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Gezer M, Hunter B, Hocking JS, Manski-Nankervis JA, Goller JL. Informing the design of a digital intervention to support sexually transmissible infection care in general practice: a qualitative study exploring the views of clinicians. Sex Health 2023; 20:431-440. [PMID: 37407286 DOI: 10.1071/sh22191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Strengthening sexually transmissible infection (STI) management in general practice is prioritised in Australian STI strategy. Digital interventions incorporating clinical decision support offer a mechanism to assist general practitioners (GPs) in STI care. This study explored clinicians' views towards a proposed digital intervention for supporting STI care in Australian general practice as a first step in the tool's design. METHODS Semi-structured one-to-one interviews were conducted during 2021 with sexual health physicians (n =2) and GPs (n =7) practicing in the state of Victoria, Australia. Interviews explored views on a proposed STI digital intervention for general practice. We applied the Theoretical Domains Framework (TDF), a behaviour change framework to our analysis. This involved: (1) directed content analysis of transcripts into TDF domains; and (2) thematic analysis to identify sub-themes within relevant TDF domains. Subthemes were subsequently categorised into enablers and barriers to the use and implementation of a STI computerised clinical decision support system (CDSS). RESULTS All interviewees viewed a digital intervention for STI care favourably, expressing confidence in its potential to improve care and support management. Within the relevant TDF domains (e.g. environmental context and resources), subthemes emerged as barriers (e.g. lack of sensitivity to patient context) or enablers (e.g. clear communication and guidance) to the use and implementation of a STI CDSS in primary care. Multiple subthemes (e.g. time constraints) have the potential to be a barrier or an enabler, and is largely dependent on end-user needs being met and clinical context being appropriately addressed. CONCLUSIONS A digital intervention incorporating clinical decision support was viewed favourably, indicating a possible role for such a tool in Australian general practice. Co-design with end-users and prototype evaluation with health consumers is recommended to ensure relevance and usefulness.
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Affiliation(s)
- Melis Gezer
- Melbourne School of Population & Global Health, The University of Melbourne, Carlton, Vic., Australia
| | - Barbara Hunter
- Department of General Practice, The University of Melbourne, Melbourne, Vic., Australia
| | - Jane S Hocking
- Melbourne School of Population & Global Health, The University of Melbourne, Carlton, Vic., Australia
| | | | - Jane L Goller
- Melbourne School of Population & Global Health, The University of Melbourne, Carlton, Vic., Australia
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2
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Milton S, McIntosh J, Boyd L, Karnchanachari N, Macrae F, Emery JD. Commentary: Pivoting during a pandemic: developing a new recruitment model for a randomised controlled trial in response to COVID-19. Trials 2021; 22:605. [PMID: 34496930 PMCID: PMC8424147 DOI: 10.1186/s13063-021-05567-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Many non-COVID-19 trials were disrupted in 2020 and either struggled to recruit participants or stopped recruiting altogether. In December 2019, just before the pandemic, we were awarded a grant to conduct a randomised controlled trial, the Should I Take Aspirin? (SITA) trial, in Victoria, the Australian state most heavily affected by COVID-19 during 2020. MAIN BODY We originally modelled the SITA trial recruitment method on previous trials where participants were approached and recruited in general practice waiting rooms. COVID-19 changed the way general practices worked, with a significant increase in telehealth consultations and restrictions on in person waiting room attendance. This prompted us to adapt our recruitment methods to this new environment to reduce potential risk to participants and staff, whilst minimising any recruitment bias. We designed a novel teletrial model, which involved calling participants prior to their general practitioner appointments to check their eligibility. We delivered the trial both virtually and face-to-face with similar overall recruitment rates to our previous studies. CONCLUSION We developed an effective teletrial model which allowed us to complete recruitment at a high rate. The teletrial model is now being used in our other primary care trials as we continue to face the impacts of the COVID-19 pandemic.
