Objectives: To explore current patterns of testing for genital chlamydial infection in primary care, and to identify practice characteristics influencing testing rates. Method: Aggregate numbers of chlamydia tests and results for each practice in Nottingham Health District were matched to practice characteristics. Age specific testing rates and diagnosed prevalence were calculated, and characteristics of the practice tested for association with chlamydia testing rates. Results: Most tests (63.1%) were performed on women over the age of 25, but the proportion of positive tests was highest in 15-19 year olds (13.3%) followed by 20-24 year olds (8.2%). A higher ratio of GP principals to female practice population was associated with higher testing rates and more chlamydia isolations, but the ratio of female GP principals to patients was associated with higher testing rates only in 20-24 year olds. Diagnosed incidence was greatest in more socioeconomically deprived practice populations, and this was not explained by higher testing rates. Men were rarely tested. Conclusion: Current testing practice in primary care does not reflect the known epidemiology of genital chlamydia infection. Practices with lower doctor-patient ratios do less testing, and measures to enable their active participation in the envisaged screening programme will be important in reaching all at-risk groups.C hlamydia tests have become available to primary care practitioners over the past decade, and in some districts are now widely used. Pilot primary care sites for the implementation of opportunistic testing for chlamydia have recently been announced, following pilot studies in which primary care was the largest contributor to testing. 1 However, in the absence of surveillance for sexually transmitted infections (STIs) in primary care, little is known about current testing practices in this important setting, and guidelines are not in general use. Although a number of practitioner surveys have been undertaken, 2-6 their results are subject to selection bias and social desirability bias, and they do not aim to provide complete descriptive information on testing patterns across a population.We undertook this study of testing patterns in the Nottingham Health District in order to identify who is currently being tested in primary care, in relation to the known epidemiology of genital chlamydia infection. We also aimed to identify practice characteristics associated with differing testing rates and positive rates, with a view to informing policy makers on likely problems in the implementation of the envisaged screening programme. METHODSThe setting was 119 general practices served by the Public Health Laboratory Service in Nottingham, UK. The laboratory processes all chlamydia samples for Nottingham Health District, of which approximately 40% are from primary care, 25% from GUM, 25% from other hospital settings, and 10% from family planning clinics. We were provided with an aggregated database of test numbers and diagnostic results for Chlamydia trac...

Background HIV infection continues to disproportionately affect MSM in the UK. The 2011 HPA report "Sexually Transmitted Infections in MSM in the UK" highlights the need for one-to-one behavioural interventions. Thus, identifying those at highest risk is essential. Aims To profile the sexual behaviour of younger MSM attending a dedicated clinic. To establish how MSM perceive their sexual risk and explore the use of a simple HIV Risk Assessment Tool (HIVRAT). Methods MSM attending a weekly clinic offering HIV testing selfcomplete a 6 question HIVRAT in addition to standard history. The HIVRAT records number of male partners in previous 12 months, and number of unprotected anal intercourse (UPAI) partners (previous 3 and 12 months). It also contains a Likert scale of perceived sexual risk. Data was collected over 6 months from June 2011. Statistical analysis was performed in Excel and correlated using Spearman's Rank methodology. Results 138 men completed the HIVRAT (aged 18e35). Median number of sexual partners in preceding 12 months ¼ 8 (range 1e250, 42% reported >10 partners). Median number of UPAI partners in preceding 3 months ¼0 (range 0e5) and 12 months ¼1 (range 0e8). Perceived risk was scored as 1¼ Very low (20.4%), 2 (44.5%), 3 (28.5%), 4 (4.4%) and 5¼ Very high (2.2%). There was poor correlation between sexual behaviour and perceived risk. For MSM who had UPAI with one or more partners in the previous 3 and 12 months, there was a moderately positive correlation between actual risk and perceived risk (SRCC 0.517 and 0.544 respectively). Conclusions Only 6.6% of MSM judged their personal HIV risk as high in a cohort where 36% reported UPAI with two or more partners in 12 months. Tools like HIVRAT provide valuable information which is not routinely collected. Asking about UPAI during the 12-month period prior to testing showed the strongest correlation between actual and perceived risk, and could help identify MSM who would benefit most from behavioural intervention.

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ResultsThe median age of all enrolled participants was 26 (IQR: 23-31), with a median of 3 (IQR: 2-4) partners reported during the previous 30-day period. Among all participants completing follow-up, 111/155 (71.6%) notified at least one partner, with a median of 1 partner notified per participant (IQR: 0-2). For participants randomised to receive PDPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (p = 0.001). The proportion of all recent partners notified was significantly greater in the PDPT than the Control arm (53.5% vs. 36.4%; p = 0.004). Conclusions Provision of PDPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of PDPT on biological outcomes of HIV/STI transmission in MSM sexual networks.

Background Early initiation of combination antiretroviral treatment (ART) is being considered as a HIV prevention strategy. Thus, it is important to examine the association between ART, viral load (VL) and the sexual behaviour of HIV+ve patients. We compared the reporting of unprotected anal sex (UAI) in 2010 and 2000 among HIV+ve men who have sex with men (MSM) and its association with VL. Methods HIV+ve MSM attending a central London HIV clinic were recruited in cross-sectional surveys in 2000 (411 men) and 2010 (423 men). Data on recent plasma VL (detectable (DVL) or undetectable (UVL)); ART status (treatment naïve or receiving ART); UAI with a boyfriend (main partner) and casual partners in the last 6 and 12 months respectively; boyfriend's HIV status (unknown/negative, or positive) were collected. Nonconcordant UAI (ncUAI) was defined as UAI with unknown/negative HIV status partner(s) and concordant UAI (cUAI) as UAI only with HIV+ve partner(s). Men reporting cUAI and ncUAI were treated as engaging in ncUAI. OR for 2010 compared to 2000 for UAI with casual partners were adjusted for age and DVL/UVL. Analysis for UAI with a boyfriend was adjusted also for boyfriend's HIV status and is restricted to those reporting a boyfriend. Results Compared to 2000, 2010 respondents were more likely to be on ART with UVL (76% vs 40%), but less likely to be on ART with DVL (6% vs 32%) or treatment naïve (19% vs 28%), p<0.001. They were older (age $45 years: 46% vs 22%, p<0.001), more likely to report an HIV+ve boyfriend (41% vs 25%; p¼0.001). An increase in cUAI with a boyfriend (27% vs 14%) remained significant after adjustment, (OR: 2.84, 95% CI: 1.59% to 5.06%; p<0.001). ncUAI with a boyfriend did not change (12% vs 11%; p¼0.63). With regards to casual partners, cUAI decreased over time (OR: 0.50, 95% CI: 0.29% to 0.86%; p¼0.01) but ncUAI increased (34% vs 17%; OR: 2.79, 95% CI: 1.93% to 4.04%; p<0.001). UVL was not associated with ncUAI with casual partners or boyfriend, but was associated with increased cUAI with casual partners (OR: 1.83, 95% CI: 1.08% to 3.13%; p¼0.02). Conclusions In comparison with 2000, cUAI with a boyfriend has increased, perhaps due to increased serosorting. In casual partnerships cUAI decreased and ncUAI increased. The latter has implications for onward HIV transmission and needs to be addressed by health promotion programmes. As UVL was not associated with ncUAI, these data do not suggest that early initiation of effective ART will increase HIV transmission.