Partner Treatment Research Articles

Emotionally Focused Couple Therapy With Neurodegenerative Diseases: A Pilot Study

ABSTRACTThis research wants to verify the effectiveness of couple's treatment, when a neurodegenerative disease affects one of the two partners. The disease affects not only the ailing individual, but also the dynamics within the couple. Fourteen patients affected by neurodegenerative diseases participated in an emotionally focused couple therapy (EFT) with their spouses. We collected a measure of the quality of life (SF-36) and relationship satisfaction (DAS) at the beginning and at the end of the treatment for both partners. The results show an improvement in quality of life and couple contentment, underlining the usefulness of such a psychotherapeutic intervention on the couple.

Trichomoniasis - are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide?

Etiology: Trichomonas vaginalis is the etiologic agent of trichomoniasis, the most common non-viral sexually transmitted disease (STD) in the world. Transmission: Trichomoniasis is transmitted by sexual intercourse and transmission via fomites is rare. Epidemiology, incidence and prevalence: The WHO estimates an incidence of 276 million new cases each year and prevalence of 187 million of infected individuals. However, the infection is not notifiable. Pathology/Symptomatology: The T. vaginalis infection results in a variety of clinical manifestations - in most cases the patients are asymptomatic, but some may develop signs typically associated to the disease. Importantly, the main issue concerning trichomoniasis is its relationship with serious health consequences such as cancer, adverse pregnancy outcomes, infertility, and HIV acquisition. Molecular mechanisms of infection: To achieve success in parasitism trichomonads develop a complex process against the host cells that includes dependent- and independent-contact mechanisms. This multifactorial pathogenesis includes molecules such as soluble factors, secreted proteinases, adhesins, lipophosphoglycan that culminate in cytoadherence and cytotoxicity against the host cells. Treatment and curability: The treatment with metronidazole or tinidazole is recommended; however, cure failures remain problematic due to noncompliance, reinfection and/or lack of treatment of sexual partners, inaccurate diagnosis, or drug resistance. Therefore, new therapeutic alternatives are urgently needed. Protection: Strategies for protection including sexual behavior, condom usage, and therapy have not contributed to the decrease on disease prevalence, pointing to the need for innovative approaches. Vaccine development has been hampered by the lack of long-lasting humoral immunity associated to the absence of good animal models.

Chlamydia trachomatis Genital Infections.

Etiology, transmission and protection: Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infection (STI) globally. However, C. trachomatis also causes trachoma in endemic areas, mostly Africa and the Middle East, and is a leading cause of preventable blindness worldwide. Epidemiology, incidence and prevalence: The World Health Organization estimates 131 million new cases of C. trachomatis genital infection occur annually. Globally, infection is most prevalent in young women and men (14-25 years), likely driven by asymptomatic infection, inadequate partner treatment and delayed development of protective immunity. Pathology/Symptomatology: C. trachomatis infects susceptible squamocolumnar or transitional epithelial cells, leading to cervicitis in women and urethritis in men. Symptoms are often mild or absent but ascending infection in some women may lead to Pelvic Inflammatory Disease (PID), resulting in reproductive sequelae such as ectopic pregnancy, infertility and chronic pelvic pain. Complications of infection in men include epididymitis and reactive arthritis. Molecular mechanisms of infection: Chlamydiae manipulate an array of host processes to support their obligate intracellular developmental cycle. This leads to activation of signaling pathways resulting in disproportionate influx of innate cells and the release of tissue damaging proteins and pro-inflammatory cytokines. Treatment and curability: Uncomplicated urogenital infection is treated with azithromycin (1 g, single dose) or doxycycline (100 mg twice daily x 7 days). However, antimicrobial treatment does not ameliorate established disease. Drug resistance is rare but treatment failures have been described. Development of an effective vaccine that protects against upper tract disease or that limits transmission remains an important goal.

Sexually Transmitted Infections

High prevalence of sexually transmitted infections (STI) among adolescents is a significant public health concern. New and repeat STI acquisition in teens and young adults remains disproportionate to other age groups. Conversations with adolescent patients should include education about abstinence, use of barrier protection, reducing number of sexual partners, STI screening recommendations, how to access services for testing and treatment, partner treatment, and availability of effective vaccines against STIs such as human papillomavirus and hepatitis B virus. As early detection and prompt intervention is critical to decreasing disease complications, transmission, and overall community prevalence, it is essential to provide greater access to testing and treatment.

