Partner Treatment Research Articles

Acceptability and efficacy of partner notification for curable sexually transmitted infections in sub-Saharan Africa: A systematic review.

Comprehensive case management of sexually transmitted infections (STIs) includes partner notification. We reviewed the recent literature evaluating the acceptability and efficacy of partner notification strategies (i.e. direct patient referral, provider referral, or expedited partner treatment) for curable STIs in sub-Saharan Africa. We conducted a systematic search following PRISMA guidelines: published January 2008 to June 2017 in the English language, study in sub-Saharan Africa, and discussion of any curable STI with an outcome on partner notification. We searched six electronic databases, conference abstracts, online clinical trial registries, and article bibliographies. The results showed that out of the 74 identified articles, 55 did not meet inclusion criteria. Of the 11 studies evaluating direct patient referral, the proportion of index cases ( n = 4163) who successfully notified sex partner(s) was 53% (range 23-95%). Among those who notified ( n = 1727), 25% (range 0-77%) had partner(s) that sought evaluation (95% CI 0.51-0.54; 95% CI 0.23-0.27). Both provider referral and expedited partner treatment had higher proportions of partner(s) who sought treatment ( n = 208, 69% and n = 44, 84%, respectively). Direct patient referral is the most commonly used and evaluated partner notification strategy for STIs in sub-Saharan Africa with mixed success. We recommend future research to investigate other strategies such as expedited partner treatment.

Are We Educating, Our Children, About Hygiene? Are We Talking, With Them, About It?

Cancer screening has always focused on screening lone individuals even when sexually transmitted diseases (STDs) have been traditionally known to require concurrent treatment of all current sexual partners. This shared responsibility towards the sexual partners cannot be limited only to the prevention and treatment of STDs, especially when human papillomavirus (HPV), which is a STD, has been implicated in the etio-pathogenesis of cervical, penile and anal cancers besides other perineal cancers. Consequently, educating Indian population about our personal perineal hygienic practices is of utmost importance to help curtailing the non-“contagious” spread of cancers.

Cooperation of Pairs

To examine the stability of prosocial behavior in groups and pairs, we use an indirect approach. We conducted linear public good experiments with two and four subjects repeatedly three times at intervals of one week. All experiments were carried out without providing feedback and used a payment mechanism promoting stable behavior. We study the dynamics of behavior in repeated sessions and find that pairs are much better at establishing and stabilizing cooperation than groups of four. Furthermore, we conducted all experiments in a partner and a stranger design. As is known from the literature, cooperation in a stranger design should be lower than in a partner design. Once again, we are interested in the differences of the strength of this cooperation reducing effect between pairs and groups. Unlike pairs, groups show very low contributions to the public good in the stranger treatment and display a strong tendency to decrease cooperation in the partner treatment. The results in all treatments demonstrate that decreasing cooperation is a stable pattern of behavior in dynamic social dilemma contexts. Finally, we conducted a norm elicitation experiment using a method introduced by Krupka and Weber (2013) and find that in pairs symmetric behavior plays a very important role.

Immunotherapy in Advanced Non-small Cell Lung Cancer Patients: Ushering Chemotherapy Through the Checkpoint Inhibitors?

New ways of exploiting the immune system for cancer treatment have been tested for decades with moderate outcomes. Based on previous immunotherapy knowledge, agents targeting immune checkpoints seem to be remarkably effective in a wide range of tumors. Immune checkpoint inhibitors in metastatic non-small cell lung cancer (NSCLC) provide longlasting responses in specific patients. Nevertheless, with overall response rates ≤ 20%, combinational protocols for various patient subgroups are needed. A good partner treatment to immunotherapy could be chemotherapy, as it successfully modulates the immune response either by controlling or enhancing the antitumor immune activity. Primary research provides promising results in metastatic NSCLC patients using this approach, but further large-scale trials are needed. The implementation of immunotherapy in nonmetastatic cases is also appealing. We review the potential clinical benefits of immunotherapy alone or in concert with chemotherapy in NSCLC.

