A national multimedia campaign was launched in Januaryto increase the proportion of young people tested for chlamydia. Reports were assigned to a pre-campaign, campaign and post campaign phase according to the test date. Exclusion criteria included tests for clinical reasons, contacts of known cases, and tests returned from prisons or military services. Negative binomial and logistic regression modelling was used to provide an estimate for the change in coverage and positivity, during, and after the campaign and
Do sexual health campaigns workers were adjusted for secular and cyclical trends.
Adjusting for cyclical and secular trends, there was no change in the overall testing coverage either during RR: The coverage varied amongst different socio-demographic groups, testing of men increased during the campaign phase while testing of people of black and other ethnic groups fell in this phase.
The positivity rate was increased during the campaign OR: The proportion of chlamydia infections detected increased for all socio-demographic and self-reported sexual behaviour groups both during and after the campaign.
The uptake of chlamydia testing rose during the campaign; however, this apparent increase was not maintained once overall trends in testing were taken into account. Nonetheless, once secular and cyclical trends were controlled for, the campaign was associated with an increased positivity linked to increased testing of high risk individuals groups in the target population who were previously less
Do sexual health campaigns workers to come forward for testing.
However, our study indicated that there may have been a disparity in the impact of the campaign on different population groups. The content and delivery of ongoing and future information campaigns aimed at increasing chlamydia screening should be carefully developed so that they are relevant to all sections of the target population.
Infections are primarily asymptomatic but if left untreated can result in serious long term complications [ 3 ]. Mass media campaigns have been used for a range of health-related areas and have successfully achieved desirable changes in behaviour and the use of healthcare services amongst young people [ 8 - 11 ]. The sought to normalise conversations about the transmission of chlamydia, raise awareness of the risk of untreated infection and explain the process of diagnosis and treatment.
The mass-media campaign with national TV, radio, on-line and poster advertising ran for Do sexual health campaigns workers total of four weeks and resources leaflets, posters
Do sexual health campaigns workers access to logos were made available for local campaigns which continued throughout February and March [ 12 ].
The campaign material consisted of short faceless dialogues about chlamydia infection, diagnosis and treatment set in everyday situations and voiced by young people from a range of socio-demographic groups. To date, a qualitative evaluation of the campaign, based on pre and post campaign interviews with children and young people found an increase in the awareness of and testing for chlamydia, however, it did not assess actual changes in chlamydia screening uptake [ 13 ].
The aim of this study was to evaluate quantitatively, using an interrupted time series analysis, the immediate impact of the campaign on the coverage and test positivity within the NSCP by socio-demographic characteristics and self-reported sexual behaviour. A unique patient identifier based on post code of residence, date of birth and sex was created to de-duplicate the dataset.
Socio-economic status for each patient was based on the overall indices of multiple deprivation IMD rank of their postcode of residence [ 14 ]. Within the NCSP dataset, patients are assigned to one of 22 ethnic groups, which we redefined into four groups: The patients were assigned to a pre-campaign phase 1st April to 31st Decembercampaign phase 1st January to 31st March and post campaign phase 1st April to 30th June according to the date of their tests.
Patients were excluded from all analyses if tests were for clinical reasons, contacts of known cases, and from prisons or military services.
Ethical approval was not needed. Coverage was calculated as the number of tests performed in each month using as the denominators mid population estimates of ethnicity by sex and age-group for each SHA publically available from the Office for National Statistics ONS [ 16 ]. The population estimate of ethnicity by socio-economic class was not available and we assumed that the distribution of socio-economic class by sex and for each age-group for the whole SHA population was the same for each ethnic group.
Records with missing sex, ethnic group, socio-economic class, SHA or age group were excluded from the analysis because of the unavailability of a comparable population denominator. The SHA denominator population is assumed to be constant throughout the study period. Positivity was defined as the proportion of positive tests in each month. Patients with missing, unknown or equivocal test results were excluded from the analysis.
An interrupted time series analysis was performed in three stages. The remaining variables as fixed effects and interaction of the socio-demographic fixed effects with phase. In both stage II and III analyses, month each taking one of twenty-seven different values and quarter each taking one of four different values were taken as continuous and categorical variables, respectively.
This was followed, in stage III, by removing non-significant interactions one at a time. The final model was reached when all main effects and interactions Do sexual health campaigns workers significant. Coverage, analysis involved negative binomial regression with number of tests as the outcome and the population as the offset denominator. For positivity, logistic regression was used with number of positive tests as outcome and total number of unequivocal tests as the denominator.
Likelihood ratio testing was used to obtain p-values, except where indicated when Wald testing was employed. The remainder were obtained from single interaction models.
Estimates were risk ratios RR for coverage and odds ratios OR for positivity. A sensitivity stage I and II analysis of including into the coverage and excluding from the positivity those individuals with unknown socio-demographics was performed as a check on robustness of results. The analysis was undertaken in Stata None of the remaining records had an unknown or equivocal test result and so 2, records were included in the positivity analysis.
Number of Chlamydia tests and proportion positive from 1st April to 30th June However, the proportion of males increased "Do sexual health campaigns workers" the campaign from Demographic characteristics of individuals included in each phase for the coverage analyses. During the campaign there was a crude increase in chlamydia testing compared with the pre-campaign phase RR: When cyclical and secular trends were adjusted for, there was no change in the overall coverage in both the campaign phase RR: Relative change in testing during and after the campaign and by socio-demographic characteristics.
Coverage for males and females and for the four ethnic groups varied between the three phases, but did not vary across the phases by age group or socio-economic status. Compared to the pre-campaign phase, males were more likely to be screened during the campaign RR: The coverage by ethnicity also varied during after the campaign compared to the pre-campaign phase. Individuals of Black RR: People of Asian origin were more likely to be tested during the campaign RR: Those of White ethnicity were less likely to be screened in the post campaign phase as compared to the pre-campaign phase RR: Demographic characteristics of individuals included in each phase for the positivity analyses.
The crude overall positivity rate was lower in the campaign phase as compared with the pre-campaign phase OR: The positivity rate increased in the post campaign phase but remained lower than the pre-campaign period OR: Adjusting for secular and cyclical trends, the positivity rate during the campaign was higher than the pre-campaign phase OR: Relative change in positivity of Chlamydia testing during and after the campaign and by socio-demographic characteristics.
The positivity rate increased in the campaign
Do sexual health campaigns workers post campaign phase for all sub groups analysed.
The following sub-groups had a greater increase in proportion testing positive during the campaign as compared with the pre-campaign phase: Our study found that the overall uptake of testing coverage did not appear to be affected by the national campaign, as the apparent increase in testing was not maintained after the secular and cyclical trends in testing were taken into account.
However, we found a differential change in the coverage in the various socio-demographic groups both during and after the campaign. Testing in women and people of "Do sexual health campaigns workers" and Other ethnic origins fell during the campaign, while testing of men and people of Asian ethnicity increased. However, the increases in testing in these groups were not sustained after the campaign.
The overall proportion Do sexual health campaigns workers people testing positive increased during the campaign, an observation that persisted in the immediate post campaign phase after adjusting for secular and cyclical trends in positivity. The campaign was associated with an increase in the positivity of chlamydia infections detected for all socio-demographic and risk groups, including people defined as having high risk sexual behaviour.