prioritise areas for change in order to drive quality and improvement.