Expedited Partner Therapy Research Articles

Extent and Role of Pharmacists in Expedited Partner Therapy in the US [18I

INTRODUCTION: Providing prescriptions to sex partners of patients diagnosed with sexually transmitted infections (STIs) is called Expedited Partner Therapy (EPT). EPT decreases reinfection and further transmission, however barriers inhibit widespread implementation. We sought to identify pharmacy-level barriers to EPT by examining United States (US) pharmacists’ legal responsibilities and practices. We hypothesized that pharmacists’ EPT legal responsibilities would vary between states. METHODS: Laws, regulations, and guidelines from LexisNexis, Board of Pharmacy, and CDC were evaluated. Pharmacist responsibilities was characterized from Level A (pharmacists screen and prescribe EPT) through Level E (EPT not enacted). Descriptive statistics were performed. RESULTS: No state/territory was Level A. Twenty-three (46%) states/territories were Level B (EPT enacted and practiced, e.g. partner’s identification not required); 14(27%) states/territories Level C (EPT enacted but not fully practiced, e.g. partner’s identification required); 11(23%) states/territories Level D (EPT enacted but not practiced); and 2(3.8%) states/territories Level E. Oregon (Level B) has amendments and new laws potentially rising to Level A. Wyoming (Level B) implemented a state-driven EPT delivery system. Oklahoma, New Jersey, and Kansas (Level D) have pending bills. Kentucky and South Carolina (Level E) have struggled to pass EPT bills. CONCLUSION: Most states/territories permit pharmacists to dispense EPT at varying scopes of practice; however, no laws currently enable pharmacists to prescribe EPT. Pharmacists’ involvement in EPT, including the ability to prescribe, play a huge role in STI prevention and public health; thus, clearer and more permissive laws and regulations regarding pharmacists’ role in EPT are needed.

Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries.

IntroductionIn light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa.Methods and findingsHIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7–23.0), NG 5.2% (95%CI 2.6–7.9) and TV 3.0% (95%CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment.ConclusionsPOC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.

Use of Expedited Partner Therapy for Treatment of Chlamydia in Adolescents

Use of Expedited Partner Therapy for Treatment of Chlamydia in Adolescents

Pharmacy-level barriers to implementing expedited partner therapy in Baltimore, Maryland

Addressing record high rates of Chlamydia trachomatis incidence in the United States requires the utilization of effective strategies, such as expedited partner therapy, to reduce reinfection and further transmission. Expedited partner therapy, which can be given as a prescription or medication, is a strategy to treat the sexual partners of index patients diagnosed with a sexually transmitted infection without prior medical evaluation of the partners. There are multiple steps in the prescription-expedited partner therapy cascade, and we sought to identify pharmacy-level barriers to implementing prescription-expedited partner therapy for Chlamydia trachomatis treatment. We used spatial analysis and ArcGIS, a geographic information system, to map and assess geospatial access to pharmacies within Baltimore, MD, neighborhoods with the highest rates of Chlamydia trachomatis (1180.25-4255.31 per 100,000 persons). Expedited partner therapy knowledge and practices were collected via a telephone survey of pharmacists employed at retail pharmacies located in these same neighborhoods. Cost of antibiotic medication in US dollars wascollected. Census tracts with the highest Chlamydia trachomatis incidence rates had lower median pharmacy density than other census tracts (26.9 per 100,000 vs 31.4 per 100,000, P < .001). We identified 25 pharmacy deserts. Areas defined as pharmacy deserts had larger proportions of black and Hispanic or Latino populations compared with non-Hispanic whites (93.1% vs 6.3%, P < .001) and trended toward higher median Chlamydia trachomatis incidence rates (1170.0 per 100,000 vs 1094.5 per 100,000, P= .110) than non-pharmacy desert areas. Of the 52 pharmacies identified, 96% (50 of 52) responded to our survey. Less than a fifth of pharmacists (18%, 9 of 50) were aware of expedited partner therapy for Chlamydia trachomatis. Most pharmacists (59%, 27 of 46) confirmed they would fill an expedited partner therapy prescription. The cost of a single dose of azithromycin (1 g) ranged from 5.00 to 39.99 US dollars (median, 30 US dollars). Limited geographic access to pharmacies, lack of pharmacist awareness of expedited partner therapy, and wide variation in expedited partner therapy medication cost are potential barriers to implementing prescription-expedited partner therapy. Although most Baltimore pharmacists were unaware of expedited partner therapy, they were generally receptive to learning about and filling expedited partner therapy prescriptions. This finding suggests the need for wide dissemination of educational material targeted to pharmacists. In areas with limited geographic access to pharmacies, expedited partner therapy strategies that do not depend on partners physically accessing a pharmacy merit consideration.