Cervicitis: a prospective observational study of empiric azithromycin treatment in women with cervicitis and non-specific cervicitis.

Treatment with 1 G azithromycin was observed prospectively in 130 women with cervicitis (>30 polymorphonuclear leucocytes/high-powered field) enrolled in a cervicitis aetiology study of 558 women at three sexually transmitted infection clinics in Sydney, Australia. Two overlapping groups of women with cervicitis were considered: 'cervicitis group 1' (n = 116) excluded women with Trichomonas vaginalis and a subgroup of this, 'cervicitis group 2' (non-specific cervicitis) (n = 96) further excluded women with Neisseria gonorrhoea, Chlamydia trachomatis and Mycoplasma genitalium at enrolment. Testing for Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis was by PCR and Neisseria gonorrhoea by PCR and culture. Treatment outcomes were cervicitis or vaginal symptoms at follow-up. Effect on cervicitis at follow-up was also assessed after additional reported partner treatment. In 'cervicitis group 1' where prevalence of Mycoplasma genitalium and/or Chlamydia trachomatis was 23/116 (19.8%), azithromycin reduced cervicitis at follow-up (RR = 0.62 (95% CI 0.39-0.97) p = 0.035), but there was no significant effect in non-specific cervicitis ('cervicitis group 2') (RR = 0.60 (95% CI 0.35-1.01) p = 0.056). Empiric treatment did not reduce vaginal symptoms at follow-up in either group. No effect of empiric partner treatment was seen. The conclusion was that empiric azithromycin treatment of cervicitis reduces cervicitis at follow-up in populations with high prevalence of Chlamydia trachomatis and/or Mycoplasma genitalium. There are no benefits of empiric azithromycin for non-specific cervicitis or empiric partner treatment.

P125 “I googled it…”: what is recommended online for the management of vulvovaginal candidiasis?

<h3>Background</h3> Recently our centre encountered women reporting self-treatment of candidiasis with intravaginal applications of foodstuffs including garlic, vinegar and yoghurt. All patients had a unifying factor of reporting “googling” their therapy. <h3>Aim</h3> To establish which candidiasis management strategies female patients are most likely to encounter when searching via Google. <h3>Method</h3> Search history data was collated from Google Trends to identify the ten most popular search terms related to candidiasis in the UK between 15/03/15–06/03/16. These terms, along with term “thrush”, were assessed totalling 11 Google searches. All websites on the initial results page for each search term were accessed to review recommended therapies. Click-through data suggests the vast majority of Google users (&gt;90%) select their chosen website from this first results page. <h3>Results</h3> 116 search results included 97 (83.6%) advising women about vulvovaginal candidiasis. 96/97 (99%) recommended imidazole therapy first line, all reassuringly advising against oral therapy in pregnancy. Patients were recommended to seek treatment via a pharmacy (72, 74.2%) or their GP (54, 55.7%) rather than attending a genitourinary service (12, 12.2%). The recommendation of natural yoghurt for symptomatic relief was frequent (40, 41.2%), more than using emollients or soap substitutes (27, 27.8%). Unfounded treatments including eating probiotic yoghurts (9, 9.3%), vinegar (8, 8.2%), and treatment of sexual partners (8, 8.2%) were encountered. <h3>Conclusions</h3> Sensible evidence-based advice is the most prevalent online for vulvovaginal candidiasis. However a number of poorly evidenced therapies are encouraged. This information should be discussed and appropriately challenged during routine management of vulvovaginal candidiasis.

P088 Sexual contact is the trigger! Women’s views and experiences of the triggers for the onset of bacterial vaginosis and exacerbating factors associated with recurrence