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Affiliation(s)
- Shakira Milton
- Centre for Cancer Research, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- Department of General Practice, University of Melbourne, Melbourne, Australia.
| | - Jennifer McIntosh
- Department of General Practice, University of Melbourne, Melbourne, Australia
- HumaniSE Lab, Department of Software Systems and Cybersecurity, Monash University, Melbourne, Victoria, Australia
| | - Lucy Boyd
- Centre for Cancer Research, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Finlay Macrae
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - Jon David Emery
- Centre for Cancer Research, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
- The Primary Care Unit, University of Cambridge, Cambridge, UK
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3
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Wood A, Braat S, Temple-Smith M, Lorch R, Vaisey A, Guy R, Hocking J. A chlamydia education and training program for general practice nurses: reporting the effect on chlamydia testing uptake. Aust J Prim Health 2021; 27:36-42. [PMID: 33526167 DOI: 10.1071/py20056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
The long-term health consequences of untreated chlamydia are an increased risk of pelvic inflammatory disease, ectopic pregnancies and infertility among women. To support increased chlamydia testing, and as part of a randomised controlled trial of a chlamydia intervention in general practice, a chlamydia education and training program for general practice nurses (GPN) was developed. The training aimed to increase GPNs' chlamydia knowledge and management skills. We compared the difference in chlamydia testing between general practices where GPNs received training to those who didn't and evaluated acceptability. Testing rates increased in all general practices over time. Where GPNs had training, chlamydia testing rates increased (from 8.3% to 19.9% (difference=11.6%; 95% CI 9.4-13.8)) and where GPNs did not have training (from 7.4% to 18.0% (difference=10.6%; 95% CI 7.6-13.6)). By year 2, significantly higher testing rates were seen in practices where GPNs had training (treatment effect=4.9% (1.1 - 8.7)), but this difference was not maintained in year 3 (treatment effect=1.2% (-2.5 - 4.9)). Results suggest a GPN chlamydia education and training program can increase chlamydia testing up to 2 years; however, further training is required to sustain the increase beyond that time.
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Affiliation(s)
- Anna Wood
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3053, Australia
| | - Rebecca Lorch
- South Eastern Sydney LHD HIV and Related Programs (HARP) Unit, Sydney, NSW 2010, Australia
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
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4
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Chen X, Gan Y, Chang D, Mi X, Liu D. Availability of Chlamydia trachomatis Testing and Its Importance in the Surveillance of Genital Chlamydial Infection. Jpn J Infect Dis 2020; 74:209-213. [PMID: 33132299 DOI: 10.7883/yoken.jjid.2020.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The reported prevalence of genital Chlamydia trachomatis infection (GCTI) is much lower in low-income countries than that in high-income countries. This study surveyed the prevalence of GCTI in 456 hospitals in Shandong province, China in December 2018. Among the hospitals surveyed, antigen testing, PCR testing, and either antigen or PCR testing were available in 200 (43.9%), 88 (19.3%), and 268 (58.8%) hospitals, respectively. PCR testing was more available in tertiary hospitals than in primary and secondary hospitals (χ2 = 28.560, P = 0.000). Significant differences were observed in the availability of antigen testing (χ2 = 15.708, P = 0.003), PCR testing (χ2 = 22.494, P = 0.000), and either antigen or PCR testing (χ2 = 21.729, P = 0.000) among different types of hospitals. In 2018, 1532 cases of GCTI were reported in 99 hospitals. Tertiary hospitals reported more cases than those in primary and secondary hospitals (χ2 = 24.082, P = 0.000). The distribution of different types of hospitals that reported GCTI cases was consistent with that of hospitals that provided laboratory testing for GCTI. Antigen and PCR testing were only available in 200 (43.9%) and 88 (19.3%) hospitals, respectively. The results highlighted that the availability of laboratory testing for GCTI in Shandong province was poor, suggesting that the prevalence of GCTI in the province had been sorely underestimated.
