Kirby Institute Seminar Series presents
Head of the Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne
About your speaker
Professor Jane Hocking is an epidemiologist whose research interests include the epidemiology and control of sexually transmitted infections. She holds an NHMRC Senior Research Fellowship and is head of the Sexual Health Unit at the Melbourne School of Population and Global Health, University of Melbourne. She is especially interested in genital chlamydia and has generated Australia’s first population-based prevalence and incidence estimates of infection. She has designed and conducted several studies that aim to improve chlamydia testing uptake including an evaluation of a computer prompt reminding doctors to test for chlamydia, a trial of incentive payments for each test conducted by a doctor and implementing a chlamydia testing program in sporting clubs. She has recently completed the Australian Chlamydia Control Effectiveness Pilot, a cluster randomised controlled trial that aimed to determine whether annual chlamydia testing for 16 to 29 year old men and women in general practice leads to a reduction in chlamydia transmission in the population. She currently leads the Rectal Chlamydia Treatment Study—a world first trial comparing azithromycin with doxycycline for the treatment of rectal chlamydia infection.
Chlamydia is the most commonly diagnosed bacterial sexually transmitted infection in the developed world. A recent systematic review of chlamydia prevalence in young adults in high income countries estimated a pooled point prevalence of 3.6% (95%CI 2.4, 4.8) in women and 3.5% (95%CI 1.9, 5.2) in men. As over 80% of infections are asymptomatic, screening is the main way to detect cases. However, there is considerable debate about the effectiveness of chlamydia screening. In response to this concern, the Australian Government funded the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) to assess the feasibility, acceptability, efficacy and cost-effectiveness of annual chlamydia testing for sexually active 16 to 29 year old men and women attending general practice.
ACCEPt was evaluated using a cluster randomised controlled trial design. A total of 143 general practices in 52 geographical areas (clusters) across four Australian states participated. An intervention to support increased chlamydia testing including incentive payments for each test done, quarterly feedback on testing performance and computer prompts was allocated to all practices in the intervention group. The primary outcome was chlamydia prevalence measured before randomisation and again at the trial conclusion among a consecutive sample of eligible patients aged 16–29 years attending participating practices. Secondary outcomes included pelvic inflammatory disease incidence and annual chlamydia testing and re-testing rates. The fundamental premise of this trial was that increased levels of testing can be achieved by providing support to clinics, and that once levels of chlamydia testing are sufficiently increased, the prevalence of chlamydia will fall. Results from ACCEPt will be presented and future priorities for chlamydia control policy will be discussed.