Figure 1.

Interventions and clinical management pathways. Accelerated partner therapy (APT) pack—contained prepackaged azithromycin 1 g, condoms, chlamydia information leaflet, a urine sample collection kit for Chlamydia trachomatis nucleic acid amplification test (NAAT) with instructions to provide the sample before taking the antibiotics, prepaid postal envelope and packaging for returning the sample to the study clinic, and a patient information leaflet about the study. APTHotline—sex partner undergoes telephone consultation and invitation for future clinic based HIV and syphilis screening with research health adviser. Sex partner or his representative collects APT Pack from clinic reception. Sex partner posts back his completed C. trachomatis NAAT urine sample kit (contained in the APT pack). Results and future clinical care are managed by specialist clinic. APTPharmacy—sex partner undergoes consultation and invitation for future clinic-based HIV and syphilis screening with sexual health trained community pharmacist. Pharmacist gives sex partner APT pack at the time of consultation, based on a patient group direction (PGD) which is a legal framework that allows some healthcare professionals to supply a specified medicine to a predefined group of patients without a doctor assessment. Sex partner posts back his completed C. trachomatis NAAT urine sample kit (contained in the APT pack). Results and future clinical care are managed by specialist clinic. Standard Partner notification (PN) (control). For the purposes of this study we define standard PN as the healthcare professional advising the index patient to notify his/her sex partner of the need for treatment (simple patient referral). In the contraception and sexual health (CASH) services this was supplemented by written information about chlamydia and the provision of details of local sexual health services to the index patient to give to her sex partner (enhanced patient referral). GUM, genitourinary medicine.