Reaching Patients and Their Partners Through Mobile: Text Messaging for Case Management and Partner Notification

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To the Editor: Approximately 83% of all US adults own a cell phone,1 and 23% of households have no landline phone service.2 Text messaging is increasingly popular with more than 61% of Americans sending text messages.3 By extension, mobile phones have become a means for finding sex partners.4 In response, sexually transmitted disease (STD) and human immunodeficiency virus (HIV) prevention programs have used mobile phones and text messaging specifically, for clinical management, sexual health services, and health promotion efforts with positive results.5,6 There have also been case studies of individual patients using text messages to inform partners of an STD exposure,7,8 but the authors are unaware of any studies that specifically address the use of text messaging by disease intervention specialists (DIS) to perform partner notification. Recent field experiences, however, compel us to highlight the need for DIS to use mobile phones as an additional tool when conducting partner notification (txtPN). Increasingly, mobile phones may be the preferred or only means for reaching sex partners. Furthermore, health care providers and patients alike are finding these new technologies acceptable.5–11 The New York State Department of Health has successfully used texting to notify patients of an STD diagnosis and to notify partners of exposure. This method is used if “traditional” efforts such as phone calls, mailed letters, the internet, and field visits do not yield contact. In June 2009, a DIS was made aware of an untreated chlamydia patient who could not be reached by the healthcare provider via mail, telephone, or voicemail. Internet contact information for this patient was not known. The DIS conducted a reverse search on the telephone number provided and discovered it was for a mobile phone. The DIS then sent a text message stating he was with the department of health and needed to speak with the patient regarding an urgent health matter. Within minutes the patient responded via text, saying she had recently moved out of state and would contact the DIS the next morning. She did, and, after verifying her date of birth, the DIS notified her that she had tested positive for chlamydia. The patient received treatment the following day. A second DIS was able to notify a partner of an early syphilis case only through text message. After replying to the text and verifying date of birth, the partner agreed to be tested, was found to have early syphilis and was subsequently treated for the infection. This partner mentioned that he travelled frequently and limited his cell phone capability to allow text messaging only. Text messaging has also been used under special circumstances, as with a DIS who used texting at the request of a hearing-impaired patient to communicate after an initial in-person interview. Patient confidentiality standards12 apply to txtPN and should be of the utmost importance. Programs should be encouraged to identify text message use among those they serve and to provide DIS with the authority to contact patients and conduct txtPN. The National Internet Partner Services workgroup, a peer-based workgroup of 164 STD/HIV prevention professionals, along with Adelson Consulting Services, developed guidance at http://www.stdpreventiononline.org/index.php/resources/download/1300. The document provides basic information about texting, examples of field experiences, potential pitfalls and barriers, and current best practices. Rather than an authoritative guidance, the document is intended to provide a starting point for the development of guidance within individual jurisdictions. As well as a potential template for empowering DIS, the authors hope the document will enable policymakers to address bureaucratic and resource barriers. Recognizing and adapting to changes in communication technology will help us better reach those we serve with STD/HIV prevention efforts. Rachel Kachur, MPH Division of STD Prevention Centers for Disease Control and Prevention Atlanta, GA Stephan Adelson Adelson Consulting, Inc. Boston, MA Kelly Firenze, BS New York State Department of Health Syracuse, NY Marcella Herrera, MPA California Department of Public Health Richmond, CA