Abstract
IntroductionDespite its wide use, passive partner notification (PN) has a low yield of sexual partners influenced by patient-related and health system (HS) factors.MethodsWe conducted a qualitative study and clinic observations during a pre-intervention phase of a quality improvement (QI) project to identify HS factors that influenced passive PN at Bwaila STI unit (BSU) in Lilongwe Malawi from January to February 2016. We conducted 15 in-depth interviews with health workers and clinic observations for six clinic flow and PN processes at the clinic.ResultsThe majority of health workers felt that the lack of incentives for sexual partners or couples who presented to the clinic was the most important negative HS factor that influenced passive PN. We observed an average clinic start time of 09:02 hours. The average duration of the group health talk was 56 minutes and there was no difference in the time spent at the clinic between index cases and partners (1 hour 41 minutes versus 1 hour 36 minutes respectively).DiscussionLack of incentives for sexual partners or couples was the most important HS factors that impacted the yield of sexual partners. Interventions focusing on designing simple non-monetary incentives and QI of passive PN should be encouraged.
Highlights
Despite its wide use, passive partner notification (PN) has a low yield of sexual partners influenced by patient-related and health system (HS) factors
In a review of health system factors that influenced passive partner notification at a busy and dynamic sexually transmitted infections clinic in a resource-limited setting, we found that lack of incentives for sexual partners or couples who presented to the clinic, inefficient use of available resources and lack of clinic space and staff were the most important health system factors that healthcare workers felt had a great impact on the yield of sexual partners
Passive PN is a simple and cost-effective intervention that is suitable for resource-limited settings (RLS) for several reasons: (1) healthcare workers (HCWs) are overworked because of large volumes of patients making provideroriented PN not ideal; (2) counselling services for passive PN have been integrated into clinics; (3) use of counsellors, which is cheaper than using physicians, for counselling on PN has been well accepted; (4) lack of physical addresses, poor road and communication infrastructure and other socio-economic factors make provider-oriented PN difficult to execute in RLS [1]
Summary
Passive partner notification (PN) has a low yield of sexual partners influenced by patient-related and health system (HS) factors. PN is a process of informing sexual contacts of a patient with HIV/STI that they may be at risk [3]. Despite the several strategies for partner notification, passive PN is the recommended first step in partner notification for resource-limited settings (RLS) by the World Health Organization (WHO) and it is the most widely used and preferred method by both providers and patients in many settings [1,2,3,4,5,6,7]. Despite being the most preferred and widely used method, passive PN has minimal success in identifying sexual partners (10). The poor usage and yield of sexual partners through passive PN is unsatisfactory and poses a big challenge to the prevention of HIV and STI transmission
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