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Affiliation(s)
- Xinlong Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, China.,Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Yanling Gan
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Degui Chang
- Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Xiongfei Mi
- Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Dianchang Liu
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
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Ford BK, Kong M, Ward JS, Hocking JS, Fairley CK, Donovan B, Lorch R, Spark S, Law M, Kaldor J, Guy R. Incomplete recording of Indigenous identification status under-estimates the prevalence of Indigenous population attending Australian general practices: a cross sectional study. BMC Health Serv Res 2019; 19:567. [PMID: 31412854 PMCID: PMC6693211 DOI: 10.1186/s12913-019-4393-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions. Recording of patients' Indigenous status in general practice records supports equitable delivery of effective clinical services. National policy and accreditation standards mandate recording of Indigenous status in patient records, however for a large proportion of general practice patient records it remains incomplete. We assessed the completeness of Indigenous status in general practice patient records, and compared the patient self-reported Indigenous status to general practice medical records. METHODS A cross sectional analysis of Indigenous status recorded at 95 Australian general practices, participating in the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) in 2011. Demographic data were collected from medical records and patient surveys from 16 to 29 year old patients at general practices, and population composition from the 2011 Australian census. General practitioners (GPs) at the same practices were also surveyed. Completeness of Indigenous status in general practice patient records was measured with a 75% benchmark used in accreditation standards. Indigenous population composition from a patient self-reported survey was compared to Indigenous population composition in general practice records, and Australian census data. RESULTS Indigenous status was complete in 56% (median 60%, IQR 7-81%) of general practice records for 109,970 patients aged 16-29 years, and Indigenous status was complete for 92.5% of the 3355 patients aged 16-29 years who completed the survey at the same clinics. The median proportion per clinic of patients identified as Indigenous was 0.9%, lower than the 1.8% from the patient surveys and the 1.7% in clinic postcodes (ABS). Correlations between the proportion of Indigenous people self-reporting in the patient survey (5.2%) compared to status recorded in all patient records (2.1%) showed a fair association (r = 0.6468; p < 0.01). After excluding unknown /missing data, correlations weakened. CONCLUSIONS Incomplete Indigenous status records may under-estimate the true proportion of Indigenous people attending clinics but have higher association with self-reported status than estimates which exclude missing/unknown data. The reasons for incomplete Indigenous status recording in general practice should be explored so efforts to improve recording can be targeted and strengthened. TRIAL REGISTRATION ACTRN12610000297022 . Registered 13th April 2010.
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Affiliation(s)
- Belinda K Ford
- Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.
| | - Marlene Kong
- Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - James S Ward
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Monash University Central Clinical School and Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Basil Donovan
- Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Rebecca Lorch
- Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Simone Spark
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew Law
- Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - John Kaldor
- Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Rebecca Guy
- Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
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Stephens N, Coleman D, Shaw K, Sullivan MO, McGregor A, Cooley L, Vally H, Venn A. Testing for chlamydial infection: are we meeting clinical guidelines? Evidence from a state-level laboratory data linkage analysis for 15- to 29-year-olds. Sex Health 2019; 14:507-513. [PMID: 28610650 DOI: 10.1071/sh16146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 04/09/2017] [Indexed: 11/23/2022]
Abstract
Background Clinical guidelines recommend annual chlamydia tests for all sexually active people aged 15-29 years. This study measured adherence to these guidelines and compared testing rates to the projected levels required to reduce chlamydia prevalence. METHODS All chlamydia tests conducted in Tasmania during 2012-13, for residents aged 15-29 years, were linked. Data linkage allowed individuals who had multiple tests across different healthcare settings to be counted only once each year in analyses. Rates of testing and test positivity by age, sex, rebate status and socioeconomic indicators were measured. RESULTS There were 31899 eligible tests conducted in 24830 individuals. Testing coverage was higher in females (21%, 19404/92685) than males (6%, 5426/98123). Positivity was higher in males (16%, 862/5426) than females (10%, 1854/19404). Most tests (81%, 25803/31899) were eligible for a rebate. Positivity was higher in females with non-rebatable tests (12%, 388/3116 compared with those eligible for a rebate (9%, 1466/16285). More testing occurred in areas of middle disadvantage (10%, 9688/93678) compared with least (8%, 1680/21670) and most (10%, 7284/75460) (both P<0.001) disadvantaged areas. Higher test positivity was found in areas of most-disadvantage (11%, 822/7284) compared with middle- (10%, 983/9688) and least- (8%, 139/1680) disadvantaged areas. CONCLUSIONS Chlamydia testing rates are lower than recommended levels. Sustaining the current testing rates in females aged 20-24 years may reduce population prevalence within 10 years. This study meets key priorities of national strategies for chlamydia control by providing a method of monitoring testing coverage and evidence to evaluate prevention programs.
