2010 Participant Summaries

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Study: 
Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners  

Researchers:
Pavlin NL, Parker RM, Piggin AK, Hopkins CA, Temple-Smith MJ, Fairley CK, Tomnay JE, Bowden FJ, Russell DB, Hocking JS, Chen MY 

Publication:
BMC Infectious Diseases; 2010:10 (274) 

Summary:
Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and patient-delivered partner therapy (PDPT) for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis. In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. GPs believe the barriers to patients telling partners included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. The barriers reported for GPs to undertake partner notification included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT - many felt concerned that it is not best clinical practice but many also felt that it is better than nothing. GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people. GPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs. 


Study:
Young pregnant women's views on the acceptability of screening for chlamydia as part of routine antenatal care  

Researchers:
Bilardi JE, De Guingand DL, Temple-Smith MJ, Garland SM, Fairley CK, Grover S, Wallace E, Hocking JS, Tabrizi S, Pirotta M, Chen MY. 

Publication:
BMC Infectious Diseases, 2010; 10:505   Summary: Untreated chlamydial infection among pregnant women has been associated with adverse outcomes for both mother and infant. Like most women, pregnant women infected with chlamydia do not report genital symptoms, and are therefore unlikely to be aware of their infection. A cross-sectional study of 100 pregnant women aged 16-25 years attending antenatal services across Melbourne, Australia, were invited to participate in a face-to-face, semi structured interview on the acceptability of screening for chlamydia during pregnancy (31 women were infected with chlamydia). Women had low levels of awareness of chlamydia before the test, retained relatively little knowledge after the test and commonly had misconceptions around chlamydia transmission, testing and sequelae. There was a strong preference for urine testing over other methods of specimen collection. Women who tested positive for chlamydia had mixed reactions, however, most felt relief and gratitude at having had chlamydia detected and reported high levels of partner support. Chlamydia screening as part of routine antenatal care was considered highly acceptable among young pregnant women who recognized the benefits of screening and strongly supported its implementation as part of routine antenatal care. The acceptability of screening is important to the uptake of chlamydia screening in future antenatal screening strategies. 


Study:
Men who have sex with men prefer rapid testing for syphilis and may test more frequently using it   

Researchers:
Lee DM, Chen MY, Fairley CK, Cummings R, Bush M and Read T

Publication:
Sexually Transmitted Diseases, 2010; 37 (9): 557-558   Summary: Syphilis has re-emerged among men who have sex with men (MSM) in Australia and internationally, with over representation among HIV-positive MSM. Syphilis is believed to increase the risk of HIV transmission. Despite public health measures aimed at reducing syphilis, reported rates remain high among MSM. Studies suggest that more frequent screening of MSM and HIV-positive MSM results in increasing early detection of early, asymptomatic syphilis and are likely to reduce transmission of infection. We undertook rapid syphilis testing of MSM using the Determine Syphilis TP immunoassay to ascertain their views on rapid testing and whether these would increase screening for syphilis. Most indicated a preference for rapid testing over conventional serology. Most also indicated that they would test for syphilis more frequently if rapid syphilis testing was available in a clinic setting. Rapid, or point of care, testing for syphilis, which can be undertaken in clinical and nonclinical settings, has the potential to increase the uptake and frequency of syphilis screening and reduce the number of syphilis infected individuals who do not return for their results. 


Study:
Australian men who have sex with men prefer rapid oral HIV testing over conventional blood testing for HIV 

Researchers:
Chen MY, Bilardi JE, Lee D, Cummings R, Bush M and Fairley CK   

Publication:
Int J STD AIDS, 2010; 21 (6): 428-430   Summary: This study examined the views of 172 community-based Australian men who have sex with men (MSM) on the acceptability and potential uptake of rapid oral testing for HIV in clinic and home-based settings. Men were asked to complete a questionnaire that sought their views on rapid testing for HIV. When asked about which HIV test they would prefer in a clinic setting, 64% indicated a preference for rapid oral HIV testing and 74% indicated that if rapid oral HIV testing was available at a clinic they would test for HIV more frequently. If rapid oral HIV testing was available for home testing, 63% of men indicated it would be likely they would test themselves for HIV and 61% indicated they would test more frequently. Overall, MSM expressed a preference for rapid oral HIV testing and would test more frequently if testing was available for clinic or home use in Australia.