Background/introduction Bacterial vaginosis (BV) is the most common vaginal infection affecting women of childbearing age. While the aetiology and transmissibility of BV remain unclear, there is strong evidence to suggest an association between BV and sexual activity. Aim(s)/objectives This study aimed to explore women’s views and experiences of the triggers for BV onset and factors associated with recurrence Methods A descriptive, social constructionist approach was chosen as the framework for the study. Thirty five women of varying sexual orientation who had experienced recurrent BV in the past five years took part in semi-structured interviews. Results The majority of women predominantly reported sexual contact triggered the onset of BV and sexual and non-sexual factors precipitated recurrence. Recurrence was most commonly referred to in terms of a ‘flare-up’ of symptoms. The majority of women did not think BV was an STI however many reported being informed this by their clinician. Single women who attributed BV onset to sex with casual partners were most likely to display self-blame tendencies and to consider changing their future sexual behaviour. Women who have sex with women (WSW) were more inclined to believe their partner was responsible for the transmission of or reinfection with BV and seek partner treatment or change their sexual practices. Discussion/conclusion Findings from this study strongly suggest women believe that BV onset is associated with sexual activity, concurring with epidemiological data which increasingly suggest sexual contact is associated with the development of BV. There was some evidence to suggest possible transmission among WSW reinforcing the need for new approaches to treatment and management strategies.

False Friends? Empirical Evidence on Trade Policy Substitution in Regional Trade Agreements

In this paper, we examine the interplay of regional economic integration and the use of bilateral antidumping (AD) measures. Our empirical analysis brings three central findings to light: (i) We find that regional trade agreements (RTAs) generally reduce the likelihood of AD activity among integration partners. (ii) In addition, an improvement in tariff treatment of trading partners —regardless of whether expressed in absolute or relative terms— generally leads to a lower likelihood of bilateral AD activity. (iii) Regarding the interaction of both events, however, an improvement in the relative tariff treatment among fellow integration partners leads to a higher likelihood of bilateral AD activity than an equal improvement in the relative tariff treatment among non-integration trading partners. The latter effect seems to be primarily driven by those RTAs with a participation of “South” countries.

Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda.

BackgroundThe prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance.MethodsWe enrolled 241 FSWs in a cross sectional study; they were aged ≥ 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. Mantel-Haenszel tests for interaction were performed.ResultsAcceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning ≤ $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education.ConclusionAcceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment.

High Rate of Partner Treatment Among Chlamydia trachomatis-Infected Pregnant Women in Lima, Peru.

This was a substudy of 60 Chlamydia trachomatis-infected women from a larger study of pregnant women in Lima, Peru. Participants were encouraged to bring their partners in for concurrent patient-partner treatment. The alternative partner treatment was expedited partner therapy. Partner treatment uptake was 91.7%. Twenty-one partners (38.2%) received treatment through concurrent patient-partner treatment, and 34 (61.8%) through expedited partner therapy. Living with the partner was significantly associated with having the partner treated (P=0.0028).

Nonspecific vulvovaginitis of mixed etiology: local treatment – the treatment of choice

The article presents the comparative study of local therapy nonspecific vaginitis in 60 patients of reproductive age. The study included patients with a diagnosis of vulvovaginitis of mixed etiology confirmed according to clinical and laboratory diagnostic methods. Participants were randomized into 2 equal groups of 30 women. Main group patients appointed tergynan vaginal tablets for 10 days for the night vaginally. The comparison group treated with combination drug (miconazolum + ornidazolum + neomycin + prednisolonum, in the form of vaginal tablets) for 8 days. Treatment of sexual partners in both groups was carried out in accordance with generally guidelines. Analysis of the results of a comparative study showed greater efficacy of tergynan treatment. Vulva itching of average severity stopped to disturb most women in both groups an average for the 4th day of treatment. In similar terms it was regression of the basic clinical symptoms in the vast majority (90.0%) main group patients, and in particular the disappearance of burning and odor. In the comparison group improvement comes after almost two days by storing complaints burning and pathological secretions almost to the 6th day of observation. The results of bacteriological examination one month after therapy completion have confirmed the effectiveness of the treatment in the majority (90.0%) of women in main group and in 80.0% patients in control group. The results allow to recommend the use of a 10-day course of combined drug tergynan (ternidazolum + nystatin + neomycin sulfate + prednisolone sodium metasulphobenzoate) as a more effective not only in the empirical, but local and causal therapy of vulvovaginitis mixed etiology. The authors conclude that topical treatment for nonspecific vulvovaginitis is effective and safe, and can be considered as first-line therapy.

Screening for cervical dysplasia and reproductive tract infections among coffee plantation workers in Kodagu District, Karnataka, India.

