Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges: a cost analysis of the ‘Test n Treat’ feasibility trial

Abstract

Background: Community-based screening may be one solution to increase testing and treatment of sexually transmitted infections in sexually active teenagers, but there are few data on the practicalities and cost of running such a service. We estimate the cost of running a 'Test n Treat' service providing rapid chlamydia (CT) and gonorrhoea (NG) testing and same day on-site CT treatment in technical colleges. Methods: Process data from a 2016/17 cluster randomised feasibility trial were used to estimate total costs and service uptake. Pathway mapping was used to model different uptake scenarios. Participants, from six London colleges, provided self-taken genitourinary samples in the nearest toilet. Included in the study were 509 sexually active students (mean 85/ college): median age 17.9 years, 49% male, 50% black ethnicity, with a baseline CT and NG prevalence of 6 and 0.5%, respectively. All participants received information about CT and NG infections at recruitment. When the Test n Treat team visited, participants were texted/emailed invitations to attend for confidential testing. Three colleges were randomly allocated the intervention, to host (non-incentivised) Test n Treat one and four months after baseline. All six colleges hosted follow-up Test n Treat seven months after baseline when students received a £10 incentive (to participate). Results: The mean non-incentivised daily uptake per college was 5 students (range 1 to 17), which cost £237 (range £1082 to £88) per student screened, and £4657 (range £21,281 to £1723) per CT infection detected, or £13,970 (range £63,842 to £5169) per NG infection detected. The mean incentivised daily uptake was 19 students which cost £91 per student screened, and £1408/CT infection or £7042/NG infection detected. If daily capacity for screening were achieved (49 students/day), costs including incentives would be £47 per person screened and £925/CT infection or £2774/NG infection detected.

Molecular chlamydia and gonorrhoea point of care tests implemented into routine practice: Systematic review and value proposition development

“…GP and other non-sexual health specialist services and outreach services share the value that the test is most likely to be used as a screening tool to increase testing, rather than the multiple purposes of screening, diagnosis, and guiding use of treatment, as is necessary in sexual health services. Non-specialist settings also have similarities for evidence of cost-effectiveness and translation challenges as this often requires new staff and training [ 52 , 74 , 75 ]. Sexual health services and GP and other non-specialist services overlap most for change in practice and change in resource requirement, and implementation metrics.…”

“…Although it did not meet all TPP or REASSURED criteria, review of its implementation and reported benefits demonstrated this did not preclude it from bringing value to a service or its stakeholders. Of note, although the cost-per-test of the Cepheid CT/NG GeneXpert exceeds the minimum TPP and REASSURED recommendations [49], cost-effectiveness models show relative valuefor-money of POCTs when considering onward transmission and progression of disease [50,[75][76][77][78]. Thus, it is only when these tools and frameworks are examined within the delivery context that sense-making happens around the adoption and implementation decision-making processes [26,79].…”

Alcohol use, cigarette smoking, vaping and number of sexual partners: A cross‐sectional study of sexually active, ethnically diverse, inner city adolescents

“…Although we provided online and paper educational fliers and posters, future studies might explore the impact of more interactive education at the time of testing on future behaviour. In addition, small financial incentives for testing might encourage uptake and reduce stigma as people could say they were just getting tested for the money 19 . In 2020, the UK government made sex and relationship education compulsory in state secondary schools.…”

“…In addition, small financial incentives for testing might encourage uptake and reduce stigma as people could say they were just getting tested for the money. 19 In 2020, the UK government made sex and relationship education compulsory in state secondary schools.…”

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“…GP and other non-sexual health specialist services and outreach services share the value that the test is most likely to be used as a screening tool to increase testing, rather than the multiple purposes of screening, diagnosis, and guiding use of treatment, as is necessary in sexual health services. Non-specialist settings also have similarities for evidence of cost-effectiveness and translation challenges as this often requires new staff and training [52, 74,75]. Sexual health services and GP and other non-specialist services overlap most for change in practice and change in resource requirement, and implementation metrics.…”