Study:
The right thing to do:  patients’ views and experiences of telling partners about chlamydia 

Researchers:
Temple-Smith MJ, Hopkins C, Fairley CK, Tomnay JE, Pavlin N, Parker R, Russell DB, Bowden F, Hocking JS, Pitts M, Chen M Publication: Family Practice, 2010; doi:10.1093/fampra/cmq028   

Summary:
Partner notification for patients diagnosed with chlamydia is a strategy recommended to reduce transmission of infection. Patients are encouraged by health practitioners to contact their sexual partners themselves. The psychosocial impact of a chlamydia diagnosis and its effect on partner notification was investigated by in-depth telephone interviews with 25 women and 15 men aged 18–55 years, diagnosed with chlamydia from clinics in Victoria, Australian Capital Territory and Queensland. Reactions to chlamydia diagnosis, as well as reasons for, and feelings about, telling their sexual partners about this infection were explored. Common reactions to initial diagnosis were surprise, shock and shame. The majority of both men and women saw partner notification as a social duty. Some cited concerns about their own health and the health of others as a reason for telling partners and ex-partners about the diagnosis. An infrequent reason offered for partner notification was to confront a partner to clarify fidelity. Reasons for not contacting a partner were typically fear of reaction or a lack of contact details. Although participants reported sexual partners exhibiting a variety of reactions when told of the diagnosis, results showed that for almost everyone, the experience of notifying their partner was better than they had expected. Findings suggested that partner notification by people diagnosed with chlamydia is achievable but many require support from their health practitioner to achieve the skills and confidence necessary during this difficult time.


Study:
Experiences and outcomes of partner notification among men and women recently diagnosed with chlamydia and their views on innovative resources aimed at improving notification rates 

Researchers:
Bilardi JE, Fairley CK, Hopkins CA, Hocking JS, Temple-Smith MJ. Bowden FJ, Russell DB, Pitts M, Tomnay JE, Parker RM, Pavlin NL, Chen MY Publication: Sexually Transmitted Disease, 2010; 37(4); 253-258   

Summary:
A telephone survey was undertaken with men and women recently diagnosed with chlamydia across 3 Australian jurisdictions between August 2007 and January 2008. Of 286 individuals who agreed to be contacted about the study, 202 (71%) completed the survey and 23% (333/1458) of recent partners were notified. Men who had sex with men (MSM) notified 15% (133/880) of their partners, heterosexual men 31% (114/370), and women 46% (86/188) of their partners. Overall, 84% (169/202) of individuals notified at least one partner. The main reasons for informing partners were out of concern for them (44%) or because it was considered “the right thing to do” (37%). The preferred methods for contacting partners were telephone (52%) and face-to-face (30%). E-mail (8%) and short message service (SMS) (11%) were less commonly used. However, if a website was offered with anonymous e-mail and SMS services, nearly half of individuals indicated they would find this useful. Of 94 who had not informed all partners with known contact details, 34% reported that if web-based tools were available they would have contacted more partners. Over half of participants expressed they would like to have been given antibiotics to give to their partner. The availability of tailored resources may assist in improving partner notification for chlamydia.   



