'Test n Treat' (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges

P Oakeshott; S Kerry-Barnard; C Fleming; R Phillips; V M Drennan; E J Adams; W Majewska; E M Harding-Esch; E C Cousins; T Planche; A Green; R I Bartholomew; S T Sadiq; F Reid

doi:10.1016/j.cmi.2018.10.019

'Test n Treat' (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges

Clin Microbiol Infect. 2019 Jul;25(7):865-871. doi: 10.1016/j.cmi.2018.10.019. Epub 2018 Nov 1.

Authors

P Oakeshott¹, S Kerry-Barnard², C Fleming², R Phillips³, V M Drennan⁴, E J Adams⁵, W Majewska⁶, E M Harding-Esch⁷, E C Cousins⁸, T Planche⁸, A Green², R I Bartholomew⁹, S T Sadiq⁸, F Reid³

Affiliations

¹ Population Health Research Institute, St George's, University of London, London UK. Electronic address: oakeshot@sgul.ac.uk.
² Population Health Research Institute, St George's, University of London, London UK.
³ School of Population Health and Environmental Sciences, King's College London, London, UK.
⁴ Centre for Health & Social Care Research, Kingston University & St George's, University of London, London, UK.
⁵ Aquarius Population Health Limited, London, UK.
⁶ WEM Consultancy Ltd, London, UK.
⁷ Institute for Infection and Immunity, St George's, University of London, London, UK; Public Health England, London, UK.
⁸ Institute for Infection and Immunity, St George's, University of London, London, UK.
⁹ Population Health Research Institute, St George's, University of London, London UK; Institute for Infection and Immunity, St George's, University of London, London, UK.

PMID: 30391581
DOI: 10.1016/j.cmi.2018.10.019

Abstract

Objectives: We conducted a cluster-randomized feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment ('Test n Treat/TnT') in six technical colleges in London, England, to assess TnT uptake rates; follow-up rates; prevalence of C. trachomatis at baseline and 7 months; time to treatment; acceptability of TnT.

Methods: Participants completed questionnaires and provided genitourinary samples at baseline and 7 months. Participants were informed that baseline samples would not be tested for 7 months and were advised to get screened independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control (no TnT). One month and 4 months post recruitment, participants at intervention colleges were texted invitations for on-site free C. trachomatis tests. A purposive sample of students who did/did not attend for screening were interviewed (n = 26).

Results: Five hundred and nine sexually active students were recruited: median age 17.9 years, 47% male, 50% black ethnicity, 55% reporting two or more sexual partners in the previous year. TnT uptake was 13% (33/259; 95% CI 8.9-17.4%) at 1 month and 10% (26/259; 6.7-14.4%) at 4 months with overall C. trachomatis positivity 5.1% (3/59; 1.1-14.2%). Follow-up at 7 months was 62% (317/509) for questionnaires and 52% (264/509) for samples. C. trachomatis prevalence was 6.2% (31/503) at baseline and 6.1% (16/264) at 7 months. Median time from test to treatment was 15 h. Interviews suggested low test uptake was associated with not feeling at risk, perceptions of stigma, and little knowledge of sexually transmitted infections (STIs).

Conclusions: Despite high C. trachomatis rates at baseline and follow-up, uptake of testing was low. Like many countries, England urgently needs better sex education, including making STI testing routine/normal. Trial registration ISRCTN58038795.

Keywords: Cluster randomized; Feasibility trial; Rapid C. trachomatis tests; Screening; Technical colleges; Test and treat; Young people.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Chlamydia Infections / diagnosis*
Chlamydia Infections / drug therapy*
Chlamydia Infections / epidemiology
Chlamydia trachomatis / isolation & purification*
Diagnostic Screening Programs
Ethnicity
Feasibility Studies
Female
Humans
London / epidemiology
Male
Prevalence
Risk Factors
Sexual Behavior
Sexual Partners
Sexually Transmitted Diseases / diagnosis*
Sexually Transmitted Diseases / drug therapy*
Sexually Transmitted Diseases / epidemiology
Students
Surveys and Questionnaires
Time-to-Treatment
Young Adult

Grants and funding

G0901608/MRC_/Medical Research Council/United Kingdom