Partner notification of chlamydia infection in primary care: randomised controlled trial and analysis of resource use

Objective To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of people with chlamydia infection. Design Randomised controlled trial. Setting 27 general practices in the Bristol and Birmingham areas. Participants 140 men and women with chlamydia (index cases) diagnosed by screening of home collected urine sample or vulval swab specimen. Interventions Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow-up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic. Main outcome measures Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for chlamydia six weeks after treatment, and the cost of each strategy in 2003 pounds sterling prices. Results 65.3% (47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9% (39/68) of those referred to a genitourinary medicine clinic (risk difference 12.4%, 95% confidence interval - 1.8% to 26.5%). Of 68 participants referred to the clinic, 21 (31%) did not attend. The costs per index case were 32.55 pound for the practice nurse led strategy and 32.62 pound for the referral strategy. Conclusion Practice based partner notification by trained nurses with telephone follow-up by health advisers is at least as effective as referral to a specialist