Monitoring and Evaluation Proposal

Monitoring and Evaluation Proposal

National Gay Men’s Syphilis Action Plan

23th October 2009Rebecca Guy and Michelle McPherson

Evaluation approach

o Resources o Staff o Funds o Materials o Activities o Training o Meetings o Collaborations

o Reach o Coverage o Acceptability

o Change in syphilis testing practices among gay men and clinicians

o Changes in the rate of contact tracing among gay men and clinicians

o Changes in syphilis awareness and sexual behaviour among gay men

o Changes in infectious syphilis prevalence

o Change in infectious syphilis incidence

o Modelled syphilis trends

Inputs/processes Outputs Outcomes (short-term) Impact (long-term)

Before and after evaluation

ObjectivesObjectives1. To evaluate the impact of the ‘activities’ on syphilis infection in gay men 2. To quantify increased syphilis testing among gay men3. To quantify increased partner notification among gay men diagnosed

with infectious syphilis4. To assess the coverage, progress and impact of local activities

undertaken in the NGMSAP 5. To obtain endorsement of the Plan at a national and jurisdictional level6. To assess change in syphilis knowledge and sexual behaviour in gay

men7. 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

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 syphilismen with 20+ partners per 6 months tested 2+ timesmen 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

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

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

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

7. To evaluate the acceptability of the ‘activities’ on gay men

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

Data sources

• 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

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 variables1. Syphilis and HIV testing and results2. HIV status3. Number of sexual partners4. Symptoms5. 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’

Blood test for syphilis None 1 Once 2 Twice 3 3 or more 4

Other blood test None 1 Once 2 Twice 3 3 or more 4

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?

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?

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)