Predictors of Index Patient Acceptance of Expedited Partner Therapy for Chlamydia trachomatis Infection and Reasons for Refusal, Sexually Transmitted Disease Clinics, New York City, 2011 to 2012

Abstract

Expedited partner therapy (EPT) for Chlamydia trachomatis (Ct) reduces repeat Ct infection and was legalized in New York State in 2009. It is a practice in which a Ct-infected index patient delivers medication or a prescription directly to sex partner(s), without those partners receiving medical evaluation. There have been few evaluations of EPT implementation assessing acceptance and uptake among index patients. We measured EPT acceptance among index patients, identified predictors of accepting EPT, and described reasons for declining EPT. We conducted a retrospective analysis using electronic medical records from patients attending New York City Department of Health and Mental Hygiene STD clinics from July 2011 to October 2012. A multivariable model examined the associations between accepting EPT and patient and clinic-level characteristics. Overall, 54.8% (1076/1964) of index patients accepted EPT when offered (55.9% of males and 54.4% of females [P = 0.55]). Predictors of EPT acceptance included having a male provider offer EPT (adjusted odds ratio, 1.43; 95% confidence interval, 1.12-1.83). Index patients who had a partner present at the clinic during the treatment visit were less likely to accept EPT (adjusted odds ratio, 0.28; 95% confidence interval, 0.20-0.40). Among 888 patients who refused EPT, common reasons were as follows: "partner in clinic today for treatment" (26.3% [234/888]), "no longer with partner" (25.0% [222/888]), "partner already treated" (20.3% [180/888]), and "prefer medication be delivered by clinician" (19.6% [174/888]). Expedited partner therapy acceptance did not differ by patient age, sex, or race. Excluding persons whose partners were already treated and persons whose partners were in the clinic for treatment, EPT acceptance rates were 69.4%. Expedited partner therapy acceptance rates were high among index patients whose partners were not otherwise treated.