Title: The BALLSEYE Program: Targeting men for better sexual health
Funder: Department of Health (England)

Abstract: The BALLSEYE PROGRAM aims to to improve the sexual health of young men in the UK by: resolving an evidence gap in strategies for STI diagnosis, using mathematical modeling and health economic analysis, to determine an optimal STI screening algorithm for asymptomatic men (Study 1); implementing new methods for rapid treatment of male sex partners of people with STIs in primary care (Study 2); determining methods of engaging men in effective STI control activity including pilot of a novel model for promotion of STI testing by football trainers (Study 3). Objectives: 1. to develop an evidence based clinical algorithm for STI testing in asymptomatic men 2. to model mathematically the epidemiological and economic impact of removing microscopy from routine STI testing in asymptomatic men 3. to implement & evaluate Accelerated Partner Therapy (APT: new models of partner notification to rapidly contact and treat male sex partners of people with STIs) in primary care, empirically and with mathematical models 4. to develop, pilot & evaluate a feasible, replicable intervention to deliver football trainer-led, STI screening targeting young men (SPORTSMART) Background: STIs are increasing in young men. Efforts to reduce transmission have failed and the impact of STIs in society is growing1 The burden of STI related disease is in women of reproductive age although the prevalence of chlamydia in men & women is similar. The annual NHS costs of untreated chlamydial infection are around £100 million. The White Paper Choosing Health sets out the importance of STIs at national level2 and led to the National Chlamydia Screening Programme (NCSP)3. However, chlamydia screening uptake in men is poor 3,4. NICE Guidance on Partner Notification recently emphasized the need to improve PN5 but did not specify standards for content or delivery6. PN and management of men with STIs in primary care is often poor7. National guidance for STI screening of asymptomatic men has changed8. The evidence for and cost-effectiveness of this new approach is questioned 9,10,11. This proposal addresses the major areas of uncertainty in the evidence-based delivery of STI care for men set out above and prioritized by the NHS. Research plans: Study 1: Impact of different clinical approaches to STI testing in men: a modeling study & economic evaluation Phase 1. Comparison of factors associated with asymptomatic non-chlamydial, non-gonococcal microscopic urethritis to develop a clinical algorithm for STI testing in men Phase 2: Mathematical modeling and health economics analysis of the implications of abandoning microscopy of urethral smears in asymptomatic men compared with alternative strategies which ensure better uptake of chlamydia and gonorrhoea screening. Study 2: The delivery of a modern, evidence-based approach to STI partner notification for men in primary care: (APT Primary Care) Phase 1: Development of a web-based tool to support the APT patient pathway in the primary care setting. Phase 2: Implementation and formal evaluation of the new APT pathway Study 3: Development and evaluation of the disease control potential of a model for testing young men at high risk of STI in a sports setting: The SPORTSMART Study Phase 1: Random probability survey of men’s sexual health care usage and leisure & sporting activities Phase 2: Feasibility pilot and integrated evaluation of the SPORTSMART interventions Research team & environment: Applicants are senior researchers with a combined current grant income of around £5million. Our existing collaborative links underpin the study. We have published extensively in sexual health service research. Barts and the London NHS Trust (BLT) will host this research working closely with East Sussex Downs and Weald PCT and Brighton and Sussex Medical School. Impact: The BALLSEYE PROGRAM will improve the sexual health of young men in the UK through: 1. Evaluation of the public health & economic impact of different clinical approaches to STI screening in men to inform national screening policy 2. Development of an evidence based algorithm for STI screening of asymptomatic men to inform national clinical guidance 3. Provision of a robust web-based method for rapid partner notification in primary care which could be implemented nationally, in line with NICE recommendations. 4. Piloting and evaluating the disease control potential of a model for promotion of male STI screening by football trainers. This example of community-rooted involvement in STI screening and may reach men who would not otherwise use sexual health services & could provide a generalisable solution for other health promotion interventions in young men such as drug and alcohol awareness. Public involvement has already played a key role in our program and we will continue to engage with consumers at the design, conduct & dissemination stages to enhance the quality of the research.


Research activity codes: 4.3 INFLUENCES AND IMPACT;7.3 MANAGEMENT AND DECISION MAKING
Health categories: INFECTION