Young men in the UK are failing to get tested for sexually transmitted infections, and a new programme aims to fix that by testing them where they already are—on the football pitch. Sexually transmitted infections are rising among young men, yet screening uptake remains poor. The annual NHS cost of untreated chlamydial infection alone is around £100 million. Current approaches miss men entirely: partner notification is often inadequate, and clinical guidelines for testing asymptomatic men have shifted without clear evidence of cost-effectiveness. The BALLSEYE programme tackles three specific gaps: determining the best screening algorithm for men without symptoms, implementing rapid treatment for male partners of infected people in primary care, and piloting STI testing delivered by football trainers. If successful, the programme could reshape how the NHS reaches young men—shifting from clinic-based, reactive care to proactive, community-based screening. The football trainer model (SPORTSMART) could become a replicable intervention for other settings. The mathematical modelling will give commissioners clear data on whether dropping microscopy from routine testing saves money without harming detection rates. The result would be fewer undiagnosed infections, reduced transmission, and lower long-term costs to the health service.
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The BALLSEYE PROGRAM aims to to improve the sexual health of young men in the UK by: resolving an evidence gap in strategies for STI diagnosis, using mathematical modeling and health economic analysis, to determine an optimal STI screening algorithm for asymptomatic men (Study 1); implementing new methods for rapid treatment of male sex partners of people with STIs in primary care (Study 2); determining methods of engaging men in effective STI control activity including pilot of a novel model for promotion of STI testing by football trainers (Study 3). Objectives:1. to develop an evidence based clinical algorithm for STI testing in asymptomatic men 2. to model mathematically the epidemiological and economic impact of removing microscopy from routine STI testing in asymptomatic men 3. to implement & evaluate Accelerated Partner Therapy (APT: new models of partner notification to rapidly contact and treat male sex partners of people with STIs) in primary care, empirically and with mathematical models 4. to develop, pilot & evaluate a feasible, replicable intervention to deliver football trainer-led, STI screening targeting young men (SPORTSMART) Background:STIs are increasing in young men. Efforts to reduce transmission have failed and the impact of STIs in society is growing1 The burden of STI related disease is in women of reproductive age although the prevalence of chlamydia in men & women is similar. The annual NHS costs of untreated chlamydial infection are around £100 million. The White Paper Choosing Health sets out the importance of STIs at national level2 and led to the National Chlamydia Screening Programme (NCSP)3. However, chlamydia screening uptake in men is poor 3,4. NICE Guidance on Partner Notification recently emphasized the need to improve PN5 but did not specify standards for content or delivery6. PN and management of men with STIs in primary care is often poor7.National guidance for STI screening of asymptomatic men has changed8. The evidence for and cost-effectiveness of this new approach is questioned 9,10,11. This proposal addresses the major areas of uncertainty in the evidence-based delivery of STI care for men set out above and prioritized by the NHS. Research plans:Study 1: Impact of different clinical approaches to STI testing in men: a modeling study & economic evaluation Phase 1. Comparison of factors associated with asymptomatic non-chlamydial, non-gonococcal microscopic urethritis to develop a clinical algorithm for STI testing in menPhase 2: Mathematical modeling and health economics analysis of the implications of abandoning microscopy of urethral smears in asymptomatic men compared with alternative strategies which ensure better uptake of chlamydia and gonorrhoea screening.Study 2: The delivery of a modern, evidence-based approach to STI partner notification for men in primary care: (APT Primary Care)Phase 1: Development of a web-based tool to support the APT patient pathway in the primary care setting. Phase 2: Implementation and formal evaluation of the new APT pathway Study 3: Development and evaluation of the disease control potential of a model for testing young men at high risk of STI in a sports setting: The SPORTSMART Study Phase 1: Random probability survey of men’s sexual health care usage and leisure & sporting activities Phase 2: Feasibility pilot and integrated evaluation of the SPORTSMART interventionsResearch team & environment:Applicants are senior researchers with a combined current grant income of around £5million. Our existing collaborative links underpin the study. We have published extensively in sexual health service research. Barts and the London NHS Trust (BLT) will host this research working closely with East Sussex Downs and Weald PCT and Brighton and Sussex Medical School. Impact:The BALLSEYE PROGRAM will improve the sexual health of young men in the UK through: 1. Evaluation of the public health & economic impact of different clinical approaches to STI screen
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