Patient Preference for Patient-Delivered Partner Therapy: Exploratory Findings From Three Sexually Transmitted Disease Clinics

The Views of Patients and Partners Toward Patient-Delivered Partner Therapy for Chlamydia: A Systematic Review

BACKGROUND

The majority of research on patient-delivered partner therapy (PDPT) has focused on its impact on reinfections. This study aimed to systematically review the evidence regarding the acceptability of PDPT by patients and partners for chlamydia infection.

METHODS

Three electronic databases were searched in March 2019 using terms related to PDPT. Studies were included if they reported on patient or partner acceptance of PDPT for chlamydia and were conducted in high-income countries. Actual and perceived acceptabilities of PDPT were assessed.

RESULTS

Thirty-three studies were included: 24 quantitative, 3 qualitative, and 6 mixed methods. Most were clinic based. Quantitative data showed that participants' perceived willingness to give PDPT to their partner(s) ranged from 44.7% to 96.3% (median, 84%), and 24% to 71% (median, 65%) of people who offered PDPT for their partner(s) accepted it. Partners' perceived willingness to accept ranged from 42.7% to 67% (median, 62%), and actual acceptance ranged from 44.7% to 80% (median, 77%). Those in longer-term relationships were generally more likely to accept PDPT; however, beyond this, we identified few clear trends. Qualitative studies found that convenience of PDPT and assurance of partner treatment were benefits, whereas partners not seeing a health care professional was viewed as a downside. Packaging that appeared legitimate and coaching on delivering PDPT were facilitators.

CONCLUSIONS

Because patients bear responsibility for the success of PDPT, this information is crucial in clinical settings. Acceptance, perceived and real, of PDPT was generally high. Patients are best placed to determine whether PDPT is appropriate for them, and it should be offered as an option.

Receptiveness to Patient-Delivered Partner Therapy (PDPT) for Chlamydia Infection: Exploratory Findings From a Sample of Canadian Youth

OBJECTIVES

To determine hypothetical receptiveness among Canadian 15-24 year old youth to providing and receiving patient-delivered partner therapy (PDPT) for Chlamydia trachomatis infection and to explore patient characteristics associated with receptiveness.

METHODS

An anonymous cross-sectional survey was administered to a convenience sample of 312 youth ages 15-24 years presenting to a youth-focused community health centre (CHC) in Ajax, ON. The survey probed comfort with PDPT for chlamydia, both if the respondent was the hypothetical index case or the hypothetical partner. Participants ranked their hypothetical receptiveness on a five-point Likert Scale. Simple descriptive statistics were performed.

RESULTS

Mean age of respondents was 19.2 years. The majority (87.6%) endorsed previous sexual activity, of which 18.8% reported a previous chlamydia diagnosis. Seventy-eight percent of respondents endorsed hypothetical comfort with providing PDPT, while 65.4% and 53.3% of respondents expressed hypothetical willingness to receive PDPT if they were symptomatic and asymptomatic from chlamydia, respectively. Having multiple recent sexual partners was associated with increased hypothetical receptiveness to PDPT. Age was not correlated with a significant difference in responses.

CONCLUSION

Among 312 Canadian youth, a majority expressed hypothetical comfort with providing and receiving PDPT for C. trachomatis. Having multiple recent sexual partners significantly increased reported potential receptiveness. Within this sample, PDPT thus has a significant potential to reach youth engaging in higher-risk sexual behavior. Variations in comfort based on symptom status emphasized the importance of tailoring partner management strategies to individual patients and of ongoing patient education.

Predictors of male partner treatment for sexually transmitted infection

BACKGROUND

Patient-initiated notification is a commonly used practice for notifying sex partners of possible exposure to a sexually transmitted infection (STI); however, 46% to 75% of partners are never treated. The Contraceptive CHOICE Project (CHOICE) is a longitudinal cohort study of women that provides no-cost contraception, STI testing, treatment to participants, and free partner treatment. Our objective was to evaluate characteristics of women who tested positive for chlamydia, gonorrhea, or trichomoniasis, and their association with successful partner treatment.

METHODS

We analyzed baseline survey and STI testing, notification, and treatment data from the first 5087 participants enrolled in CHOICE. We considered "treated partners" to be men who received antibiotic treatment at the study clinic or by a prescription through the study. Independent predictors of successful partner treatment were identified using univariate analysis and multivariable analysis using Poisson regression with robust error variance.

RESULTS

Forty-four percent of male partners were successfully treated. Women whose partners were less likely to obtain treatment were black (adjusted Relative Risk (RR adj) RR adj = 0.6; 95% confidence interval [CI]: 0.5-0.8) or reported some concern about future STI with the partner (RR adj = 0.6; 95% CI: 0.4, 0.8). Women whose partners were more likely to receive treatment were living with their partner (RR adj = 1.4; 95% CI: 1.1-1.8) or reported recent inconsistent condom use (RR adj = 1.5; 95% CI: 1.1-2.1).

CONCLUSIONS

The male partner treatment rate resulting from female patient-initiated partner notification in our study was low. Our findings highlight the need to develop novel notification interventions that yield higher partner treatment rates and consider patient-specific factors, such as race and relationship status.

Managing chlamydia infections in young men: results from an audit of a public men's clinic in New York City

Research on management of Chlamydia trachomatis (CT) among men has largely been neglected. Findings from an audit of 284 CT-infected men from 2004 to 2005 attending a young men's clinic primarily serving Latino men in New York City, NY, USA, are presented. Ninety-nine percent received treatment, with 81% treated within 14 days of a positive test. Three percent reported no partner in the last three months, 17% were referred by a CT-positive partner and 24% were missing partner information. Among the rest, 18% received expedited partner therapy, 4% directly observed therapy, 12% partner referral and 65% did not receive documented partner management. Of the 34% who had a post-treatment visit at least three months after their index visit, only 36% received a test for re-infection. Among primarily Latino men in an urban clinic in New York City, a high proportion of CT cases were treated in a timely manner. However, documentation of partner management was often lacking and few CT cases received tests for re-infection.