Accelerated partner therapy contact tracing for people with chlamydia: The LUSTRUM cluster cross-over randomised controlled trial
Authors:   Core writing group, Estcourt Claudia S , Copas Andrew , Low Nicola , Mapp Fiona , Stirrup Oliver ,   the LUSTRUM research programme, Cassell Jackie 
Published: August 2021

Objective

To assess accelerated partner therapy (APT) as a contact tracing intervention for people with chlamydia.

Design

Cross-over cluster-randomised controlled trial.

Setting

17 sexual health clinics (clusters) in the United Kingdom, 2018-2019.

Participants

Heterosexual people aged over 16 years with a positive Chlamydia trachomatis test result and/or clinical diagnosis of pelvic inflammatory disease, cervicitis, non-gonococcal urethritis or epididymo-orchitis, and reporting one or more contactable sexual partner in the past six months, and their sexual partners.

Interventions

Clusters were assigned by random permutation to either (a) usual care: health care professional advises the index patient to tell their sex partner(s) to attend clinic for sexually transmitted infection (STI) screening and treatment, or (b) usual care plus the offer of APT: healthcare professional assesses sex partner(s) by telephone, then sends or gives the index patient antibiotics and STI self-sampling kits for their sex partner(s). After a two-week washout period, clinics crossed over to the opposite exposure. Each period lasted 6 months.

Main outcome measures

The primary outcome was the proportion of index patients with a positive C. trachomatis test 12-24 weeks after treatment. Secondary outcomes included proportions and types of sex partners treated.

Analysis

Intention-to-treat, fitting random effects logistic regression models.

Results

All clinics completed both periods. Overall, 1536 and 1724 recruited index patients provided data in intervention and control phases respectively. In total, 4807 sex partners were reported, of whom 1636 (34%) were committed/established partners. Overall, 293/1536 (19.1%) of index patients chose APT for a total of 305 partners, of whom 248 accepted. In intervention and control phases, 666 (43%) and 800 (46%) of index patients were tested for C. trachomatis at 12-24 weeks; 31 (4.7%) and 53 (6.6%) were positive, adjusted odds ratio (aOR) 0.66 (95% CI 0.41–1.04, p=0.07). Among index patients with treatment status recorded, the proportion with ≥1 sex partner treated was 775 (88.0%) in the intervention and 760 (84.6%) in the control phase, aOR 1.27 (95% CI 0.96–1.68, p=0.10). Seven adverse events of low severity were recorded.

Conclusions

APT can be safely offered as a contact tracing option for people with C. trachomatis and might reduce the risk of repeat infection. Future research should find ways to increase uptake and develop alternative interventions for one-off partners.

Trial registration

ISRCTN15996256

Ethical approval

London - Chelsea Research Ethics Committee (18/LO/0773)

Protocol

doi: 10.1136/bmjopen-2019-034806

What is already known on this topic

Contact tracing (partner notification) for chlamydia is a key element of infection control in the population but achieving even modest outcomes can be challenging.

Accelerated partner therapy (APT) is a contact tracing intervention that provides testing and treatment for sex partners without the need for a face-to-face consultation.

Pilot studies of APT found improvements in patient-reported outcomes of contact tracing but evidence about biological outcomes is required and the types of sexual partnerships benefitting most from APT are unknown.

What this study adds

The offer of APT as an additional contact tracing method to usual care likely caused a small reduction in repeat chlamydia infection 12-24 weeks after treatment and an increase in proportion of sex partners treated, compared with usual care alone.

APT can be safely offered as a cost-saving contact tracing option for heterosexual people with chlamydia and might reduce the risk of repeat infection, particularly for those in emotionally connected relationships, although uptake needs to be improved and novel approaches are needed for one-off partners.