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

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

STIs in sex partners notified for chlamydia exposure: implications for expedited partner therapy

ObjectivesExpedited partner therapy (EPT) may reduce chlamydia reinfection rates. However, the disadvantages of EPT for chlamydia include missing the opportunity to test for other STIs and unnecessary use of antibiotics...

Addressing missed opportunities for HIV testing by including rapid-HIV self-testing kits with patient-delivered partner therapy.

Patient-delivered partner therapy (PDPT) is the practice of providing patients diagnosed with bacterial sexually transmitted infections (STIs) medication to give directly to their partner for treatment, which can result in missed opportunities for partner HIV testing. Fifteen STI clinic patients were asked about their opinions of including HIV self-testing (HIVST) kits with PDPT. Interview data fit well into constructs of the information-motivation-behavioral skills (IMB) model. Patients' motivations to deliver HIVST kits to their partners included the importance of earlier identification of HIV, convenience, avoidance of STI clinic stigma, and empowerment of individual and partner protection against HIV. Patients described the need for more information with worries about the quality of the HIVST device and questions about how it worked. Patients worried about their partners' reaction, including the potential for violence, and needed skills to support their partner with HIVST. Public health policies should support the inclusion of HIVST kits with PDPT, but additional intervention research is needed to more fully support patients and their partners with HIVST and PDPT.

Pharmacy-level barriers in implementing expedited partner therapy in baltimore

Pharmacy-level barriers in implementing expedited partner therapy in baltimore

Use of Patient-Delivered Partner Therapy in US College Settings: Associations With Legality, Perceived Legality and Other Sexual and Reproductive Health Services.

Young adults, including college students, have higher rates of chlamydia than the general population. Patient-delivered partner therapy (PDPT) is a partner treatment option for sex partners of individuals diagnosed with chlamydia or gonorrhea. We examined college health center use of PDPT in a national sample of colleges. During 2014 to 2015, we collected data from 482 colleges and universities (55% of 885 surveyed), weighting responses by institutional characteristics abstracted from a national database (eg, 2-year vs 4-year status). We asked whether the school had a student health center and which sexual and reproductive health (SRH) services were offered. We also assessed the legal and perceived legal status of PDPT in states where schools were located. We then estimated PDPT availability at student health centers and measured associations with legal status and SRH services. Most colleges (n = 367) reported having a student health center; PDPT was available at 36.6% of health centers and associated with perceived legality of PDPT in the state in which the college was located (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.17-18.28). Patient-delivered partner therapy was significantly associated with availability of SRH services, including sexually transmitted disease diagnosis and treatment of STI (56.2% vs 1.1%), gynecological services (60.3% vs 12.2%), and contraceptive services (57.8% vs 7.7%) (all P < .001). Compared with schools taking no action, PDPT was more likely to be available at schools that notified partners directly (OR, 8.29; 95% CI, 1.28-53.85), but not schools that asked patients to notify partners (OR, 3.47; 95% CI, 0.97-12.43). PDPT was more likely to be available in colleges that offered SRH services and where staff believed PDPT was legal. Further research could explore more precise conditions under which PDPT is used.

Perceived Risk of Intimate Partner Violence Among STI Clinic Patients: Implications for Partner Notification and Patient-Delivered Partner Therapy.

Patient-delivered partner therapy (PDPT) is the practice of providing patients diagnosed with a bacterial sexually transmitted infection (STI) medication to give directly to their partner for treatment without requiring the partner to participate in diagnostic testing and counseling. Despite a growing body of evidence in support of PDPT, literature is limited to date on the influence of perceived risk of intimate partner violence (IPV) on PDPT use. We analyzed mixed-method data from 196 quantitative surveys (61% male, M age=31.2, 92% Black or African-American) and 25 qualitative interviews to better understand the barriers and facilitators associated with PDPT delivery for patients attending a Midwestern, publicly funded STI clinic in the U.S. Nearly a third of surveyed patients (29; 34% of women, 26% of men) expressed worry about IPV when delivering PDPT. Patients had concerns about infidelity worry, embarrassment, and anxiety (referred to as IWEA hereafter) associated with partner notification and PDPT delivery. We found IWEA was highly correlated with IPV concerns in a fully adjusted logistic regression model. Women had 2.43 (95% CI=1.09-5.42) times greater odds of worrying about IPV than men; other significant factors associated with IPV worry included higher condom use, no prior STI diagnosis, and being uninsured (as compared to having Medicare/Medicaid insurance). Encouraging communication between healthcare providers and their patients about the potential for IPV could facilitate patient triaging that results in the consideration of alternative partner referral mechanisms for patients or partners at risk of harm and better outcomes for patients and their partners.

