Impact of rapid near-patient STI testing on service delivery outcomes in an integrated sexual health service in the United Kingdom: a controlled interrupted time series study

Abstract

Objectives: To evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service.

Design: Controlled interrupted time series study.

Setting: Two integrated sexual health services (SHS) in UK: Unity Sexual Health in Bristol, UK (intervention site) and Croydon Sexual Health in London (control site).

Participants: Electronic patient records for all 58 418 attendances during the period 1 year before and 1 year after the intervention.

Intervention: Introduction of an in-clinic rapid testing system for gonorrhoea and chlamydia in combination with revised treatment pathways.

Outcome measures: Time-to-test notification, staff capacity, cost per episode of care and overall service costs. We also assessed rates of gonorrhoea culture swabs, follow-up attendances and examinations.

Results: Time-to-notification and the rate of gonorrhoea swabs significantly decreased following implementation of the new system. There was no evidence of change in follow-up visits or examination rates for patients seen in clinic related to the new system. Staff capacity in clinics appeared to be maintained across the study period. Overall, the number of episodes per week was unchanged in the intervention site, and the mean cost per episode decreased by 7.5% (95% CI 5.7% to 9.3%).

Conclusions: The clear improvement in time-to-notification, while maintaining activity at a lower overall cost, suggests that the implementation of clinic-based testing had the intended impact, which bolsters the case for more widespread rollout in sexual health services.

Keywords: Epidemiology; HEALTH ECONOMICS; SEXUAL MEDICINE.

Figure 1

Modelled outcome estimates for males. ‘Panther’ indicates the intervention date representing the first week the Panther system was implemented for the male pathway: 12 November 2018. (A) Gonorrhoea culture swabs (urethral) per consultation, (B) median time-to-notification, (C) examinations per symptomatic attendance, (D) follow-up attendances per episode.

Figure 2

Modelled outcome estimates for females. ‘Panther for females’ indicates the intervention date representing the first week the Panther system was implemented for the female pathway: 29 May 2019. (A) Gonorrhoea culture swabs (cervical) per consultation, (B) median time-to-notification, (C) examinations per symptomatic attendance, (D) follow-up attendances per episode.

Figure 3

Modelled estimates of staff capacity for males and females combined.