‘Test n Treat (TnT)’– Rapid testing and same-day, on-site treatment to reduce rates of chlamydia in sexually active further education college students: study protocol for a cluster randomised feasibility trial

Abstract

BackgroundSexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We will conduct a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing and same-day treatment (Test and Treat (TnT)) in six FE colleges (with parallel qualitative and economic assessments) to assess the feasibility of conducting a future trial to investigate if TnT reduces chlamydia rates.MethodsWe will recruit 80 sexually active students aged 16–24 years from public areas at each of six colleges. All participants (total n = 480) will be asked to provide samples (urine for males, self-taken vaginal swabs for females) and complete questionnaires on sexual lifestyle and healthcare use at baseline and after 7 months. Participants will be informed that baseline samples will not be tested for 7 months and be advised to get screened separately. Colleges will be randomly allocated to the intervention (TnT) or the control group (no TnT).One and 4 months after recruitment, participants at each intervention college (n = 3) will be texted and invited for on-site chlamydia tests using the 90-min Cepheid GeneXpert system. Students with positive results will be asked to see a visiting nurse health adviser for same-day treatment and partner notification, (backed by genitourinary medicine follow-up). Participants in control colleges (n = 3) will receive ‘thank you’ texts 1 and 4 months after recruitment.Seven months after recruitment, participants from both groups will be invited to complete questionnaires and provide samples for TnT. All samples will be tested, and same-day treatment offered to students with positive results.Acceptability of TnT will be assessed by qualitative interviews of purposively sampled students (n = 30) and college staff (n = 12). We will collect data on costs of TnT and usual healthcare.DiscussionFindings will provide key values to inform feasibility, sample size and timescales of a future definitive trial of TnT in FE colleges, including:Recruitment ratesTnT uptake ratesFollow-up ratesPrevalence of chlamydia in participants at baseline and 7 monthsAcceptability of TnT to students and college staffEstimate of the cost per person screened/treated in TnT versus usual careTrial registrationInternational Standard Randomised Controlled Trials Registry, ID: ISRCTN58038795, Registered on 31 August 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2674-8) contains supplementary material, which is available to authorized users.

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

“…The protocol and main results of the TnT trial are available elsewhere [5,6]. In summary, 509 sexually active ethnically diverse students aged 16-24 years were recruited from communal areas in six technical colleges in South London in October 2016 ( Fig.…”

“…Although NG is less common than CT, it is a potentially more serious STI over which there are concerns about antibiotic resistance [4]. Therefore, in this study, participants diagnosed with NG were referred to specialist clinics for further management [5,6].…”

“…We used field data from the 'Test n Treat' (TnT) feasibility trial of screening for CT/NG in further education/ technical colleges [5,6]. (Further education colleges offer both academic and practical courses such as plumbing and hairdressing and take many students from socioeconomically deprived backgrounds.)…”

Understanding the acceptability, barriers and facilitators for chlamydia and gonorrhoea screening in technical colleges: qualitative process evaluation of the “Test n Treat” trial

“…The “Test n Treat” (TnT) trial investigated the feasibility of offering rapid 90-min on-site CT/GC testing, (with same day on-site treatment for chlamydia and referral to sexual health services for gonorrhoea), to students attending six technical colleges in London, UK in the academic year 2016–17 [ 16 , 17 ]. The trial reported a high rate of chlamydia (6%) and gonorrhoea (1%) for that age group in a community setting [ 17 ].…”

“…However, the uptake of the on-site TnT testing was only 13% at one month and 10% at four months after recruitment [ 17 ]. This low uptake of the STI testing occurred despite the TnT feasibility trial incorporating evidence from young female, technical college student preferences regarding on-site STI screening [ 18 ], a successful pilot study [ 19 ], and involving students in the trial design [ 16 , 17 ].…”