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Kalichman S, Banas E, Kalichman M, Dewing S, Jennings K, Daniels J, Berteler M, Mathews C. Brief Enhanced Partner Notification and Risk Reduction Counseling to Prevent Sexually Transmitted Infections, Cape Town, South Africa. Sex Transm Dis 2021; 48:174-182. [PMID: 32976362 PMCID: PMC7886347 DOI: 10.1097/olq.0000000000001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence-based interventions are needed to stem sexually transmitted infections (STIs). Clinic-delivered counseling remains an important avenue for effective STI prevention. METHODS A 3-arm randomized clinical trial compared (a) STI health education control condition, (b) risk reduction counseling, and (c) enhanced partner notification counseling. Men and women (n = 1050) were recruited from an STI clinic in Cape Town, South Africa. After baseline assessments, participants were randomly allocated to receive 1 of the 3 single-session counseling interventions and were followed up for 9 months of behavioral assessments and 12 months of electronic medical records abstraction for STI clinic services. RESULTS Sexual risk reduction counseling reported greater condom use than did the other 2 conditions during the 3 and 6 months follow-ups. In addition, women receiving risk reduction counseling were significantly less likely to have returned for STI clinic services but did not differ in the number of STI clinic visits over the year. CONCLUSIONS Brief single-session STI prevention counseling demonstrates significant targeted outcomes. The findings suggest that counseling approaches to both increase condom use and enhance partner notification may offer more robust and sustained outcomes and should be tested in future research.
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Affiliation(s)
- Seth Kalichman
- From the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT
| | - Ellen Banas
- From the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT
- Health Systems Research Unit, South African Medical Research Council, Tygerberg
| | - Moira Kalichman
- From the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT
| | - Sarah Dewing
- Health Systems Research Unit, South African Medical Research Council, Tygerberg
| | | | - Johann Daniels
- City Health, Health Information and Technology, Cape Town, South Africa
| | - Marcel Berteler
- City Health, Health Information and Technology, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Tygerberg
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Mathews C, Lombard C, Kalichman M, Dewing S, Banas E, Dumile S, Mdlikiva A, Mdlikiva T, Jennings KA, Daniels J, Berteler M, Kalichman SC. Effects of enhanced STI partner notification counselling and provider-assisted partner services on partner referral and the incidence of STI diagnosis in Cape Town, South Africa: randomised controlled trial. Sex Transm Infect 2020; 97:38-44. [PMID: 32482641 PMCID: PMC7841487 DOI: 10.1136/sextrans-2020-054499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/18/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives We investigated the effects of an enhanced partner notification (PN) counselling intervention with the offer of provider-assisted referral among people diagnosed with STI in a Cape Town public clinic. Methods Participants were adults diagnosed with STI at a community clinic. After the standard STI consultation, participants were randomly allocated in a 1:1:1 ratio to (1) ‘HE’: 20 min health education; (2) ‘RR’: 45 min risk reduction skills counselling; or (3) ‘ePN’: 45 min enhanced partner notification communication skills counselling and the offer of provider-assisted referral. The primary outcome was the incidence of repeat STI diagnoses during the 12 months after recruitment, and the secondary outcome was participants’ reports 2 weeks after diagnosis of notifying recent partners. Incidence rate ratios (IRRs) were used to compare the incidence rates between arms using a Poisson regression model. Results The sample included 1050 participants, 350 per group, diagnosed with STI between June 2014 and August 2017. We reviewed 1048 (99%) participant records, and identified 136 repeat STI diagnoses in the ePN arm, 138 in the RR arm and 141 in the HE arm. There was no difference in the annual incidence of STI diagnosis between the ePN and HE arms (IRR: 1.0; 95% CI 0.7 to 1.3), or between the RR and HE arms (IRR: 0.9; 95% CI 0.7 to 1.2). There was a greater chance of a partner being notified in the ePN condition compared with the HE condition, 64.3% compared with 53.8%, but no difference between the RR and HE arms. Conclusions PN counselling and education with provider-assisted services has the potential to change the behaviour of people diagnosed with STIs, increasing the number of partners they notify by more than 10%. However, these changes in behaviour did not lead to a reduction of repeat STI diagnoses. Trial registration number PACTR201606001682364.
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Affiliation(s)
- Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa .,School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Carl Lombard
- Biostatistics Unit, South Africa Medical Research Council, Tygerberg, South Africa
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Sarah Dewing
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Ellen Banas
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Sekelwa Dumile
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Amanda Mdlikiva
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Thembinkosi Mdlikiva
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Karen Ann Jennings
- City Health Department of Cape Town Municipality, Cape Town, South Africa
| | - Johann Daniels
- City Health Department of Cape Town Municipality, Cape Town, South Africa
| | - Marcel Berteler
- City of Cape Town IS&T Department, City of Cape Town, Cape Town, Western Cape, South Africa
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
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Lurie MN, Kirwa K, Daniels J, Berteler M, Kalichman SC, Mathews C. High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study. Sex Transm Infect 2014; 90:615-9. [PMID: 24837992 DOI: 10.1136/sextrans-2013-051446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the burden of sexually transmitted infections (STIs) among HIV-positive South Africans in the period prior to antiretroviral therapy (ART) initiation compared with the period once on ART. METHODS We linked the clinic records of 1465 patients currently on ART to the electronic database which records all visits to city clinics. We used a mixed effects Poisson model to assess the relative rates of occurrence of treatment seeking for an STI in the periods prior to initiation of ART and while on ART. RESULTS We accumulated 4214 person-years of follow-up, divided nearly equally between the pre-ART and on-ART periods. The rate of treatment seeking for new STIs was 5.50 (95% CI 5.43 to 5.78) per 100 person-years, and individuals had on average a sevenfold higher rate of seeking treatment for STIs in the period prior to initiating ART (9.57 per 100 person-years) compared with the period once on ART (5.5 per 100 person-years) (adjusted rate ratio (RR) 7.01, 95% CI 4.64 to 10.59). Being male (RR 1.73, 95% CI 1.18 to 2.55) or younger (age <25) (RR 2.67, 95% CI 1.53 to 4.65) was associated with higher incidence of clinic visits for STI treatment, while advanced stage of HIV disease (WHO stage 4) (RR 0.33, 95% CI 0.15 to 0.69) was associated with lower incidence. CONCLUSIONS The period prior to the initiation of ART is a critical period where increased attention should be focused on the detection and treatment of STIs. A successful effort to treat STIs in this period will likely reduce further HIV transmission and fits within a test-and-treat approach.
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Affiliation(s)
- Mark N Lurie
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kipruto Kirwa
- Brown University School of Public Health, Providence, Rhode Island, USA Department of Epidemiology and Nutrition, Moi University School of Public Health, Eldoret, Kenya
| | - Johann Daniels
- Health Information and Technology, City Health, Cape Town, South Africa
| | - Marcel Berteler
- Health Information and Technology, City Health, Cape Town, South Africa
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council; and the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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