Pilot study for the ‘Test n Treat’ trial of on-site rapid chlamydia/gonorrhoea tests and same day treatment

Balendra, Anjella; Cousins, Emma; Lamplough, Helen; Oakeshott, Pippa; Majewska, Wendy; Kerry, Sally

doi:10.1136/sextrans-2016-053084

Cited by 7 publications

(8 citation statements)

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“…This has significant potential to reduce complications and interrupt chains of infection arising from long time sequeale of undiagnosed STIs besides reducing patient waiting time, thus reducing the number of patients who might not return to a clinic for their result. Similar rapid on‐site diagnostics permitting prompt recognition and treatment of infections using the Cepheid Xpert ® CT/NG assay has also been reported independently by other groups 22,23 …”

Section: Discussionsupporting

confidence: 60%

Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr‐area, Germany: PreYoungGo study

Skaletz‐Rorowski

Potthoff

Nambiar

et al. 2020

Acad Dermatol Venereol

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Background and objectivesSTIs present a significant threat to individual and public health, disproportionately affecting youth. The study aimed to evaluate (a) the prevalence of asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among youth using a rapid assay platform, (b) the participants' sexual behaviour and STI knowledge, (c) the utility of the rapid assay in reducing diagnosis‐to‐treatment time.MethodsIn this study, 272 subjects (14–31 years) were included between 12/2016 and 7/2018. A questionnaire was used to collect sociodemographic data, sexual behaviour and STI knowledge. Prevalence of CT and NG infections were tested from oral, vaginal and anal swabs for women and oral, anal swabs and urine for men, using the Cepheid Xpert® CT/NG assay. Time intervals between (i) test to the time the patient were informed of the result (turn around time – TAT) and (ii) test to therapy initiation was documented.ResultsOf the 272 subjects (48.9% female, 48.9% male, undisclosed 2.2%), 56.6 % reported university education. 46.6% were men who have sex with men (MSM), and 47.4% of women and 63.1% of men had anal intercourse. 59.9% had previously been tested for HIV, while only 39.7% had for CT, 20.6% for NG. Among these asymptomatic youth 7.7% were positive for CT and 5.5% for NG. The localization of CT were 3.7% genital, 5.5% anal and 2.2% oral, while the corresponding localization of NG were 0.4%, 2.9%, 4.4% respectively. 91.8% of the participants were informed of a positive result within 24 h with a median TAT of 03:09 h. 73.3% initiated therapy within 24 h, with a median time from testing to therapy initiation being 06:50 h.ConclusionAsypmtomatic CT and NG infections are common and often not tested in persons at risk. The Cepheid Xpert® CT/NG assay is an effective strategy as it reduces STI diagnosis‐to‐treatment time to less than a day.

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Section: Discussionsupporting

confidence: 60%

Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr‐area, Germany: PreYoungGo study

Skaletz‐Rorowski

Potthoff

Nambiar

et al. 2020

Acad Dermatol Venereol

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“…The main weakness is that testing uptake may have been limited by the study designonly students recruited and consented into the study were eligible to use the service. During our earlier one-day pilot of TnT when any sexually active student could take part, attendance was considerably higher (34 per day) [19]. Using the same cost data, the cost per screen in the pilot was £56.53 and the cost per CT infection detected, £640.66 (as CT prevalence was 11% [3/34]).…”

Section: Strengths and Weaknessesmentioning

confidence: 97%

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

Kerry-Barnard

Huntington

Fleming

et al. 2020

BMC Health Serv Res

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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.

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“…sufficiently narrow confidence intervals) in a feasibility study [15,17]. As previously described [18], assuming a 30% recruitment rate [13], we aimed to approach 1600 students to recruit 480 overall (80 per college across six colleges).…”

Section: Sample Size and Statistical Analysismentioning

confidence: 99%

‘Test n Treat’ (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges

Oakeshott

Kerry-Barnard

Fleming

et al. 2019

Clinical Microbiology and Infection

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Objectives: We conducted a cluster-randomized feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment ('Test n Treat/TnT') in six technical colleges in London, England, to assess TnT uptake rates; follow-up rates; prevalence of C. trachomatis at baseline and 7 months; time to treatment; acceptability of TnT. Methods: Participants completed questionnaires and provided genitourinary samples at baseline and 7 months. Participants were informed that baseline samples would not be tested for 7 months and were advised to get screened independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control (no TnT). One month and 4 months post recruitment, participants at intervention colleges were texted invitations for on-site free C. trachomatis tests. A purposive sample of students who did/did not attend for screening were interviewed (n ¼ 26). Results: Five hundred and nine sexually active students were recruited: median age 17.9 years, 47% male, 50% black ethnicity, 55% reporting two or more sexual partners in the previous year. TnT uptake was 13% (33/259; 95% CI 8.9e17.4%) at 1 month and 10% (26/259; 6.7e14.4%) at 4 months with overall C. trachomatis positivity 5.1% (3/59; 1.1e14.2%). Follow-up at 7 months was 62% (317/509) for questionnaires and 52% (264/509) for samples. C. trachomatis prevalence was 6.2% (31/503) at baseline and 6.1% (16/264) at 7 months. Median time from test to treatment was 15 h. Interviews suggested low test uptake was associated with not feeling at risk, perceptions of stigma, and little knowledge of sexually transmitted infections (STIs). Conclusions: Despite high C. trachomatis rates at baseline and follow-up, uptake of testing was low. Like many countries, England urgently needs better sex education, including making STI testing routine/ normal.

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Pilot study for the ‘Test n Treat’ trial of on-site rapid chlamydia/gonorrhoea tests and same day treatment

Cited by 7 publications

References 0 publications

Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr‐area, Germany: PreYoungGo study

Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr‐area, Germany: PreYoungGo study

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

‘Test n Treat’ (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges

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