Background: Cervical dysplasia is a pre malignant condition and cervical cancer is a leading cause of death among women in developing countries. This study was undertaken to coffee plantation workers to assess the prevalence of cervical dysplasia and reproductive tract infections (RTI) and its associated ethological factors among women aged 40 years and above.Methods: It was a cross sectional study conducted among female plantation workers aged 40 years and above and employed in coffee estates in Kodagu District, Karnataka, India. The tools in this study included an interview schedule to help collect socio demographic details and the procedures included per vaginal and per speculum examination along with Pap smear test. Results: A total of 141 women aged 40 years and above were screened for cervical dysplasia and reproductive tract infections. The prevalence of cervical dysplasia on Pap smear was seven percent and that of RTI was 12.05%. In this study there was no statistically significant association between cervical dysplasia or RTI with socio demographic variables like age, education, per capita in-come, age at marriage, age at first pregnancy or number of children.Conclusion: The prevalence of cervical dysplasia on Pap smear was seven percent and that of RTI was 12.05%. Regular screening of women in the reproductive age group with Pap smear and prevention and treatment of both partners with RTI may help reduce the chances of developing cervical cancer.International Journal of Occupational Safety and Health, Vol 4 No 2 (2014) 01 – 04

Women's Views and Experiences of the Triggers for Onset of Bacterial Vaginosis and Exacerbating Factors Associated with Recurrence.

BackgroundBacterial vaginosis (BV) is the most common vaginal infection affecting women of childbearing age. While the aetiology and transmissibility of BV remain unclear, there is strong evidence to suggest an association between BV and sexual activity. This study explored women’s views and experiences of the triggers for BV onset and factors associated with recurrence.MethodsA descriptive, social constructionist approach was chosen as the framework for the study. Thirty five women of varying sexual orientation who had experienced recurrent BV in the past five years took part in semi-structured interviews.ResultsThe majority of women predominantly reported sexual contact triggered the onset of BV and sexual and non-sexual factors precipitated recurrence. Recurrence was most commonly referred to in terms of a ‘flare-up’ of symptoms. The majority of women did not think BV was a sexually transmitted infection however many reported being informed this by their clinician. Single women who attributed BV onset to sex with casual partners were most likely to display self-blame tendencies and to consider changing their future sexual behaviour. Women who have sex with women (WSW) were more inclined to believe their partner was responsible for the transmission of or reinfection with BV and seek partner treatment or change their sexual practices.ConclusionFindings from this study strongly suggest women believe that BV onset is associated with sexual activity, concurring with epidemiological data which increasingly suggest BV may be sexually transmitted. Exacerbating factors associated with recurrence were largely heterogeneous and may reflect the fact it is difficult to determine whether recurrence is due to persistent BV or a new infection in women. There was however evidence to suggest possible transmission and reinfection among WSW, reinforcing the need for new approaches to treatment and management strategies including male and female partner treatment trials.

The Expedited Partner Therapy Continuum: A Conceptual Framework to Guide Programmatic Efforts to Increase Partner Treatment.

Expedited partner therapy (EPT) is a partner treatment strategy wherein health care providers give patients antibiotics or a prescription to deliver to their sex partners as treatment, without an intervening medical evaluation. We used PubMed and the Cochrane database to systematically identify published articles about EPT after 2006 and randomized controlled trials before that date; we also sought conference abstracts and unpublished data from 2013 to 2014. We described key steps in a hypothetical "EPT continuum," beginning with diagnosis of Chlamydia trachomatis or Neisseria gonorrhoeae in a patient and ending with treatment for the patient's sex partner(s) with EPT. All reports were abstracted for a set of defined measures and related interventions. We reviewed 100 published articles, unpublished data reports, and conference abstracts; 42 met the inclusion criteria and provided measures of the following: provider uptake and offer of EPT, patient acceptance and receipt of EPT, patient delivery of EPT to sex partners, and partner receipt of EPT and treatment. Implementation phase, populations, settings, and methodologies varied across reports. Providers' uptake and offer of EPT are rate-limiting steps in the EPT continuum and were the focus of all 5 programmatic interventions we identified. There were 7 population-based measures of patient receipt of EPT; however, several of the patient populations overlapped. A heterogenous body of literature describes EPT, and variation in study population, setting, and metrics limit generalizability. Programs seeking to increase partner treatment should focus their efforts on provider uptake and offer and should use population-based measures to monitor EPT use.