Not again! Effect of previous test results, age group and reason for testing on (re-)infection with Chlamydia trachomatis in Germany

BackgroundInfection with Chlamydia trachomatis (Ct) is the most commonly reported sexually transmitted infection in Europe. In Germany, Ct screening is offered free of charge to pregnant women since 1995 and to women < 25 years of age since 2008. For symptomatic individuals, testing is covered by statutory health insurance. Study results have shown that repeat Ct infection occurs in 10–20% of previously infected women and men. Our aim was to describe persons tested for Ct and to investigate the determinants of (repeat) Ct infection in women and men in Germany.MethodsWe analysed Ct test results from men and women tested between 2008 and 2014 in laboratories participating in the German Chlamydia trachomatis Laboratory Sentinel surveillance. Reinfection was defined as at least 2 positive laboratory tests within more than 30 days. We performed logistic regression stratified by sex and, for women, reason for testing to determine the effect of previous test results and age group on subsequent test results.ResultsIn total, 2,574,635 Ct tests could be attributed to 1,815,494 women and 123,033 men. 5% of women and 14% of men tested positive at least once. 15–19- and 20–24-year-old women tested positive at least once respectively in 6.8 and 6.0%, while men respectively in 16.6 and 21.2%. Altogether, 23.1% of tested women and 11.9% of tested men were tested repeatedly between 2008 and 2014. Among those who previously tested positive, reinfection occurred in 2.0% of women and 6.6% of men. Likelihood to be tested Ct positive was higher in women and men with a positive Ct test in the past compared to previously tested Ct negative, odds ratios 4.7 and 2.6 (p < 0.01) respectively. Odds ratios ranged by age group and test reason.ConclusionA history of Ct infection increased the likelihood of infection with Ct in women and men taking into account the result of the previous test. Health education, safer sex and treatment of partners are necessary for women and men who have tested positive to prevent reinfection and complications and to interrupt the chain of transmission. To identify potential reinfection repeat testing after treatment should be performed.

Barriers and facilitators of partner treatment of chlamydia: A qualitative investigation with prescribers and community pharmacists

Chlamydia trachomatis is the most frequently-notified sexually transmitted infection in Australia. Effective and timely partner treatment of chlamydia is essential to reduce overall prevalence and the burden of infection. Currently in most of Australia, the only avenue for partner treatment of chlamydia (standard partner therapy) is a tedious, and often inconvenient, process. The barriers and facilitators of standard partner therapy, and newer models of accelerated partner therapy (APT), need to be identified in the Australian setting. Additionally, the potential role of community pharmacists need to be explored. Semi-structured interview guides for two key stakeholder groups (prescribers and pharmacists) were developed and piloted. Eleven prescribers (general practitioners, sexual health clinicians and nurse practitioners) and twelve pharmacists practicing in the Perth metropolitan region were interviewed. Key reported barriers to standard partner therapy were lack of or delayed chlamydia testing. Key facilitators included ability to test and educate sexual partner. Key barriers for APT included prescribers' legal responsibility and potential for medication-related adverse effects. Healthcare provider consultation and chlamydia testing were seen as potential facilitators of APT. Pharmacists were receptive to the idea of expanding their role in chlamydia treatment, however, barriers to privacy must be overcome in order to be acceptable to prescribers and pharmacists.

A Survey of Patient and Partner Outcome and Treatment Preferences in Mild Cognitive Impairment.

Background:The patient-centered movement in health care is increasing efforts to design studies and interventions that address the outcomes that matter most to patients and their families. Research has not adequately addressed Alzheimer’s disease patient and caregiver preferences.Objective:To survey the outcome and treatment preferences of patients and caregivers who had completed a multicomponent behavioral intervention for mild cognitive impairment (MCI).Methods:Extending prior work, we conducted an online survey regarding outcome and intervention preferences. Participants were patients with MCI and partners who completed the HABIT Healthy Action to Benefit Independence & Thinking ® program.Results:Both patient and partner respondents ranked patient quality of life as the highest priority, followed by patient self-efficacy, functional status, patient mood, and patient memory performance. Distressing behaviors and caregiver outcomes (burden, mood, and self-efficacy) had low rankings. Regarding the importance of HABIT ® program components, memory compensation training was ranked highest and wellness education lowest by all groups.Conclusion:Additional research should compare patient preference for patient reported outcomes, traditional neuropsychological and clinician outcomes, and modern biomarker outcomes.

A pill for the partner via the chlamydia patient? Results from a mixed method study among sexual health care providers in the Netherlands

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.

Development and Content Validation of a Patient-Reported Sexual Risk Measure for Use in Primary Care.

Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools. To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure. Qualitative item development/quantitative instrument validation. We developed SRBI items based on patient interviews (n = 128) at four geographically diverse US primary care clinics. Patients were diverse in gender identity, sex, sexual orientation, age, race/ethnicity, and HIV status. We compared sexual risk behavior identified by the SRBI and the Risk Assessment Battery (RAB) among patients (n = 422). We constructed an item pool based on validated measures of sexual risk, developed an in-depth interview guide based on pool content, and used interviews to elicit new sexual risk concepts. We coded concepts, matched them to item pool content, and developed new content where needed. A provider team evaluated item clinical relevance. We conducted cognitive interviews to assess item comprehensibility. We administered the SRBI and the RAB to patients. Common, clinically relevant concepts in the SRBI included number of sex partners; partner HIV status; partner use of antiretroviral medication (ART)/pre-exposure prophylaxis (PrEP); and recent sex without barrier protection, direction of anal sex, and concern regarding HIV/STI exposure. While 90% reported inconsistent condom use on the RAB, same-day SRBI administration revealed that for over one third, all their partners were on ART/PrEP. The SRBI is a brief, skip-patterned, clinically relevant measure that ascertains sexual risk behavior across sex, sexual orientation, gender identity, partner HIV serostatus, and partner treatment status, furnishing providers with context to determine gradations of risk for HIV/STI.

Electronic case reporting of STIs: Are non-existent codes the reason for missing information?

Objective: Previous research identified data gaps between traditional paper-based STI notifiable condition reporting and pilot electronic initial case reporting (eICR) relying on Continuity of Care Documents (CCDs) exported from our clinical partner’s electronic health record (EHR) software.1 Structured data capture is needed for automatic processing of eICR data imported into public health repositories and surveillance systems, similar to electronic laboratory reporting (ELR). Coding data gaps (between paper and electronic case reports) using standardized vocabularies will allow integration of additional questions into EHR or other data collection systems and may allow creation of standard Clinical Data Architecture (CDA) templates, Logical Observation Identifiers Names and Codes (LOINC) panels, or Fast Healthcare Interoperability Resources (FHIR) resources. Furthermore, identifying data gaps can inform improvements to other standards including nationwide standardization efforts for notifiable conditions.Introduction: Under the CDC STD Surveillance Network (SSuN) Part B grant, WA DOH is testing eICR of sexually transmitted infections (STI) with a clinical partner. Existing standard vocabulary codes were identified to represent previously-identified information gaps, or the need for new codes or concepts was identified.Methods: In prior work, CCDs were securely received from our clinical partner and then analyzed for gaps compared to the existing paper-based STI case reporting form.1 Now, codes associated with gap concepts were identified in standard vocabularies such as LOINC and SNOMED CT. Standards were searched using online browsers offered by the standards development organizations (SDO) to identify potential codes, which were reviewed with public health epidemiologists and clinicians. Gaps were listed, and wording and intent was compared to standard codes including accessory information found in the SDO browsers and a final table of recommended codes was produced.Results: Acceptable congruity between currently used case reporting questions and coded vocabularies was found for the majority of data gaps previously identified. Where data need was incongruous with standard coded vocabularies, new codes or concepts could be proposed to the SDO.Pregnancy status is often missing from CDA documents but is well-conceptualized in both LOINC and SNOMED CT systems under several codes, including any current laboratory tests for pregnancy. HIV status is similarly well-conceptualized in both LOINC and SNOMED CT both as a problem list item well as thru a variety of laboratory tests. However, problem list EHR models lack standard inclusion of date of last HIV test or dates of current pregnancy as an associated coded data element which is desirable for public health.Information about the case patient’s sexual partners, need for partner STI treatment, and partner treatment completed is lacking in standard CCD documents.1 Number of current sexual partners [requiring treatment] – has a SNOMED-CT code, but lacks a match in LOINC coding system. This gap identified the need for exploration of how information about sexual partners can best be represented in interoperability artifacts, including the most useful division of information content between the information model and the standard terminology. Needed concept could resemble ‘record target’ found in HL7 version 3.0 and would allow data to be provided without specifying additional codes. Exploration of information model options or new codes is recommended.Many codes are possible for site of infection and specific symptoms but the overall concepts of ‘symptomatic infection’ and ‘site of infection’ as coded elements would need to be added.Conclusions: This coded element gap analysis found that most information requested in an STI case report can be found in a CCD. Gaps can be addressed by using existing standard terms except for concepts about sexual partners that might be better addressed by exploring the information model rather than through the addition of standard codes. Standards use will facilitate complete case reporting using CDA or FIHR, for example, within a ‘blue button’ or other system with functionality for exchanging additional information about notifiable condition case patients. Collaboration with clinicians, public health practitioners, informaticians, and EHR vendors in will help determine how these concepts might best be modeled. Understanding data gaps involves working closely with a broad range of stakeholders, to understand why gaps exist and how well proposed solutions will meet stakeholder needs.

