18 months on: an interrupted time series analysis investigating the effect of COVID-19 on chlamydia and gonorrhoea testing and test positivity at the Gold Coast, Australia

BACKGROUND

STI rates have been reported as reduced during the height of the COVID-19 pandemic. Our study evaluates the number of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections recorded relative to the number of tests performed in 2017-2021, thus accurately depicting trends over time and evaluate the effect of COVID-19 restrictions since these were implemented in March 2020.

METHODS

Data was extracted from an electronic database of pathology and clinical records used at Gold Coast Sexual Health Service (GCSHS) in Queensland, Australia from January 2017 to October 2021. Poisson regression-based interrupted time series analyses were performed for number of tests performed and test positivity over the study period. The COVID-19 period was defined as starting from March 2020 when public health directives were implemented.

RESULTS

CT and NG testing dropped significantly in the month after COVID-19 restrictions were brought in, by 30% and 23% respectively. Over the 5year study period, the proportion of positive CT tests has consistently decreased by approximately 0.33% points per year (P≤0.001). The instigation of COVID-19 restrictions had no effect on this trend. The proportion of NG positive tests remained steady prior to COVID-19 (P=0.96) at approximately 3.5%, decreased immediately at the onset of COVID-19 restrictions to approximately 2.5% (P<0.001) and has remained at this level post-COVID restrictions (P=0.54). Testing at GCSHS continued to target gay and bisexual men, accounting for ≥50% of all tests performed.

CONCLUSION

Our study suggests that there has been a sustained reduction in test positivity of NG infections in the 18months since COVID-19 restrictions were implemented, and that this is not an artifact of reduced testing. It highlights the importance of maintaining health messaging including screening for sexually transmissible infections and maintaining access to services, which may include alternative models of care such as Telehealth, self-testing and collaboration between all sexual health service providers.

The adequacy of consent forms for informing patients entering oncological clinical trials

The impact on 100 patients of information and consent forms signed prior to medical oncology clinical trials was evaluated by a survey at a subsequent visit. Only 40 patients believed that the purpose of the form was to explain the treatment. The form was listed as the major source of information by 12 patients while 52 listed a doctor and 26 a nurse. Although 21 patients believed that the form mad them less anxious, 19 patients believed that it made them more anxious. Despite 80 patients reading all of the form, 60 claiming to understand all of it and 68 claiming that in contained adequate information, in tests of recall only 52 patients could name all of their drugs and only 4 all of the side effects. The number of drugs named correlated with how much of the consent form had been read (p = 0.003) and the highest education level achieved by the patient (p = 0.0003). Patients under 55 years had significantly better recall. Patients with a better ECOG performance status were more likely to find the form very helpful. Such forms may not ensure that the requirements for informed consent are satisfied.