Improving levels of partner notification (PN) is key to reducing the transmission of STIs in the UK, but doing so has proved to be difficult, time consuming, and expensive for many. As few as 25% of sexual health care providers achieve the BASHH target of 0.6 partners seen for every patient diagnosed with an STI . It’s a frustrating situation, but one that could be improved by harnessing the power of modern communications technology in the right way.
Extremely interesting work has already been done in this area, in the UK. In particular on Accelerated Partner Therapy (APT) , in which two proactive approaches towards PN have been modelled, shown to work, and to be regulation compliant. These approaches employ many non-standard techniques, including, for example, the use of SMS technology to send PIN numbers to partners. Unfortunately trials of APT have come up against significant recruitment problems and the results have been disappointing, but the new ideas and possibilities APT raises, deserve to be developed further.
This is what we, at SXT Health Community Interest Company (CIC) have been doing. We are a London-based social enterprise, run by sexual and reproductive health professionals, whose sponsors include Public Health England and Big Issue Invest. Our website, www.sxt.org.uk, already functions as an online signposting service, directing individuals to the right sexual and reproductive health services, based on their needs and preferences. We have just launched our interactive digital Contact Slip (idCS) – a new PN tool, carried on our website, which allows patients to decide how they want to inform sexual partners of an STI diagnosis. They can choose to do so anonymously or not, by email or text, within the clinic setting (helped by the clinician), or in private. The system gives the partner an ID number and helps them find an appropriate local clinic. It informs that clinic wherever they are in the UK (via the ID number) what the partner has been exposed to and when. It collates information on PN effectiveness (how many have been informed, seen by a health care worker) in one place. And it does all this without storing any personal information about the individuals involved.
We have been running a live pilot of our idCS in Lambeth and Southwark, through providers such as Guy’s & St Thomas’ NHS Foundation Trust (GSTT), King’s College Hospital, SH:24 www.sh24.org.uk, Burrell Street Clinic and Brook Clinic. Although we know we have a lot more work to do to improve the way the tool works, and to train the staff using it, we have had some encouraging results. Our tool already bears comparison with a more fully developed tool from the Netherlands, which was the subject of a cross sectional pilot study in 2012 . The Dutch tool ‘Suggest-a-test’ (SAT), functioned in a similar way to our idCS – key differences being that it gave index patients the option of delivering PN via postal letter and gay dating site (as well as SMS and email); it named the STI in the initial notification (our idCS tells the partner that they have come into contact with ‘an STI’ – a clinic then uses our ID number to discover which one); and it asked partners to print their code and bring it to the STI testing centre (we assume that partners will be able to show the ID number in the email/SMS show via their smartphones). There are also, altogether, fewer steps to go through with our idCS – so that it can take as little as 60 minutes between a partner being told and being tested. The Dutch (SAT), and our (idCS) results so far, are summarized below.
|Partners seen in clinic (%PT)||No. of clinics partners seen in|
|SAT (91/7)||67||402||213 (53)||124 (56)||45 (20)||2|
|203||426||149 (35)||90 (60)||35 (23)||14|
We are encouraged that the % of contacts opening our link, and then being seen in clinic, are both slightly higher than in the case of SAT. Before our idCS undergoes a fully evaluated trial, we want to improve on these figures, and also address the markedly lower % of ‘Partners Told’ via our tool, compared with SAT. We hope that by doing so, our tool will ultimately out-perform SAT.
To increase number of ‘Partners Told’ via our idCS, we plan to encourage those staff currently trialing the tool to offer provider led PN (which is so far yielding much better results than patient initiated notification). We plan to introduce online training module for the staff currently using the tool. We also plan to use digital signage & marketing in clinics outlining the benefits of PN to patients, and priming them to expect to be asked about this in their consultation.
We hope that after refinement, testing and full evaluation, the idCS will come to be seen as an indispensible tool for the health care worker delivering PN – something that will take some of the more time-consuming aspects of the process out of their hands (the sending of notifications, the tracking of outcomes), that’ll increase their chances of success (with more options to offer patients, including an anonymous embarrassment-free way of telling partners) and will free them up to do the side of their job no online tool can do better than them – the counseling, and informed decision making. We anticipate that our idCS will save health care providers money. Current PN methods are estimated to be (in the case of Chlamydia) between £9-27 per positive index case , not including testing or treatment. Our tool will be available to providers at a cost of £2 per index patient they expect to diagnose annually. By taking PN online, and automating those parts of the process that can be automated, we believe we can cut costs, standardize the process across the country, improve data management, and, most important of all, improve PN rates.
1 Turner K, Adams E, Grant A, et al. Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study. BMJ 2011;342:c7250
2 Estcourt CS, Sutcliffe LJ, Copas A, et al. Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial. Sex Transm Infect 2015;91:548-554 http://sti.bmj.com/content/91/8/548.full
3 Hannelore M Gotz, Martijn S van Rooijen, Pjer Vriens, et al. Initial evaluation of use of an online partner notification tool for STI, called ‘suggest a test’: a cross sectional pilot study. Sex Transm Infect 2014;90(3)195-200
Correction to Gotz et al. 90(3):195 http://sti.bmj.com/content/91/1/74.1.full