Sarah J. Martin

‘Show me the money’: financial incentives increase chlamydia screening rates among tertiary students: a pilot study

BACKGROUND We hypothesise that text-messaging and financial incentives would increase tertiary student participation in chlamydia screening. METHODS A cross-sectional study was conducted over two phases on eight tertiary campuses during 2007. During Phase 1 (6 months) study activities were advertised through student organisations and media. Education and screening were offered during a range of student activities. During Phase 2 (4 days) education and screening were offered via text messages. Non-financial incentives were offered during Phase 1 and a

Rectal chlamydia infection in women at high risk of chlamydia attending Canberra Sexual Health Centre

10 cash incentive was offered during Phase 2. Rates of specimens provided by students and the direct costs incurred during each phase were compared. RESULTS 2786 students attended the 31 activities conducted in Phase 1. Of these, 627 students (22.5%) provided urine specimens for chlamydia testing. During Phase 2, the dissemination of 866 text messages resulted in urine specimens from 392 students (45.3%). Costs per test were AUD

Screening for chlamydia and gonorrhoea in men who have sex with men in clinical and non-clinical settings.

175.11 in Phase 1 and AUD

Ethambutol toxicity manifesting as acute onset psychosis

27.13 in Phase 2. CONCLUSIONS Compared with more labour intensive (and therefore more expensive) screening activities conducted over a 6-month period, offering a small financial incentive to tertiary students through text messaging over a 4-day period significantly increased participation in on-campus chlamydia screening. This model could readily be applied to other populations to increase participation in chlamydia screening.

Community pharmacy and cash reward: a winning combination for chlamydia screening?

Chlamydia is the most commonly notified sexually transmitted infection in Australia. Australian guidelines recommend urogenital screening in asymptomatic men and women, and rectal screening in men who have sex with men or women reporting anal sex/symptoms. International studies describe a rectal chlamydia prevalence in women of 5% to 21%. We found that in women at high risk of chlamydia, 57% (32/56) tested positive for rectal chlamydia. Of these, 97% (31/32) had concurrent urogenital chlamydia. Women with urogenital chlamydia were significantly more likely to have a positive rectal result (χ2, p = 0.000). Neither anal symptoms nor reported anal sex were associated with a positive rectal chlamydia test. The recommended treatment of rectal chlamydia differs substantially from that of urogenital chlamydia, raising the possibility that Australian women are being regularly undertreated due to a lack of rectal testing. Untreated rectal chlamydia may increase the risk of persistent infection, reproductive tract reinfection, complications and transmission. Further work is needed to determine the optimal management of chlamydia in women.

Can pharmacy assistants play a greater role in public health programs in community pharmacies? Lessons from a chlamydia screening study in Canberra, Australia

BACKGROUND There are few published data on the rate of chlamydia and gonorrhoea infection in men who have sex with men (MSM). Our aim was to determine the rate of positive chlamydia and gonorrhoea tests in this population in the Australian Capital Territory (ACT). METHODS Results of all chlamydia and gonorrhoea tests generated by Canberra Sexual Health Centre between June 2001 and September 2003, including those from outreach clinics, were reviewed (audit one). Between September 2003 and April 2004, Canberra Sexual Health Centre outreach program staff and a general practitioner with a high caseload of MSM offered screening of the throat, urethra and rectum to all MSM, irrespective of their reported participation in unprotected anal intercourse. Chlamydia and gonorrhoea test results generated during this period were reviewed (audit two). RESULTS In the first audit, 1086 specimens from 314 individuals were tested and 30/314 (9.6%, 95% CI 6.6-13.4) men were positive for chlamydia in one or more anatomical site. A total of 306 specimens from 118 individuals were tested for gonorrhoea. Of these, eight (6.8%, 95% CI 3.0-12.9) individuals tested positive. In the second audit, 16 of 157 men (10.2%, 95% CI 9.5-16.0) tested positive for chlamydia and 4/155 (2.6%, 95% CI 0.7-6.5) tested positive for gonorrhoea. The rectum was the most commonly infected anatomical site for both infections. The overall proportions of positive chlamydia and gonorrhoea tests were 36/471 (7.6%, 95% CI 5.4-10.4) and 12/273 (4.4%, 95% CI 2.2-7.6) respectively. CONCLUSIONS These data, collected in a range of settings, indicate high rates of chlamydia and gonorrhoea in MSM in the ACT and provide support for annual testing, particularly of the rectum, in this population.

Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic.

Ethambutol is commonly used for the treatment of tuberculous and atypical mycobacterial infection. Central nervous system (CNS) toxicity other than optic neuropathy is not widely reported. A 40-year-old man with advanced HIV infection and Mycobacterium avium complex infection experienced rapid cognitive decline after commencement of ethambutol, and symptoms fully resolved with cessation.

'Catching chlamydia': combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people

Objectives To date, the uptake of chlamydia screening in community pharmacies has been limited. The objective of this cross-sectional study was to determine if a cash reward, offered to both the provider and the consumer of chlamydia screening, increased the uptake of screening in community pharmacies. Methods During 4 weeks in 2011, chlamydia screening and education were offered in four city and two suburban pharmacies to people aged 16–30 years. Those who provided a urine sample for testing, contact details, and completed a brief questionnaire were rewarded with

Do cash incentives increase the uptake of chlamydia testing in pharmacies

A10. Positive participants, and their nominated contacts, were offered treatment. Results Over a period of 751.5 h, 979 testing kits were requested, and 900 (93%) urine samples returned. Using probabilistic linkage methods, we determined that 671/900 (75%) urine samples were from unique individuals. 0.9 unique samples were obtained/hour of screening, 63% of which were provided by men. 19/671 (2.8%; 95% CI 1.7% to 4.4%) people tested positive, 5.2% (95% CI 2.8% to 8.8%) of women, and 1.4% (1.4 0.5 to 3.1) of men. 11/19 (58%) people were contacted and treated—two for suspected pelvic inflammatory disease. Conclusions Providing a cash reward to encourage chlamydia screening in community pharmacies resulted in greater participation rates than previously reported pharmacy-based studies, particularly among men. Easily implemented mechanisms to reduce inappropriate repeat screening, incorrect contact details and effects on pharmacy work flow may enhance the efficiency of this approach.

Screening for hepatitis C in sexual health clinic attendees

BACKGROUND Little is known about the engagement of pharmacy assistants (PA) in public health service provision. OBJECTIVE To explore the experiences of PA participating in a study to determine whether a cash reward, offered to consumers and pharmacy businesses, increased participation in community pharmacy-based chlamydia screening. METHODS PA experience of the study education and training package, participant recruitment and conducting screening (providing information about chlamydia, specimen collection and handling urine samples) were evaluated using knowledge assessment, a questionnaire and focus groups. RESULTS Twenty PA participated in the study: 15 (75%) completed all education and training components, 20 (100%) completed the questionnaire and 10 (50%) attended a focus group. PA rated all education and training components as effective (mean visual analog scale scores >8.5). Most PA (13/18, 72.2%) did not support/were unsure about continuing the program, citing the 25% repeat testing rate (presumed to relate to the cash reward) and privacy/confidentiality issues as reasons. Qualitative analysis suggested that minimizing repeat testing, improved workload management and recognition of, and remuneration for, education and training would make this model more acceptable to PA. CONCLUSION Findings from this study support the assertion that PA can play a significant role in public health initiatives.