High chlamydia and gonorrhoea rates but do they get tested? “Test and Treat/TnT” feasibility trial in ethnically diverse, sexually active teenagers

Conference:

SAPC ASM 2018 - London

Talk Code:

P2.11

Presenter:

Pippa Oakeshott

Co-authors:

Sarah Kerry-Barnard, Fiona Reid, Vari Drennan, Elisabeth Adams, Tariq Sadiq

Author institutions:

St George's, University of London

Problem

The burden of sexually transmitted infections (STIs) is high in young people. Bringing new rapid 90 minute chlamydia/gonorrhoea tests and on-site treatment (“TnT=Test n Treat”) into the community might get more people treated faster. We aimed to assess the feasibility of conducting a trial of rapid chlamydia/gonorrhoea testing and same day on-site treatment (“Test n Treat/TnT”) to reduce rates of chlamydia and gonorrhoea in sexually active students.

Approach

We conducted a cluster randomised feasibility trial during the academic year September 2016 to July 2017 in six Further Education colleges in London, UK. We recruited 509 sexually active students, median age 17.9 years (range 16-24); 47% male. Self-reported ethnicity was black (50%), white (26%) or other ethnic groups (24%); and 55% reported ≥2 sexual partners in the previous year. Participants were asked to complete questionnaires and provide genitourinary samples at baseline and seven months. All participants were informed that baseline samples would not be tested for seven months and advised to get an STI screen independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control group (no TnT).InterventionOne and four months after recruitment participants at each intervention college (n=3) were texted invitations for on-site 90 minutes chlamydia/gonorrhoea tests. Students with infections were asked to see a nurse health-adviser.Main outcome measures • TnT uptake rates • Follow-up rates • Prevalence of chlamydia/gonorrhoea at baseline and 7 months• Acceptability of TnT (from qualitative interviews)

Findings

TnT uptake (the proportion of intervention participants providing samples for rapid on-site testing) was 13% (33/259, 95% CI 8.9 to 17.4%) at one month and 10% (26/259, 6.7 to 14.4%) at four months. Of 59 tests, three (5%) were positive for chlamydia including one which was also positive for gonorrhoea. Median time to treatment for chlamydia was one day (range 6-27 hours). Follow-up at seven months was 62% (317/509, 58 to 67%) for questionnaires and 52% (265/509, 48 to 56%) for samples. Overall prevalence of chlamydia and gonorrhoea was 6.2% (31/503, 4.2 to 8.6%) and 0.6% (3/503, 0.1 to 1.7%) at baseline, and 6.0% (16/265, 3.5 to 9.6%) and 1.1% (3/265, 0.2 to 3.3%) at 7 months.Twenty seven percent (86/317) of participants followed up reported testing for chlamydia/gonorrhoea outside the trial. Although TnT was popular with attenders, interviews with a purposive sample of intervention students who did/did not attend TnT (n=26) suggested low uptake was associated with little knowledge about STIs, not feeling at risk and perceptions of stigma.

Consequences

Despite high rates of chlamydia and gonorrhoea at both baseline and follow-up, uptake of college-based TnT by ethnically diverse teenagers was low. Progression criteria for a definitive trial were not met. England urgently needs better sex and relationships education and normalisation of STI testing.

Submitted by:

Pippa Oakeshott

Funding acknowledgement:

This independent research is funded by the NIHR under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1014-35007). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funding body had no role in the design of the study, the collection, analysis or interpretation of the data, or the write-up of the manuscript.