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Affiliation(s)
- Nicola Stephens
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia
| | - David Coleman
- Communicable Diseases Prevention Unit, Public Health Services, Department of Health and Human Services, Argyle Street, Hobart, Tas. 7000, Australia
| | - Kelly Shaw
- Primary Health Tasmania, 15 Victoria Street, Hobart, Tas. 7000, Australia
| | - Maree O' Sullivan
- Gold Coast Hospital and Health Service, Queensland Health, 1 Hospital Boulevard, Southport, Qld 4215, Australia
| | | | - Louise Cooley
- Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tas. 7000, Australia
| | - Hassan Vally
- Faculty of Health Sciences, La Trobe University, 360 Collins Street, Melbourne, Vic. 3000, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tas. 7000, Australia
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7
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Test of cure, retesting and extragenital testing practices for Chlamydia trachomatis and Neisseria gonorrhoeae among general practitioners in different socioeconomic status areas: A retrospective cohort study, 2011-2016. PLoS One 2018. [PMID: 29538469 PMCID: PMC5851648 DOI: 10.1371/journal.pone.0194351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background For Chlamydia trachomatis (CT), a test of cure (TOC) within 3–5 weeks is not recommended. International guidelines differ in advising a Neisseria gonorrhoeae (NG) TOC. Retesting CT and NG positives within 3–12 months is recommended in international guidelines. We assessed TOC and retesting practices including extragenital testing in general practitioner (GP) practices located in different socioeconomic status (SES) areas to inform and optimize local test practices. Methods Laboratory data of 48 Dutch GP practices between January 2011 and July 2016 were used. Based on a patient’s first positive CT or NG test, the proportion of TOC (<3 months) and retests (3–12 months) were calculated. Patient- and GP-related factors were assessed using multivariate logistic regression analyses. Results For CT (n = 622), 20% had a TOC and 24% had a retest at the GP practice. GP practices in low SES areas were more likely to perform a CT TOC (OR:1.8;95%CI:1.1–3.1). Younger patients (<25 years) were more likely to have a CT TOC (OR:1.6;95%CI:1.0–2.4). For CT (n = 622), 2.4% had a TOC and 6.1% had a retest at another STI care provider. For NG (n = 73), 25% had a TOC and 15% had a retest at the GP practice. For NG (n = 73), 2.7% had a TOC and 12.3% had a retest at another STI care provider. In only 0.3% of the consultations patients were tested on extragenital sites. Conclusion Almost 20% of the patients returned for a CT TOC, especially at GP practices in low SES areas. For NG, 1 out of 4 patients returned for a TOC. Retesting rates were low for both CT (24%) and NG (15%), (re)infections including extragenital infections may be missed. Efforts are required to focus TOC and increase retesting practices of GPs in order to improve CT/NG control.
