GUM & primary care based STI services: Maximising STI control & cost-effectiveness for a population.

We aim to build a web-based tool to help public health decision-makers plan the most effective services for sexually transmitted infections (STIs) according to the characteristics of their local population.
 
Patients with STIs attend a variety of services, including specialist genitourinary medicine (GUM) clinics and primary care (including GP surgeries). In 2001, the government published the ‘National Strategy for Sexual Health and HIV‘. It proposed that, in future, more services for STIs should be provided in primary care. Since then, many areas have started to increase testing for, and treatment, of STIs by GPs and practice nurses. These services, usually called ‘Locally Enhanced Services’, vary considerably, and decision-makers and service commissioners have found it difficult to make appropriate local plans.
 
The aim of all STI services is to reduce the transmission of STIs as cost-effectively as possible. A number of factors influence how well this is achieved in local health economies e.g. the capacity of the services, the extent that the partners of people diagnosed with STIs are also treated, whether services are seeing people at greater or lower risk of STIs. These can be hard to measure.
 
We will develop instruments to measure public health outcomes of existing services and use modelling techniques to identify the key elements of service provision that could impact on the effectiveness (i.e. the number of STIs prevented) and the cost effectiveness of different combinations of primary care and GUM provision. The resulting web tool will facilitate local evidence-based planning of services for STIs across the UK.

Background: Patients with sexually transmitted infections (STIs) have always presented in a variety of healthcare settings, and it has been increasingly realised that settings outside the traditional genitourinary medicine (GUM) clinic need to be equipped to manage such patients and their partners. Over the past few years, STI Foundation Courses aimed at educating primary care practitioners in STI care, and a competency framework for providers of the various levels of STI services have been jointly developed by GUM and primary care professional groups.

However, the novel development of dedicated STI services in the primary care setting now provides a wider challenge for commissioners and public health specialists beyond the improvement of ad hoc care for patients who present to primary care. A wide range of national and local initiatives for the provision of services in primary care for STIs have developed since publication of the National Strategy for Sexual Health and HIV in 2001. Yet there is little consensus or evidence on the extent to which various models of ?locally enhanced? (LES) and ?nationally enhanced? (NES) primary care services, or indeed GUM services, and in what combination, can provide a cost-effective approach to the control of STIs for differing populations. Commissioners and public health specialists are therefore having to plan services without a clear evidence base.


Aim: To build a Decision Analytic Model (DAM) as a tool for the evidence based planning of cost-effective STI services for differing populations in the UK.


Method: We will construct a DAM, a mathematical tool for decision makers that identifies the major drivers of incremental costs and of cost-effectiveness for a population. We will undertake:
(a) Synthesis and collection of data relating to STI epidemiology (including behavioural studies and modeling data), public health outcomes, economic costs and key elements of the quality of clinical services (including a simple, reproducible ?Rapid Assessment Module capable of supplying local data)
(b) Development of a DAM using the above data, and
(c) Development of a web-based software tool for use by commissioners and public health specialists in estimating the consequences of different options in service configuration.
(d) Implementation of the DAM in 3 contrasting settings with specification of a cost-effective service configuration.
We will measure cost effectiveness in terms of (i) incremental cost per transmission of chlamydia or gonorrhoea averted, and (ii) the incidence and prevalence of chlamydia, gonorrhoea and pelvic inflammatory disease at a range of time horizons.