title: The relative clinical effectiveness and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections: a cluster randomised trial in primary care.
abstract: BACKGROUND
  Partner notification is the process of providing support for, informing and treating sexual partners of individuals who have been diagnosed with sexually transmitted infections (STIs). It is traditionally undertaken by specialist sexual health services, and may involve informing a partner on a patient's behalf, with consent. With an increasing proportion of STIs diagnosed in general practice and other community settings, there is a growing need to understand the best way to provide partner notification for people diagnosed with a STI in this setting using a web-based referral system.
  
  
  OBJECTIVE
  We aimed to compare three different approaches to partner notification for people diagnosed with chlamydia within general practice.
  
  
  METHODS
  Cluster randomised controlled trial.
  
  
  METHODS
  General practices in England and, within these, patients tested for and diagnosed with genital chlamydia or other bacterial STIs in that setting using a web-based referral system.
  
  
  METHODS
  Three different approaches to partner notification: patient referral alone, or the additional offer of either provider referral or contract referral.
  
  
  METHODS
  (1) Number of main partners per index patient treated for chlamydia and/or gonorrhoea/non-specific urethritis/pelvic inflammatory disease; and (2) proportion of index patients testing negative for the relevant STI at 3 months.
  
  
  RESULTS
  As testing rates for chlamydia were far lower than expected, we were unable to scale up the trial, which was concluded at pilot stage. We are not able to answer the original research question. We present the results of the work undertaken to improve recruitment to similar studies requiring opportunistic recruitment of young people in general practice. We were unable to standardise provider and contract referral separately; however, we also present results of qualitative work aimed at optimising these interventions.
  
  
  CONCLUSIONS
  External recruitment may be required to facilitate the recruitment of young people to research in general practice, especially in sensitive areas, because of specific barriers experienced by general practice staff. Costs need to be taken into account together with feasibility considerations. Partner notification interventions for bacterial STIs may not be clearly separable into the three categories of patient, provider and contract referral. Future research is needed to operationalise the approaches of provider and contract partner notification if future trials are to provide generalisable information.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN24160819.
  
  
  BACKGROUND
  This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 5. See the NIHR Journals Library website for further project information.
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.
authors.forename: Jackie A
authors.initials: JA
authors.lastname: Cassell
authors.affiliation: Medical Research Council, General Practice Research Framework, London, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Dodds
authors.affiliation: BICMS, Barts and The London School of Medicine and Dentistry, Queen Mary College, University of London, London, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Estcourt
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.
authors.forename: Carrie
authors.initials: C
authors.lastname: Llewellyn
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.
authors.forename: Stefania
authors.initials: S
authors.lastname: Lanza
authors.affiliation: Research Department of Primary Care and Population Health, UCL and Medical Research Council General Practice Research Framework, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Richens
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
authors.affiliation: BICMS, Barts and The London School of Medicine and Dentistry, Queen Mary College, University of London, London, UK.
authors.forename: Merle
authors.initials: M
authors.lastname: Symonds
authors.affiliation: Research Department of Primary Care and Population Health, UCL and Medical Research Council General Practice Research Framework, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Copas
authors.affiliation: Health Economics Unit, School of Health and Population Science, University of Birmingham, , UK.
authors.forename: Tracy
authors.initials: T
authors.lastname: Roberts
authors.affiliation: Research Department of Primary Care and Population Health, UCL and Medical Research Council General Practice Research Framework, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: White
authors.affiliation: STI Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lowndes
authors.affiliation: Health Economics Unit, School of Health and Population Science, University of Birmingham, , UK.
authors.forename: Hema
authors.initials: H
authors.lastname: Mistry
authors.affiliation: Health Economics Unit, School of Health and Population Science, University of Birmingham, , UK.
authors.forename: Melcior
authors.initials: M
authors.lastname: Rossello-Roig
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Smith
authors.affiliation: Medical Research Council, General Practice Research Framework, London, UK.
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
mesh_terms: D002690:Chlamydia Infections / Q000175:diagnosis* / Q000635:transmission*; D016000:Cluster Analysis; D016358:Contact Tracing / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008219:Lymphogranuloma Venereum / Q000175:diagnosis / Q000635:transmission; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D018570:Risk Assessment; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000517:prevention & control*; D006113:United Kingdom; D055815:Young Adult