Institute of Epidemiology & Health Care


Infections in Primary Care Research Group

Supervisors: Dr Greta Rait, Dr Lorraine McDonagh

We are an interdisciplinary team of researchers and clinicians from primary care, psychology, epidemiology, and public health. We work across different disease areas, populations, and institutions. The majority of our work focuses on adolescent health and sexually transmitted infections (STIs). We also collaborate on research in other areas, such as malaria, e-health, respiratory and gastrointestinal infections. Our projects include epidemiological research (including working with electronic health records), clinical trials, qualitative research and online questionnaires. We have excellent collaborative links with Brighton and Sussex Medical School and work closely with Public Health England (PHE).

We are part of the NIHR Health Protection Research Unit (HPRU) in Blood Borne Viruses and STIs led by UCL, in partnership with PHE, in collaboration with London School of Hygiene & Tropical Medicine. (http://bbsti.hpru.nihr.ac.uk/). PhD fellows would have the opportunity to join the HPRU Academy. This offers a unique environment to those wishing to gain exposure to interdisciplinary research within an organisation pursuing a highly acclaimed international research agenda.

We have numerous project individuals can become involved with. 

Project 1: Approaches to young person's health in primary care

Supervisors: Dr Greta Rait, Dr Lorraine McDonagh

Good health care during adolescence is the foundation for good health and wellbeing in later life. Particular issues sexual health (e.g., testing for STIs) as well as mental health and physical health (e.g., alcohol, smoking, drugs, nutrition, exercise). For example, young people account for a substantial proportion of new sexually transmitted infection diagnoses. Youth-friendly primary care services, which can quickly and accurately assess (and address) their needs, are needed to improve the health and wellbeing of young people. The aim of this project is to qualitatively explore how primary health care professionals currently approach young people in practice and what has been (or could be) done in general practice to promote young people's health. Semi-structured individual interviews and focus groups will be conducted, guided by a theoretical model of behaviour. Quesitons will focus on sexual health (e.g., testing for STIs) as well as mental health and physical health (e.g., alcohol, smoking, drugs, nutrition, exercise).This will inform the development of an intervention to improve young people's health via general practice. 

Project 2: Chlamydia retesting and text messaging interventions

Supervisors: Dr Greta Rait, Dr Lorraine McDonagh

An examination of barriers and facilitators to chlamydia retesting and exploration of how these can be incorporated into text messaging interventions Young people (ages 16-24 years) who test positive for chlamydia are at high risk of repeat infection. Chlamydia reinfection is common and increases the risk of reproductive complications. Possible reasons for such repeat infections include non-compliance with treatment, incomplete or unsuccessful partner notification, unsafe sexual behaviours and treatment failure. Guidelines recommend retesting three months after a positive result, but often these individuals do not return for repeat testing. This project seeks to identify the key barriers and facilitators associated with the decision to re-test. Quantitative and qualitative methodologies will be employed. A psychological theory of behaviour and behaviour change will be used to guide the methodologies and analyses. Ultimately, this project will inform the development of a digital intervention to increase re-testing rates among those who have been previously treated for chlamydia. 

Project 3: Sexual health and well-being needs of sexual and gender minority youth

Supervisors: Dr Greta Rait, Dr Lorraine McDonagh

Lesbian, gay, bisexual, transgender (LGBT) and other sexual and gender minority have unique health care needs. Social environments and structural factors (created through stigma, prejudice, and discrimination) cause poor health outcomes for this population. They bear a disproportionate burden of poor health and wellbeing in terms of sexual health and HIV, mental health, behavioural health (substance use). The situation is exacerbated by a lack of orientation-appropriate health and wellbeing support and services. The aim of this study is to qualitatively examine young sexual and gender minority people's attitudes towards the provision of sexual health care via general practice, and explore the best means through which to improve this. This will inform the development of effective interventions to improve the provision of health care service via general practice for this population. 

Project 4: Factors associated with testing for sexually transmitted infections among young people

Supervisors: Dr Greta Rait, Dr Lorraine McDonagh

In 2016, there were approximately 420,000 diagnoses of sexually transmitted infections (STIs) made in England. The burden of STIs is greatest among people aged 15-24 years where highest prevalence rates are found. STIs are often asymptomatic, and if left undiagnosed and/or untreated, can pose severe health consequences. Annual testing for sexually active young people is recommended in the UK; however, many of those at risk do not receive testing. The aim of this project is to quantitatively assess factors associated with STI testing. Specifically, an online questionnaire will be developed which will be guided by theoretical models of behaviour change. This will inform the development of an intervention to increase STI testing in young people.

Project 5: Interventions to increase chlamydia testing in general practice.

Supervisors: Dr Greta Rait, Dr Lorraine McDonagh

There were 200,288 chlamydia diagnoses made in England in 2015, with the highest prevalence rates found amongst you people aged 15-24 years. General practice is one logical setting for chlamydia testing for a variety of reasons: 1) Over 60% of young people attend general practice annually; 2) Young people have reported a preference to receive testing and testing results from a general practitioner; 3) Higher rates of positivity have been found, particularly for males, in general practice compared to non-healthcare settings such as universities; and 4) Regular screening is easier to maintain in this setting, due to patients attending for other reasons, which is necessary for continued transmission reduction. However, in 2015, only 19% of chlamydia tests were performed in the general practice setting. The aim of this systematic review, therefore, is to examine the effectiveness and efficacy of interventions to increase chlamydia testing in general practice.

Contact: g.rait@ucl.ac.uk, l.mcdonagh@ucl.ac.uk