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8
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Stephens N, Coleman D, Shaw K, Venn A. Geographical differences in Chlamydia trachomatis testing in 15-29 year-olds in Tasmania: Findings from a statewide laboratory data linkage study. Aust J Rural Health 2016; 25:182-184. [PMID: 27600207 DOI: 10.1111/ajr.12316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nicola Stephens
- Victorian Department of Health and Human Services, Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Melbourne, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - David Coleman
- Tasmanian Department of Health and Human Services, Communicable Diseases Prevention Unit, Hobart, Tasmania, Australia
| | - Kelly Shaw
- Primary Health Tasmania, Hobart, Tasmania, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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9
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Dukers-Muijrers NHTM, Wolffs PFG, Eppings L, Götz HM, Bruisten SM, Schim van der Loeff MF, Janssen K, Lucchesi M, Heijman T, van Benthem BH, van Bergen JE, Morre SA, Herbergs J, Kok G, Steenbakkers M, Hogewoning AA, de Vries HJ, Hoebe CJPA. Design of the FemCure study: prospective multicentre study on the transmission of genital and extra-genital Chlamydia trachomatis infections in women receiving routine care. BMC Infect Dis 2016; 16:381. [PMID: 27502928 PMCID: PMC4977887 DOI: 10.1186/s12879-016-1721-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/15/2016] [Indexed: 11/17/2022] Open
Abstract
Background In women, anorectal infections with Chlamydia trachomatis (CT) are about as common as genital CT, yet the anorectal site remains largely untested in routine care. Anorectal CT frequently co-occurs with genital CT and may thus often be treated co-incidentally. Nevertheless, post-treatment detection of CT at both anatomic sites has been demonstrated. It is unknown whether anorectal CT may play a role in post-treatment transmission. This study, called FemCure, in women who receive routine treatment (either azithromycin or doxycycline) aims to understand the post-treatment transmission of anorectal CT infections, i.e., from their male sexual partner(s) and from and to the genital region of the same woman. The secondary objective is to evaluate other reasons for CT detection by nucleic acid amplification techniques (NAAT) such as treatment failure, in order to inform guidelines to optimize CT control. Methods A multicentre prospective cohort study (FemCure) is set up in which genital and/or anorectal CT positive women (n = 400) will be recruited at three large Dutch STI clinics located in South Limburg, Amsterdam and Rotterdam. The women self-collect anorectal and vaginal swabs before treatment, and at the end of weeks 1, 2, 4, 6, 8, 10, and 12. Samples are tested for presence of CT-DNA (by NAAT), load (by quantitative polymerase chain reaction -PCR), viability (by culture and viability PCR) and CT type (by multilocus sequence typing). Sexual exposure is assessed by online self-administered questionnaires and by testing samples for Y chromosomal DNA. Using logistic regression models, the impact of two key factors (i.e., sexual exposure and alternate anatomic site of infection) on detection of anorectal and genital CT will be assessed. Discussion The FemCure study will provide insight in the role of anorectal chlamydia infection in maintaining the CT burden in the context of treatment, and it will provide practical recommendations to reduce avoidable transmission. Implications will improve care strategies that take account of anorectal CT. Trial registration ClinicalTrials.gov Identifier: NCT02694497.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands. .,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
| | - Petra F G Wolffs
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Lisanne Eppings
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Hannelore M Götz
- Department Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond (GGD Rotterdam), Rotterdam, The Netherlands.,National Institute of Public Health and the Environment (RIVM), Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sylvia M Bruisten
- Public Health Laboratory, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Kevin Janssen
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Mayk Lucchesi
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Titia Heijman
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - Birgit H van Benthem
- National Institute of Public Health and the Environment (RIVM), Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Jan E van Bergen
- National Institute of Public Health and the Environment (RIVM), Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Department of General Practice, Academic Medical Centre, Amsterdam, The Netherlands.,STI AIDS Netherlands (SOA AIDS Nederland), Amsterdam, The Netherlands
| | - Servaas A Morre
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos Herbergs
- DNalysis Maastricht, Maastricht, The Netherlands
| | - Gerjo Kok
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Mieke Steenbakkers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands
| | - Arjan A Hogewoning
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - Henry J de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.,STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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