Monitoring and Evaluation Proposal National Gay Men’s Syphilis Action Plan 23th October 2009 Rebecca Guy and Michelle McPherson

Evaluation approach Before and after evaluation Inputs/processes Outputs Outcomes (short-term) Impact (long-term)

Before and after evaluation

Objectives Objectives To evaluate the impact of the ‘activities’ on syphilis infection in gay men To quantify increased syphilis testing among gay men To quantify increased partner notification among gay men diagnosed with infectious syphilis To assess the coverage, progress and impact of local activities undertaken in the NGMSAP To obtain endorsement of the Plan at a national and jurisdictional level To assess change in syphilis knowledge and sexual behaviour in gay men To evaluate the acceptability of the NGMSAP activities on gay men and stakeholders

Objectives

To evaluate the impact of the ‘activities’ on syphilis infection in gay men

To quantify increased syphilis testing among gay men

To quantify increased partner notification among gay men diagnosed with infectious syphilis

To assess the coverage, progress and impact of local activities undertaken in the NGMSAP

To obtain endorsement of the Plan at a national and jurisdictional level

To assess change in syphilis knowledge and sexual behaviour in gay men

To evaluate the acceptability of the NGMSAP activities on gay men and stakeholders

1. To evaluate the impact of the ‘activities’ on syphilis infection in gay men Number of notifications of infectious syphilis Syphilis prevalence Modelled syphilis epidemic trends

Number of notifications of infectious syphilis

Syphilis prevalence

Modelled syphilis epidemic trends

2. To quantify increased syphilis testing among gay men Annually, percentages of HIV + men having 3+ tests HIV- men having 2+ tests men tested for HIV also tested for syphilis men with 20+ partners per 6 months tested 2+ times men never tested Plus Total number of tests outside clinical settings

Annually, percentages of

HIV + men having 3+ tests

HIV- men having 2+ tests

men tested for HIV also tested for syphilis

men with 20+ partners per 6 months tested 2+ times

men never tested

Plus

Total number of tests outside clinical settings

3. To quantify increased partner notification among gay men diagnosed with infectious syphilis % Notifications where contact tracing done Websites - number of hits/messages The number of ‘contacts’ presenting for testing

% Notifications where contact tracing done

Websites - number of hits/messages

The number of ‘contacts’ presenting for testing

4. To assess the coverage, progress and impact of local activities undertaken in the NGMSAP Participants enrolled in syphilaxis trial by July 2010 Awareness of campaign material Description of activities and program evaluations

Participants enrolled in syphilaxis trial by July 2010

Awareness of campaign material

Description of activities and program evaluations

5. To obtain endorsement of the Plan at a national and jurisdictional level NGMSAP recommendations in guidelines Activities undertaken in response to Action Plan

NGMSAP recommendations in guidelines

Activities undertaken in response to Action Plan

6. To assess changes in syphilis knowledge and sexual behaviour in gay men The % of men reporting High levels of syphilis knowledge Condom use with casual partners and other behaviour

The % of men reporting

High levels of syphilis knowledge

Condom use with casual partners and other behaviour

7. To evaluate the acceptability of the ‘activities’ on gay men Program acceptability among gay men and stakeholders

Program acceptability among gay men and stakeholders

Data sources Notification data GP testing data Sexual health service data Periodic Surveys Jurisdictional questionnaire – program data In-depth interviews with gay men/stakeholders

Notification data

GP testing data

Sexual health service data

Periodic Surveys

Jurisdictional questionnaire – program data

In-depth interviews with gay men/stakeholders

Data sources Notification data GP testing data Sexual health service data Periodic Surveys Jurisdictional questionnaire – program data In-depth interviews with gay men/stakeholders

Notification data

GP testing data

Sexual health service data

Periodic Surveys

Jurisdictional questionnaire – program data

In-depth interviews with gay men/stakeholders

Sexual health service data

Sexual health service network 24 sexual health services participating Monitor chlamydia testing and diagnoses Established in 2008 Retrospective data from 2004 onwards Funded by DoHA Collaborators Sexual health services National Centre in HIV Epidemiology & Clinical Research Burnet Institute Centre for Population Health National Serology Reference Laboratory National Perinatal Statistics Unit

