Impact of rapid near-patient STI testing on service delivery outcomes in an integrated sexual health service in the United Kingdom: a controlled interrupted time series study.

Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE

Original Publication: [London] : BMJ Publishing Group Ltd, 2011-

Gonorrhea*/diagnosis ; Gonorrhea*/epidemiology ; Sexually Transmitted Diseases*/diagnosis ; Sexually Transmitted Diseases*/epidemiology; Humans ; Interrupted Time Series Analysis ; United Kingdom/epidemiology ; Health Services

Objectives: To evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service.
Design: Controlled interrupted time series study.
Setting: Two integrated sexual health services (SHS) in UK: Unity Sexual Health in Bristol, UK (intervention site) and Croydon Sexual Health in London (control site).
Participants: Electronic patient records for all 58 418 attendances during the period 1 year before and 1 year after the intervention.
Intervention: Introduction of an in-clinic rapid testing system for gonorrhoea and chlamydia in combination with revised treatment pathways.
Outcome Measures: Time-to-test notification, staff capacity, cost per episode of care and overall service costs. We also assessed rates of gonorrhoea culture swabs, follow-up attendances and examinations.
Results: Time-to-notification and the rate of gonorrhoea swabs significantly decreased following implementation of the new system. There was no evidence of change in follow-up visits or examination rates for patients seen in clinic related to the new system. Staff capacity in clinics appeared to be maintained across the study period. Overall, the number of episodes per week was unchanged in the intervention site, and the mean cost per episode decreased by 7.5% (95% CI 5.7% to 9.3%).
Conclusions: The clear improvement in time-to-notification, while maintaining activity at a lower overall cost, suggests that the implementation of clinic-based testing had the intended impact, which bolsters the case for more widespread rollout in sexual health services.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Int J STD AIDS. 2016 Mar;27(4):273-80. (PMID: 25907347)
BMJ. 2017 Nov 30;359:j5395. (PMID: 29192020)
Int J STD AIDS. 2020 Jan;31(1):4-15. (PMID: 31870237)
Sex Transm Infect. 2014 Mar;90(2):82. (PMID: 24431187)
J Med Internet Res. 2018 Mar 07;20(3):e74. (PMID: 29514776)
BMJ Open. 2013 Oct 28;3(10):e003240. (PMID: 24165028)
BMJ Open. 2018 Sep 10;8(9):e020394. (PMID: 30201794)
PLoS One. 2019 Feb 22;14(2):e0212420. (PMID: 30794589)
BMC Med Res Methodol. 2021 Feb 11;21(1):32. (PMID: 33573595)
PLoS One. 2015 Dec 29;10(12):e0145993. (PMID: 26713441)
Int J STD AIDS. 2018 Apr;29(5):474-482. (PMID: 29059032)
BMJ Open. 2020 Jul 8;10(7):e037084. (PMID: 32641336)
Sex Transm Infect. 2014 Mar;90(2):104-11. (PMID: 24273127)
Sex Transm Infect. 2011 Jun;87(4):272-8. (PMID: 21441274)
Int J Epidemiol. 2018 Dec 1;47(6):2082-2093. (PMID: 29982445)
Sex Transm Infect. 2012 Nov;88(7):504-9. (PMID: 22628665)
Clin Med (Lond). 2009 Aug;9(4):349-52. (PMID: 19728509)
BMJ Open. 2014 Jul 23;4(7):e005322. (PMID: 25056977)
Health Technol Assess. 2016 Mar;20(22):1-250. (PMID: 27007215)
Sex Transm Infect. 2018 Mar;94(2):93-99. (PMID: 28798195)
Sex Health. 2013 Dec;10(6):541-5. (PMID: 24160838)
BMJ Open. 2021 Oct 22;11(10):e050109. (PMID: 34686552)

Keywords: Epidemiology; HEALTH ECONOMICS; SEXUAL MEDICINE

Date Created: 20230111 Date Completed: 20230113 Latest Revision: 20240910

20240910

PMC9835959

10.1136/bmjopen-2022-064664

36631238