Abstract
BackgroundChlamydia prevalence in the Netherlands remains high despite targeted efforts. Effective Partner Notification (PN) and Partner Treatment (PT) can interrupt transmission and prevent re-infections. Patient Initiated Partner Treatment (PIPT) may strengthen chlamydia control. This study explores the current practice of PN and PT, and benefits of, and barriers and facilitators for PIPT among professionals in sexual health care in the Netherlands.MethodsA qualitative study was performed among GPs, GP-assistants (GPAs), physicians and nurses working at Sexual Health Clinics (SHC) and key-informants on ethnical diversity using topic lists in focus groups (N = 40) and semi-structured questionnaires in individual interviews (N = 9). Topics included current practices regarding PN and PT, attitude regarding PIPT, and perceived barriers and facilitators for PIPT. Interviews were taped, transcribed verbatim, and coded using ATLAS.ti. A quantitative online questionnaire on the same topics was sent to all physicians and nurses employed at Dutch SHC (complete response rate 26% (84/321)).ResultsThe qualitative study showed that all professionals support the need for more attention to PN, and that they saw advantages in PIPT. Mentioned barriers included unwilling PN-behaviour, Dutch legislation, several medical considerations and inadequate skills of GPs. Also, concerns about limited knowledge of cultural sensitivity around PN and PT were raised. Mentioned facilitators of PIPT were reliable home based test-kits, phone-contact between professionals and notified partners, more consultation time for GPs or GPAs and additional training. The online questionnaire showed that SHC employees agreed that partners should be treated as soon as possible, but also that they were reluctant towards PIPT without counselling and testing.ConclusionsProfessionals saw advantages in PIPT, but they also identified barriers hampering the potential introduction of PIPT. Improving PN and counselling skills with specific focus on cultural sensitivity is needed. PIPT could be considered for specific partners. PIPT in combination with home based testing and using e-healthcare should be further explored and developed.
Highlights
Chlamydia prevalence in the Netherlands remains high despite targeted efforts
Expedited Partner Therapy (EPT) allows health care providers to provide STI-patients with a prescription or antibiotics for their sex partner(s) without an intervening medical evaluation of the partner(s) [7]. This can be done by handing out medication to the partner by the index-case, (Patient Delivered Partner Therapy (PDPT)) [8, 9], or by providing an accelerated prescription for the partner with medical history gained through a telephone-hotline or at a pharmacy (Accelerated Partner Therapy (APT)) [10, 11]
As chlamydia is more common in specific migrant groups [18] we explored views about Partner Notification (PN) and beliefs, norms and acceptability of Patient Initiated Partner Treatment (PIPT) among these groups in key-informants from various cultural backgrounds
Summary
Chlamydia prevalence in the Netherlands remains high despite targeted efforts. Effective Partner Notification (PN) and Partner Treatment (PT) can interrupt transmission and prevent re-infections. Patient Initiated Partner Treatment (PIPT) may strengthen chlamydia control. Expedited Partner Therapy (EPT) allows health care providers to provide STI-patients with a prescription or antibiotics for their sex partner(s) without an intervening medical evaluation of the partner(s) [7]. This can be done by handing out medication to the partner by the index-case, (Patient Delivered Partner Therapy (PDPT)) [8, 9], or by providing an accelerated prescription for the partner with medical history gained through a telephone-hotline or at a pharmacy (Accelerated Partner Therapy (APT)) [10, 11]. In the UK APT is seen as a viable option, but did not achieve high uptake in practice [10, 11, 15]
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