Accelerated partner therapy contact tracing for people with chlamydia (LUSTRUM): a crossover cluster-randomised controlled trial

Claudia S. Estcourt*, Oliver Stirrup, Andrew Copas, Nicola Low, Fiona Mapp, John Saunders, Catherine H. Mercer, Paul Flowers, Tracy Roberts, Alison R. Howarth, Melvina Woode Owusu, Merle Symonds, Rak Nandwani, Chidubem Ogwulu, Susannah Brice, Anne M. Johnson, Christian L. Althaus, Eleanor Williams, Alex Comer-Schwartz, Anna TostevinJackie A. Cassell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Accelerated partner therapy has shown promise in improving contact tracing. We aimed to evaluate the effectiveness of accelerated partner therapy in addition to usual contact tracing compared with usual practice alone in heterosexual people with chlamydia, using a biological primary outcome measure. Methods: We did a crossover cluster-randomised controlled trial in 17 sexual health clinics (clusters) across England and Scotland. Participants were heterosexual people aged 16 years or older with a positive Chlamydia trachomatis test result, or a clinical diagnosis of conditions for which presumptive chlamydia treatment and contact tracing are initially provided, and their sexual partners. We allocated phase order for clinics through random permutation within strata. In the control phase, participants received usual care (health-care professional advised the index patient to tell their sexual partner[s] to attend clinic for sexually transmitted infection screening and treatment). In the intervention phase, participants received usual care plus an offer of accelerated partner therapy (health-care professional assessed sexual partner[s] by telephone, then sent or gave the index patient antibiotics and sexually transmitted infection self-sampling kits for their sexual partner[s]). Each phase lasted 6 months, with a 2-week washout at crossover. The primary outcome was the proportion of index patients with a positive C trachomatis test result at 12–24 weeks after contact tracing consultation. Secondary outcomes included proportions and types of sexual partners treated. Analysis was done by intention-to-treat, fitting random effects logistic regression models. This trial is registered with the ISRCTN registry, 15996256. Findings: Between Oct 24, 2018, and Nov 17, 2019, 1536 patients were enrolled in the intervention phase and 1724 were enrolled in the control phase. All clinics completed both phases. In total, 4807 sexual partners were reported, of whom 1636 (34%) were steady established partners. Overall, 293 (19%) of 1536 index patients chose accelerated partner therapy for a total of 305 partners, of whom 248 (81%) accepted. 666 (43%) of 1536 index patients in the intervention phase and 800 (46%) of 1724 in the control phase were tested for C trachomatis at 12–24 weeks after contact tracing consultation; 31 (4·7%) in the intervention phase and 53 (6·6%) in the control phase had a positive C trachomatis test result (adjusted odds ratio [OR] 0·66 [95% CI 0·41 to 1·04]; p=0·071; marginal absolute difference –2·2% [95% CI –4·7 to 0·3]). Among index patients with treatment status recorded, 775 (88·0%) of 881 patients in the intervention phase and 760 (84·6%) of 898 in the control phase had at least one treated sexual partner at 2–4 weeks after contact tracing consultation (adjusted OR 1·27 [95% CI 0·96 to 1·68]; p=0·10; marginal absolute difference 2·7% [95% CI –0·5 to 6·0]). No clinically significant harms were reported. Interpretation: Although the evidence that the intervention reduces repeat infection was not conclusive, the trial results suggest that accelerated partner therapy can be safely offered as a contact tracing option and is also likely to be cost saving. Future research should find ways to increase uptake of accelerated partner therapy and develop alternative interventions for one-off sexual partners. Funding: National Institute for Health Research.

Original languageEnglish
Pages (from-to)e853-e865
JournalThe Lancet Public Health
Volume7
Issue number10
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Funding Information:
This report presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (reference number RP-PG-0614-20009). The views and opinions expressed in this publication are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR, Medical Research Council, Central Commissioning Facility, NIHR Evaluation, Trials, and Studies Coordinating Centre, the Programme Grants for Applied Research Programme, or the Department of Health. The authors would like to thank the Trial Steering Committee (Simon Barton [chair], Robbie Currie, David Crundwell, Artemis Koukounari, Lynis Lewis, Emmanuel Rollings-Kamara, and Rachel Shaw), the Data Monitoring Committee (Simon Barton, David Crundwell, and Artemis Koukounari), all members of the LUSTRUM Patient and Public Involvement Group (with substantial contributions from C Ward, N Sutherland, D Rosen, and D Crundwell), participating centres (Barking, Havering and Redbridge University Hospitals NHS Trust [AU], Barts Health NHS Trust [VA], Buckinghamshire Healthcare NHS Trust [JS], Chelsea and Westminster Hospital NHS Foundation Trust [CE], Croydon Health Services NHS Trust [DP], Manchester University NHS Foundation Trust [GS], Midlands Partnership NHS Foundation Trust, NHS Greater Glasgow and Clyde [RN], Northamptonshire Healthcare NHS Foundation Trust [SH], Royal Berkshire NHS Foundation Trust, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Solent NHS Trust [RP], and University Hospitals Birmingham NHS Foundation Trust [JR]). The authors would also like to thank epiGenesys (Sheffield, UK) who developed the RELAY software; Soazig Clifton (support with ethics submission); Jacqueline Gray and Sarah Lasoye (administrational help); Jo Gibbs (support on RELAY development); and all of the staff, management, and patients involved in the study at all the participating sexual health clinics.

Funding Information:
This report presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (reference number RP-PG-0614-20009). The views and opinions expressed in this publication are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR, Medical Research Council, Central Commissioning Facility, NIHR Evaluation, Trials, and Studies Coordinating Centre, the Programme Grants for Applied Research Programme, or the Department of Health. The authors would like to thank the Trial Steering Committee (Simon Barton [chair], Robbie Currie, David Crundwell, Artemis Koukounari, Lynis Lewis, Emmanuel Rollings-Kamara, and Rachel Shaw), the Data Monitoring Committee (Simon Barton, David Crundwell, and Artemis Koukounari), all members of the LUSTRUM Patient and Public Involvement Group (with substantial contributions from C Ward, N Sutherland, D Rosen, and D Crundwell), participating centres (Barking, Havering and Redbridge University Hospitals NHS Trust [AU], Barts Health NHS Trust [VA], Buckinghamshire Healthcare NHS Trust [JS], Chelsea and Westminster Hospital NHS Foundation Trust [CE], Croydon Health Services NHS Trust [DP], Manchester University NHS Foundation Trust [GS], Midlands Partnership NHS Foundation Trust, NHS Greater Glasgow and Clyde [RN], Northamptonshire Healthcare NHS Foundation Trust [SH], Royal Berkshire NHS Foundation Trust, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Solent NHS Trust [RP], and University Hospitals Birmingham NHS Foundation Trust [JR]). The authors would also like to thank epiGenesys (Sheffield, UK) who developed the RELAY software; Soazig Clifton (support with ethics submission); Jacqueline Gray and Sarah Lasoye (administrational help); Jo Gibbs (support on RELAY development); and all of the staff, management, and patients involved in the study at all the participating sexual health clinics.

Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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