Study:
Telling partners about chlamydia: how acceptable are the new technologies?   Researchers:
Hopkins CA, Temple-Smith MJ, Fairley CK, Pavlin NL, Tomnay JE,  Parker RM, Bowden FJ, Russell DB, Hocking JS, Chen MY      

Publication:
BMC Infectious Diseases, 2010; 10:58 

Summary:
The newer technologies of email and SMS have been used as a means of improving partner notification rates. This study explored the use and acceptability of different partner notification methods to help inform the development of strategies and resources to increase the number of partners notified. Semi-structured telephone interviews were conducted with 40 people who were recently diagnosed with chlamydia from three sexual health centres and two general practices across three Australian jurisdictions. Most participants chose to contact their partners either in person (56%) or by phone (44%). Only 17% chose email or SMS. Participants viewed face-to-face as the “gold standard” in partner notification because it demonstrated caring, respect and courage. Telephone contact, while considered insensitive by some, was often valued because it was quick, convenient and less confronting. Email was often seen as less personal while SMS was generally considered the least acceptable method for telling partners. There was also concern that emails and SMS could be misunderstood, not taken seriously or shown to others. Despite these, email and SMS were seen to be appropriate and useful in some circumstances. Letters, both from the patients or from their doctor, were viewed more favourably but were seldom used. These findings suggest that many people diagnosed with chlamydia are reluctant to use the new technologies for partner notification, except in specific circumstances, and our efforts in developing partner notification resources may best be focused on giving patients the skills and confidence for personal interaction.  


Study:
Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial 

Researchers:
Bilardi JE, Fairley CK, Temple-Smith MJ, Pirotta MV, McNamee KM, Bourke S, Gurrin LC, Hellard M, Sanci LA, Wills MJ, Walker J, Chen MY, Hocking JS Publication: BMC Public Health, 2010; 10:70 

Summary:
The aim of this pilot study was to determine if offering general practitioners (GP) a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice. General practice clinics (n = 12) across Victoria, Australia, were cluster randomized to receive either a $AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia. Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods: 12 month pre-trial and 6 month trial period. The impact of the intervention was assessed and testing increased from 6.2% (95% CI: 4.2, 8.4) to 8.8% (95% CI: 4.8, 13.0) (p = 0.1) in the control group and from 11.5% (95% CI: 4.6, 18.5) to 13.4% (95% CI: 9.5, 17.5) (p = 0.4) in the intervention group. Overall, the intervention did not result in a significant increase in chlamydia testing in general practice. The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 (95% CI: 0.6, 1.2). Major barriers to increased chlamydia testing reported by GPs included lack of time, difficulty in remembering to offer testing and a lack of patient awareness around testing. A small financial incentive alone did not increase chlamydia testing among young women attending general practice. It is possible small incentive payments in conjunction with reminder and feedback systems may be effective, as may higher financial incentive payments.


Study:
Estimating the number of unlicensed brothels operating in Melbourne Researchers: Chen MY, Donovan B, Harcourt C, Morton A, Moss L, Wallis S, Cook K, Batras D, Groves J, Tabrizi SN, Garland S, Fairley CK

Publication:
Australian and New Zealand Journal of Public Health, 2010; 34(1): 67-71 

Summary:
This study estimated the number of unlicensed brothels operating in Melbourne, Australia and the sexual health of the women working at these sites. In July 2006, advertisements published inMelbourne newspapers were systematically analysed to identify unlicensed brothels There were 438 advertisements collated, representing 174 separate establishments. Of these, 78 were not considered likely to be brothels. Of the remaining 96, addresses were available for 42 and all of these premises were visited. Thirteen were confirmed as unlicensed brothels. We estimate there were between 13 and 70 unlicensed brothels in Melbourne. Twenty-three women were recruited from four brothels. Only 56% (35-77%) reported having regular sexual health checks and only 13% (3-36%) reported prior testing for HIV. Among the 22 women tested, one had chlamydia while another had gonorrhoea representing a prevalence of 4.5% (2 - 20%) for each infection. The number of unlicensed brothels in Melbourne is much smaller than is generally believed. Women in this sector are infrequently tested for STIs. As long as a licensing system persists, promotion of sexual health among women in this sector is likely to face hurdles. Further research is needed to determine the best model for regulating or not regulating sex industries.