Sigara Bırakma Kliniği Hastalarının İzlem Sonuçları ve Bu Sonuçları Etkileyen Faktörler

Objective: One third of approximately 1.5 billion smokers live in 10 countries, which involves Turkey. Smoking cessation clinics are increasing day by day. However, long term smoking cessation rates are unsatisfactory. The aim of this research is to calculate success rates for the patients who admitted to smoking cessation outpatient clinic in light of the data that will be obtained from follow-ups, to determine their tobacco-use behaviours, the complicating and facilitating factors that are encountered during smoking cessation process and calculate effectiveness of different therapy modalities for tobacco cessation, thereby to contribute to tobacco control strategies, and to increase the success of tobacco cessation interventions. Material and Methods: 114 patients who admitted to smoking cessation clinic were followed up for 6 months. Patients? status of restarting smoking during follow-up was calculated based on even if smoking just a draw (slip) criterion. Results: The periods without smoking for participants whose spouses do not smoke, who used treatment for 28 days and more and whose type of treatment is varenicline were longer. In multivariate analyses, non-smoker spouse, long treatment period and varenicline use as treatment option were found to be factors positively affecting the success rate. Conclusion: The mean period without smoking for the participants in the first month found to be 12.8 days, have revealed that close follow-up of the patient in this early period is very critical in smoking cessation process. In addition to provision of proper treatment to patients, ensuring that the patient uses this treatment for a sufficient amount of time is also important in tobacco cessation process. Concomitant treatment of tobacco sing partners or encouraging the non-smoker partner to actively participate in treatment process may increase the success rate of tobacco cessation.

Perceived Sexual Abuse and Quality of Life of Female Workers of Unorganized Sector- An Exploratory Study from Four Districts of West Bengal

Women workers today play an essential and significant role in the economic structure of the country and 94% of women make up the unorganized sector of India. Domestic Violence affects women’s productivity in all forms of life i.e. assaulted women will always get agonized and emotionally disturbed and are often bruised after occurrence of the torment. A working woman may lose her efficiency in work or drop out from work in some cases. The present study aims to explore the magnitude of sexual abuse by intimate partners and the quality of life of women aged 18 -35 years in 4 districts of West Bengal. Close ended questionnaire and focused group discussions were conducted to understand their experiences regarding perception of sexual abuse. The contributing factors to violence were alcohol abuse, desire to gain control over another family member and unjustified suspicion. This analysis might be used to improve future partner violence prevention and treatment programs.

Patient-Delivered Partner Treatment for Chlamydia, Gonorrhea, and Trichomonas Infection Among Pregnant and Postpartum Women in Kenya

Patient-delivered partner treatment (PDPT) for sexually transmitted infections (STIs) increases rates of partner treatment and decreases reinfection, but has not been evaluated during pregnancy. This prospective cohort was nested within a larger study of peripartum HIV acquisition. Participants with microbiologic diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis were screened for participation. Questionnaires were administered to determine PDPT acceptability and barriers. Women were reassessed at least 30 days to determine partner treatment and reinfection. Women whose partners did or did not receive PDPT were compared. One hundred twelve (22.2%) women in the parent cohort had a treatable STI; 78 within the PDPT study period, of whom 66 were eligible and 59 (89.3%) accepted PDPT. Fifty-one women had PDPT outcome data, 37 (73%) of whom reported partners treated with PDPT. Fourteen women (27%) refused or did not deliver partner treatment. Median age was 22 years (interquartile range, 20-26 years) and 88% were married. Compared with women who delivered PDPT, those who did not were more likely to have a partner living far away (23% vs. 0%, P = 0.004) and to report current intimate partner violence (14% vs. 0%, P = 0.02). Reported PDPT barriers included fear of partner's anger/abuse (5%) and accusations of being STI source (5%). Patient-delivered partner treatment was acceptable and feasible for pregnant/postpartum Kenyan women and may reduce recurrent STIs in pregnancy.