Chlamydia and gonorrhea screening and expedited partner therapy (EPT) practices of college student health centers

ABSTRACTObjective: To examine college student health centers' (SHCs) practices related to sexually transmitted disease (STD) screening and treatment over a 5-year period. Participants: College SHCs that completed the ACHA Pap and STI Survey between 2010 and 2014. Methods: Chi-square tests were conducted with Cramer's V providing a measure of association. Results: Chlamydia screening of women under 25 years of age was a well-established practice. Almost one-third of SHCs did not report screening practices of men who have sex with men (MSM) consistent with current chlamydia and gonorrhea guidelines; however, there was improvement over time. Few college SHCs utilized expedited partner therapy (EPT), though fewer had blanket restrictions prohibiting its use in 2014 compared to 2010. Conclusions: Over the 5-year period, more SHCs followed current best practices. Improvement in compliance with guidelines related to MSM STD screening as well as increased usage of EPT is needed to best address the needs of the diverse college student population.

Partner Notification for Gonorrhea and Syphilis in Belgrade

Abstract “Contact tracing” or “partner notification” refers to clinicians’ efforts to identify sex partners of infected persons to ensure their medical evaluation and treatment. For many years partner notification has been a cornerstone in the management of patients diagnosed with sexually transmitted infections (STIs) and it is the essential component in the control of these infections. Clinicians’ efforts to ensure the treatment of a patient’s sex partners can reduce the risk for re-infection and potentially diminish transmission of STIs. Partner notification includes three different approaches for notifying the sexual partners of the person infected with a STI: provider referral, patient referral, and contract referral. The aim of our study was to evaluate the efficacy of partner notification among syphilis and gonorrhea cases registered at the City Institute for Skin and Venereal Diseases in Belgrade in 2016, and its contribution to prevention and control of these diseases. A retrospective chart review of patients with gonorrhea and early syphilis registered in 2016 was undertaken. We analyzed data about the possible source of infection as well as sexual orientation, provided on the official form for notification of syphilis and gonorrhea. The study included 112 male patients, 67 with gonorrhea and 45 with syphilis. Out of three modalities of partner notification offered to patients, only patient notification of sexual partner/s was accepted. Although all patients accepted this type of partner notification, index patients with gonorrhea notified only 17 partners (25.4%) and index patients with syphilis also notified 17 partners (37.8%). The effectiveness of partner notification for gonorrhea and syphilis cases was only 30.4%, and its contribution to prevention and control of these diseases was lower than we expected. National guidelines offering standardized protocols for partner notification service provision can improve this process, as a novel approach with non-traditional method of partner notification such as patient-delivered partner therapy.

Pharmacists’ attitudes regarding provision of sexual and reproductive health services

ObjectivesThe primary objective was to assess attitudes from Ohio pharmacists about contraceptive authority. Secondary objectives included determining pharmacists’ perceptions of benefits, barriers, and preparedness for offering such services and examining attitudes about and experiences with other reproductive health topics to inform future research. MethodsAn anonymous 26-question Institutional Review Board–approved electronic survey was developed and distributed via Qualtrics to a random sample of 500 licensed pharmacists in Ohio. Two months were allotted for survey completion. A link to free Accreditation Council for Pharmacy Education–approved continuing pharmacy education (CPE) through Ohio Northern University was offered as an incentive for completing the survey. ResultsOne hundred thirty-eight pharmacists completed the survey (62% female). Fifty-eight percent worked in community pharmacy and 34% in health-system pharmacy. The majority indicated that oral and transdermal contraceptive methods should be pharmacist-initiated (57% and 54%, respectively) through a collaborative practice agreement or statewide protocol. More pharmacists supported provision of hormonal contraception through a collaborative practice agreement rather than a statewide protocol. Increased access to care and convenience for patients were identified most frequently as potential benefits. Time constraints, concerns of increased liability, and other barriers for initiating such services were identified by pharmacists. Pharmacists most frequently listed clinical guidelines, CPE, and patient education materials as tools needed to successfully initiate contraceptive therapy regimens. Pharmacists responding to the survey were also proponents of increasing involvement in other aspects of sexual and reproductive health, such as expedited partner therapy (64%) and human papilloma virus vaccination (67%). Respondents indicated a potential lack of experience or training in topics such as expedited partner therapy and intimate partner violence. ConclusionPharmacists surveyed showed interest in providing sexual and reproductive health services, including pharmacist-provided prescription contraceptive products and preventive health services. Further studies are needed to evaluate pharmacists’ roles in other sexual and reproductive health services.

P209 What makes expedited partner therapy (EPT) and accelerated partner therapy (APT) work for partner notification for bacterial stis? a systematic review of interventions

IntroductionExpedited Partner Therapy (EPT) treats the sex partners of persons with STIs without prior clinical evaluation. These interventions have been shown to reduce rates of re-infection and treat a higher...

