The impact of rapid near-patient STI testing on service delivery outcomes: a controlled interrupted time series study

Abstract

AbstractObjectivesTo evaluate the impact of a new clinic-based rapid STI testing, diagnosis and treatment service on healthcare delivery and resource needs in a sexual health service.DesignControlled interrupted time series study.SettingTwo sexual health services in UK: Unity Sexual Health in Bristol, UK (main site) and Croydon Sexual Health in London (control site).ParticipantsElectronic patient records for all attendances during the period one year before and one year after the intervention.InterventionIntroduction of an in-clinic rapid testing system for gonorrhoea and chlamydia in combination with revised treatment pathways.Outcome measuresTime-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.ResultsTime-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 Unity SHS, and the mean cost per episode decreased by 7.5% (95%CI 5.7%, 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 in parallel to postal testing kits had the intended impact, which bolsters the case for more widespread rollout in SHS.Strengths and limitations of this studyWe used controlled interrupted time series models with confounder adjustment to estimate the effect of the intervention distinct from any background changes and independent of other time varying factors.Model validity was bolstered by using a relatively long time series with good temporal resolution.Data from both the main and control sites was derived from the same electronic patient record system.There was a general consensus between main and sensitivity analyses.Our study was limited by being non-randomised, having only one control site, and the follow up period for females being truncated by the impact of the Covid-19 pandemic.