Optimizing the Impact of Expedited Partner Therapy.

Optimizing the Impact of Expedited Partner Therapy.

Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV-1 serodiscordant couples in East Africa: a qualitative evaluation study in Uganda.

IntroductionSerodiscordant couples are a priority population for delivery of new HIV prevention interventions in Africa. An integrated strategy of delivering time‐limited, oral pre‐exposure prophylaxis (PrEP) to uninfected partners in serodiscordant couples as a bridge to long‐term antiretroviral treatment (ART) for infected partners has been implemented in East Africa, nearly eliminating new infections. We conducted a qualitative evaluation of the integrated strategy in Uganda, to better understand its success.MethodsData collection consisted of 274 in‐depth interviews with 93 participating couples, and 55 observations of clinical encounters between couples and healthcare providers. An inductive content analytic approach aimed at understanding and interpreting couples’ experiences of the integrated strategy was used to examine the data. Analysis sought to characterize: (1) key aspects of services provided; (2) what the services meant to recipients; and (3) how couples managed the integrated strategy. Themes were identified in each domain, and represented as descriptive categories. Categories were grouped inductively into more general propositions based on shared content. Propositions were linked and interpreted to explain “why the integrated strategy worked.”ResultsCouples found “couples‐focused” services provided through the integrated strategy strengthened partnered relationships threatened by the discovery of serodiscordance. They saw in services hope for “getting help” to stay together, turned joint visits to clinic into opportunities for mutual support, and experienced counselling as bringing them closer together.Couples adopted a “couples orientation” to the integrated strategy, considering the health of partners as they made decisions about initiating ART or accepting PrEP, and devising joint approaches to adherence. A couples orientation to services, grounded in strengthened partnerships, may have translated to greater success in using antiretrovirals to prevent HIV transmission.ConclusionsVarious strategies for delivering antiretrovirals for HIV prevention are being evaluated. Understanding how and why these strategies work will improve evaluation processes and strengthen implementation platforms. We highlight the role of service organization in shaping couples’ experiences of and responses to ART and PrEP in the context of the integrated strategy. Organizing services to promote positive care experiences will strengthen delivery and contribute to positive outcomes as antiretrovirals for prevention are rolled out.

Sexually Transmitted Infection Review for the Acute Care Pharmacist

Purpose: Review selected sexually transmitted infections (STIs) and treatment recommendations for pharmacists and providers practicing in the acute care setting. Summary: In 2015, the Centers for Disease Control and Prevention (CDC) published an updated guideline on the treatment of STIs with an emphasis on prevention and new diagnostic strategies to combat the growing problem of STIs in the United States. Despite this guidance, the incidence of infection has continued to grow. In October 2016, an in-depth analysis reported that 20 million new infections occur annually in the United States. With this growing burden of disease, it is pertinent that health-care providers optimize their treatment strategies to improve upon the management of STIs. Focusing on identification of asymptomatic- and symptomatic-infected persons, treatment, education, effective follow-up, and counseling for patients and sexual partners, emergency medicine pharmacists and providers can help minimize the negative long-term health consequences of STIs. Conclusion In the emergency department setting, clinical pharmacists and providers can play a crucial role in preventing and treating STIs and should continue to expand and keep current their knowledge of this topic.

Stress, anxiety, and depression of both partners in infertile couples are associated with cytokine levels and adverse IVF outcome.

Psychiatric disorders and stress in women have been associated with poor IVF outcome. We hypothesized that both partners in the infertile couples are emotionally affected, and cytokines in both may link psychological to reproductive outcome. Forty-five IVF couples completed questionnaires and visual analog scales for stress and psychiatric disorders and had cytokines measured in serum, semen, cervicovaginal, and follicular fluids. Multivariable analyses, t tests, maximum likelihood estimates, Spearman correlation, and data mining were applied. Psychopathology was found in 72% of the couples. Female and male stress were associated with stress, anxiety, and depression in the respective partner, and with a lower likelihood of clinical pregnancy and live birth. Lower serum TGF-β and higher cervicovaginal IL-6 and IL-1β were associated with stress. In data decision trees, cytokines in relation to stress and depression in both partners were found indicative of IVF failure. Infertile couples may benefit from psychiatric evaluation and treatment of both partners.