Impact of expedited partner therapy (EPT) implementation on chlamydia incidence in the USA

ObjectivesThe diagnosis and treatment of Chlamydia trachomatis infection is important in preventing persistent or recurrent infection. Expedited partner therapy (EPT) is the favoured and supported method for STI treatment of...

Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial

BackgroundExpedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection.MethodsWe enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up.ResultsThe median age of participants was 26 (interquartile range [IQR]: 23–31) with a median of 3 sexual partners (IQR: 2–4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0–2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68–7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0–62.0% versus 36.4%, 95% CI: 27.0–47.4%).ConclusionsProvision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks.Trial registrationClinicalTrials.gov, NCT01720654. Registered on 10/29/2012.

Assessing Different Partner Notification Methods for Assuring Partner Treatment for Gonorrhea: Looking for the Best Mix of Options.

Partner notification for gonorrhea is intended to interrupt transmission and to bring people exposed to infection to care. Partner notification may be initiated through public health professionals (disease intervention specialist: DIS referral) or patients (patient referral). In some cases, patients may carry medications or prescriptions for partners (patient-delivered partner therapy: PDPT). To examine how patterns of notifying and treating partners of persons with gonorrhea differ by partner notification approach. From published literature (2005-2012), we extracted 10 estimates of patient referral data from 7 studies (3853 patients, 7490 partners) and 5 estimates of PDPT data from 5 studies (1781 patients, 3125 partners). For DIS referral estimates, we obtained 2010-2012 data from 14 program settings (4581 patients interviewed, 8301 partners). For each approach, we calculated treatment cascades based on the proportion of partners who were notified and treated. We also calculated cascades based on partners notified and treated per patient diagnosed. Proportions of partners notified and treated were, for patient referral, 56% and 34%; for PDPT, 57% and 46%; for DIS referral, 25% and 22%. Notification and treatment estimates for patient referral and PDPT were significantly higher than for DIS referral, but DIS referral was more efficacious than the other methods in assuring treatment among those notified (all Ps < .001). The notification and treatment ratios per patient seen were, for patient referral, 0.96 and 0.61; for PDPT, 0.90 and 0.73; for DIS referral, 0.45 and 0.40. Patient-based methods had higher proportions of partners treated overall, but provider referral had the highest proportion treated among those notified. These data may assist programs to align the most efficacious strategies with the most epidemiologically or clinically important cases while assuring the best scalable standard of care for others.

Patient Delivered Expedited Partner Therapy for Chlamydia Among Female Adolescents Using School Based Health Centers: Is It Feasible?

Patient Delivered Expedited Partner Therapy for Chlamydia Among Female Adolescents Using School Based Health Centers: Is It Feasible?

State-level gonorrhea rates and expedited partner therapy laws: insights from time series analyses

ObjectiveIn this study, we examined state-level monthly gonorrhea morbidity and assessed the potential impact of existing expedited partner therapy (EPT) laws in relation to the time that the laws were enacted. Study designLongitudinal study. MethodsWe obtained state-level monthly gonorrhea morbidity (number of cases/100,000 for males, females and total) from the national surveillance data. We used visual examination (of morbidity trends) and an autoregressive time series model in a panel format with intervention (interrupted time series) analysis to assess the impact of state EPT laws based on the months in which the laws were enacted. ResultsFor over 84% of the states with EPT laws, the monthly morbidity trends did not show any noticeable decreases on or after the laws were enacted. Although we found statistically significant decreases in gonorrhea morbidity within four of the states with EPT laws (Alaska, Illinois, Minnesota, and Vermont), there were no significant decreases when the decreases in the four states were compared contemporaneously with the decreases in states that do not have the laws. ConclusionWe found no impact (decrease in gonorrhea morbidity) attributable exclusively to the EPT law(s). However, these results do not imply that the EPT laws themselves were not effective (or failed to reduce gonorrhea morbidity), because the effectiveness of the EPT law is dependent on necessary intermediate events/outcomes, including sexually transmitted infection service providers' awareness and practice, as well as acceptance by patients and their partners.

Expedited Partner Therapy: A Review for the Pediatric Nurse Practitioner

The rate of sexually transmitted infections in the United States increased in 2015 for the second year in a row. Adolescents bear an undue portion of this burden because of increased physiologic susceptibility, higher rates of reinfection, and developmental age. Despite expedited partner therapy (EPT) being legalized in 39 states, health care providers still report infrequently providing EPT to their adolescent patients. Patients who benefit most from EPT include those with high-risk sexual behavior, a steady relationship status, higher education level, or an established relationship with the provider. This article will review the barriers to providing EPT and factors associated with patient acceptance or refusal, highlight current legal issues, and discuss the role of the pediatric nurse practitioner addressing specific strategies for implementation in practice. EPT is a valuable tool for the pediatric nurse practitioner to promote treatment and prevent reinfection with sexually transmitted infections.