O14.4 Home-based specimen collection forchlamydia trachomatisandneisseria gonorrhoeaetesting does not improve clinical management outcomes: systematic review

Introduction Home-based specimen collection is promoted as an innovative method to improve convenience and uptake of, and reduce barriers to clinic-based Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. It is not known whether this strategy increases successful case management or the impact of screening programmes. The objective of this systematic review was to assess the effectiveness and safety of home-based and clinic-based specimen collection for CT and NG. Methods We searched for randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL and LILACS databases, the Cochrane Sexually Transmitted Infections Group Specialised Register, two trials registers and grey literature up to February 2015. The primary effectiveness outcome was complete case management, defined as completed testing, diagnosis and treatment of index cases with positive test results. Secondary outcomes included testing uptake, test positivity, partner treatment and infections cured. Results We screened 496 unique records and included 10RCTs (6,291 participants). All reported on testing uptake but only three (1,566 people) assessed the primary outcome. There was no difference in complete case management between participants with home- vs. clinic-collected specimens (RR 0.88, 95% CI 0.60 to 1.29, I 2 0%). The trials were heterogeneous with respect to test uptake (I 2 100%) but eight reported more participants tested with home- vs. clinic-based testing. In nine studies (2,928 participants) the pooled positive test prevalence was lower in the home-based than the clinic-based group (RR 0.73, 95% CI 0.61 to 0.86, I 2 0%). No RCTs evaluated adverse events, rates of partner treatment or infection cure. Conclusion We found no evidence that home- vs. clinic-based specimen collection increased complete case management for CT and NG infections. Testing uptake might increase with home-based specimen collection but heterogeneity between studies was high. Safety and biological outcomes, such as infection cure, of home-based specimen collection strategies need to be evaluated. Disclosure of interest statement The Cochrane Sexually Transmitted Infections Group receives funding from the Faculty of Medicine, Universidad Nacional de Colombia. No pharmaceutical grants were received in the development of this study.

S09.3 The impact of screening on chlamydia transmission in australia -– a mathematical modelling study

Background Repeat chlamydia infection following treatment is common among young people and is associated with increased risk of pelvic inflammatory disease. Retesting and providing treatment to infected partners can reduce the reinfection rate. Both strategies have their own merits and limitations. Here we present a comparison of the impact of these two strategies on population prevalence through the use of modelling. Methods An individual-based model was developed to represent the transmission of chlamydia in a heterosexual population. A proportion of the modelled population is tested for chlamydia and treated annually under the testing coverage achieved in ACCEPt. We estimate the additional reduction in chlamydia prevalence achieved by retesting individuals who were infected with chlamydia and compare with the estimated reduction achieved by treating the partners of infected individuals. Results Preliminary results suggest that retesting at the rate achieved in ACCEPt would yield an additional 0.7% to 1.0% reduction in chlamydia prevalence. This reduction is greater than would be achieved by treating 10% of infected partners of index cases alone, which only yields an additional 0.5% to 0.8% reduction in chlamydia prevalence. If 10% of infected partners are treated in addition to retesting, the model predicts a further 0.6% to 0.7% reduction in chlamydia prevalence. Conclusion Both retesting and partner treatment can result in reductions in chlamydia prevalence in the population. Assuming that the retesting rate achieved in ACCEPt can be extended to the general Australian heterosexual population, this strategy should result in a greater reduction in prevalence than treating 10% of infected partners. More substantial reductions can be achieved by combining both strategies. Disclosure of interest statement The Kirby Institute is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, University of New South Wales. The views expressed in this publication do not necessarily represent the position of the Australian Government.

Understanding decisions made about hepatitis C treatment by couples who inject drugs.

Efforts to increase the number of people having hepatitis C virus (HCV) treatment require understanding how to best deliver services to meet consumers' needs. The general health literature has examined the role that partners can play in supporting health outcomes. This study examines the experiences of couples who inject drugs in relation to knowledge of, decisions about and management of HCV treatment. This is a qualitative interview study of people who inject drugs in couples. Participants were recruited from harm reduction services in two major Australian cities. Couples were interviewed separately. Data were examined using the couple as the unit of analysis and to identify patterns of experience related to the HCV serostatus of couples. Knowledge of HCV and HCV treatment was low and variable but showed some relationship to serostatus. Decisions about HCV treatment were deeply informed by concerns regarding treatment side effects. Positive concordant couples considered 'staging' treatment to ensure that each partner could (in turn) care for the other. People with HCV in serodiscordant relationships may need specific support regarding HCV treatment information. Within positive concordant partnerships, our data indicated the need to support the HCV-positive 'carer' during their partner's treatment. Changing treatment regimens, and their anticipated lower side effect profiles, will need to be actively promoted to ensure that couples understand how these changes affect their treatment options.