24 sexual health services participating

Monitor chlamydia testing and diagnoses

Established in 2008

Retrospective data from 2004 onwards

Funded by DoHA

Collaborators

Sexual health services

National Centre in HIV Epidemiology & Clinical Research

Burnet Institute Centre for Population Health

National Serology Reference Laboratory

National Perinatal Statistics Unit

Sites

Chlamydia annual testing rates and positivity in MSM, 19 sexual health services 2006 2007 2008 New patients 3509 3645 3800 Testing rate 77.7 80.1 81.6 Positivity rate (%) 7.2 6.5 7.3

Sexual health service network - Enhancements required Collation of new variables Syphilis and HIV testing and results HIV status Number of sexual partners Symptoms Reason for test i.e contact of a case

Collation of new variables

Syphilis and HIV testing and results

HIV status

Number of sexual partners

Symptoms

Reason for test i.e contact of a case

Gay Community Periodic Surveys

Recent changes Previously ‘ Other blood tests’ (proxy for syphilis) 2009 additional question in Syd, QLD surveys ‘ Syphilis test’

Previously

‘ Other blood tests’ (proxy for syphilis)

2009 additional question in Syd, QLD surveys

‘ Syphilis test’

Syphilis testing frequency in MSM, Sydney Periodic Survey, 2009

Syphilis testing frequency in MSM reporting 11+ partners, Sydney Periodic Survey, 2009

Periodic Surveys – Possible Enhancements Number of sexual partners categories 0, 1, 2-5, 6-10, 11-20, 21-60 , >60 Syphilis testing ever, in addition to last 12m ‘ Syphilis test’ rather than ‘other blood test’ – all jurisdictions Knowledge questions?

Number of sexual partners categories

0, 1, 2-5, 6-10, 11-20, 21-60 , >60

Syphilis testing ever, in addition to last 12m

‘ Syphilis test’ rather than ‘other blood test’ – all jurisdictions

Knowledge questions?

Summary Notification data – collate data nationally GP sentinel testing data – more states? Sexual health service data – add variables Periodic Survey – add questions Process data –collate nationally from programs In-depth interviews?

Notification data – collate data nationally

GP sentinel testing data – more states?

Sexual health service data – add variables

Periodic Survey – add questions

Process data –collate nationally from programs

In-depth interviews?

Acknowledgements Jurisdictions – Sue Botham (SES), Patrick Maywood (CS), Nasra Higgins (VIC), Craig Davis and Diane Rouwling (QLD), Carolien Giele (WA), Tess Davey (SA), Jiunn-Yih Su (NT), David Coleman (TAS) and Sue Reid (ACT) Sexual health service network NCHECR - Neil Franklin, Iryna Zablostka , Melanie Middleton , John Kaldor Victorian Primary Care Network - Jane Goller (Burnet Institute)

Jurisdictions – Sue Botham (SES), Patrick Maywood (CS), Nasra Higgins (VIC), Craig Davis and Diane Rouwling (QLD), Carolien Giele (WA), Tess Davey (SA), Jiunn-Yih Su (NT), David Coleman (TAS) and Sue Reid (ACT)

Sexual health service network

NCHECR - Neil Franklin, Iryna Zablostka , Melanie Middleton , John Kaldor

Victorian Primary Care Network - Jane Goller (Burnet Institute)

ACT NT 1. Canberra Sexual Health Centre 16. Alice Springs Clinic 34 NSW 17. Darwin Clinic 34 2. Coffs Harbour SHS QLD 3. Greater Southern Area Health Service 18. Dolls House Sexual Health Clinic 4. Holden St Clinic Gosford 19. Gold Coast Sexual Health 5. Hunter New England Sexual Health Service 20. Princess Alexandra Sexual Health 6. Lismore / Tweed Heads Sexual Health Service 21. Townsville Sexual Health Service 7. Northern Sydney Sexual Health Service Tas 8. Sydney West Area Health Service – Eastern Division 22. Hobart Sexual Health Service (Laun, Devon, Hobart) 9. Sydney West Area Health Service – Western Division Vic 10. Orange Sexual Health Clinic 23. Melbourne Sexual Health Centre 11. Royal Prince Alfred Hospital WA 12. South East Sydney and Illawarra Health Service Fremantle Hospital SHS 13. Sydney Sexual Health Centre 14. St George Short St Clinic 15. Kirketon Road Centre

Chlamydia testing frequency in MSM, 19 sexual health services

MSM patients by jurisdiction, 19 sexual health services, 2006-2008 PASH not included here