Preparing for the Chlamydia and Gonorrhea Self-Test.

New technology may soon allow individuals to test themselves for chlamydia and gonorrhea. These new self-tests might help increase screening, but they will also bring new issues for treatment, prevention, and surveillance. Providers will need to decide how to respond to patients who present after a positive screening test and how to approach partner testing and treatment. Research will be needed to identify approaches to increase screening using these tests. Laboratory-based surveillance will not capture infections if testing does not involve a laboratory, so new surveillance techniques will be needed. Self-tests are new tools that will soon be available. We should be prepared to use them.

A Conceptual Model of Dyadic Coordination in HIV Care Engagement Among Couples of Black Men Who Have Sex with Men: A Qualitative Dyadic Analysis.

Among Black men who have sex with men (MSM), HIV incidence is disproportionately high and HIV care engagement is disproportionately low. There may be important opportunities to leverage the primary relationship to improve engagement in HIV care and treatment among Black MSM couples. Using dyadic qualitative analysis of semi-structured, one-on-one interviews, we explored dyadic aspects of HIV care engagement among 14 Black MSM couples in which at least one partner was HIV-positive and identified as a Black cisgender man. Findings showed that men varied in how involved they were in their HIV-positive partner's care and treatment, and in how they reciprocated their partner's involvement. Patterns of dyadic HIV care engagement supported a conceptual model of dyadic coordination that describes Black MSM relationships in terms of two conceptual dimensions of dyadic HIV care engagement, and guides future intervention designs with Black MSM couples.

Barriers and Facilitators of Partner Treatment of Chlamydia: A Qualitative Investigation with Prescribers and Community Pharmacists.

Chlamydia trachomatis is the most frequently-notified sexually transmitted infection in Australia. Effective and timely partner treatment of chlamydia is essential to reduce overall prevalence and the burden of infection. Currently in most of Australia, the only avenue for partner treatment of chlamydia (“standard partner therapy”) is a tedious, and often inconvenient, process. The barriers and facilitators of standard partner therapy, and newer models of accelerated partner therapy (APT), need to be identified in the Australian setting. Additionally, the potential role of community pharmacists need to be explored. Semi-structured interview guides for two key stakeholder groups (prescribers and pharmacists) were developed and piloted. Eleven prescribers (general practitioners, sexual health clinicians and nurse practitioners) and twelve pharmacists practicing in the Perth metropolitan region were interviewed. Key reported barriers to standard partner therapy were lack of or delayed chlamydia testing. Key facilitators included ability to test and educate sexual partner. Key barriers for APT included prescribers’ legal responsibility and potential for medication-related adverse effects. Healthcare provider consultation and chlamydia testing were seen as potential facilitators of APT. Pharmacists were receptive to the idea of expanding their role in chlamydia treatment, however, barriers to privacy must be overcome in order to be acceptable to prescribers and pharmacists.

20 - Partner Notification, Treatment, and Subsequent Condom Use: Pelvic Inflammatory Disease: Implications for Dyadic Intervention

20 - Partner Notification, Treatment, and Subsequent Condom Use: Pelvic Inflammatory Disease: Implications for Dyadic Intervention

159 - Expedited Partner Therapy: Adolescents' Acceptance of a Partner Treatment Method

159 - Expedited Partner Therapy: Adolescents' Acceptance of a Partner Treatment Method

Preoccupied Attachment as Predictor of Enabling Behavior: Clinical Implications and Treatment for Partners of Substance Abusers

Substance use can affect partners in innumerable ways. The emotional pain, turmoil, stress, and strain alone leave family members searching for ways to help, or simply to cope. Enabling is one such method. A common coping mechanism in families struggling with substance use, enabling involves actions and behaviors employed by loved ones to incite change, regain control, and increase stability. Enabling is unique however. Rather than minimizing use, enabling has an adverse effect of contributing to, and reinforcing the partner’s substance use and addictive behaviors. For Clinical Social Workers, Licensed Addiction Specialists, and other Mental Health Practitioners, working with family members who enable their partners can be challenging, complex, and still, even with one’s best efforts, fail to reduce or eliminate the behavior. Looking at a single case through the lens of Classical and Modern Attachment Theory, a close examination of enabling and its correlation with preoccupied attachment style is provided, contributing to the current research on affect regulation through the marital dyad, attunement, attachment repair through therapeutic relationship, and enabling behavior, concluding that the characteristics of an insecure/preoccupied attachment generate a very specific vulnerability to, and motivation towards, enabling behavior.