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 for the practice nurse led strategy and £32.62 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 health adviser at a genitourinary medicine clinic, and costs the same.