Patient-delivered Partner Therapy Use Research Articles

Patient-delivered partner therapy: One option for management of sexual partner(s) of a patient diagnosed with a chlamydia infection.

Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) in Australia. Partner management is key to reducing transmission and a cornerstone of best practice chlamydia management. While most patients will opt for telling their partner(s) themselves, patient-delivered partner therapy (PDPT) offers an alternative way to inform and treat partners where usual management isinappropriate or unlikely to be undertaken. Guidelines for PDPT vary across Australia. Recent research found that general practitioners (GP)s want practical guidance for using PDPT in appropriate situations. The aim of this article is to provide an overview of the process of offering PDPT and note the challenges GPs mayface in its provision. PDPT is one option for partner management when sexual partner(s) areunlikely or unable to seek timely carethemselves. However, there are challenges to the use of PDPT in general practice. The provision of clear guidelines is an essential step to promote its appropriate use.

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.

O11.1 Patient-delivered partner therapy (pdpt) increases the frequency of partner notification among msm in lima, peru: a randomised clinical trial

Background Patient-Delivered Partner Therapy (PDPT) improves treatment outcomes among sexual partners of individuals with curable STIs. Although use of PDPT with MSM has been questioned due to the high prevalence of undiagnosed HIV and syphilis in MSM networks, increasing partner notification (PN) through PDPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of PDPT on self-reported partner notification (PN) among Peruvian MSM with gonorrheal (GC) and/or chlamydial (CT) infection. Methods We screened 898 MSM in Lima, Peru for GC and/or CT between 2012–2014. Screening included syndromic management of urethritis/proctitis and nucleic acid testing for GC/CT at urethral, pharyngeal, and rectal sites (Aptima Combo-2 TMA). Enrollment was limited to participants with symptomatic urethritis/proctitis (n = 44) and/or laboratory-diagnosed GC/CT infection (n = 263). 173 eligible participants were randomly assigned to receive either standard PN counselling (n = 84) or counselling and PDPT (Cefixime 400 mg/Azithromycin 1 g) for up to 5 recent partners (n = 89). Self-reported notification of recent partners was assessed by CASI with 155 participants who returned for 14-day follow-up. Results The median age of all enrolled participants was 26 (IQR: 23–31), with a median of 3 (IQR: 2–4) partners reported during the previous 30-day period. Among all participants completing follow-up, 111/155 (71.6%) notified at least one partner, with a median of 1 partner notified per participant (IQR: 0–2). For participants randomised to receive PDPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (p = 0.001). The proportion of all recent partners notified was significantly greater in the PDPT than the Control arm (53.5% vs. 36.4%; p = 0.004). Conclusions Provision of PDPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of PDPT on biological outcomes of HIV/STI transmission in MSM sexual networks.

Patient-Delivered Partner Therapy for Chlamydial Infections

Treatment of sex partners is a core strategy for the control of chlamydia. Innovations such as patient-delivered partner therapy (PDPT) are effective in preventing repeat chlamydial infections, but providers' practice and perceptions of PDPT have not been adequately evaluated. This evaluation describes family planning providers' practices, knowledge, attitudes, and barriers regarding PDPT and assesses factors associated with routine use. A cross-sectional, self-administered, Internet-based survey of a convenience sample of family planning providers in California was conducted in 2007. Multivariate logistic regression was used to determine predictors associated with routine PDPT use. Of the 286 respondents, 73% reported routinely using PDPT for chlamydia and 77% provided medication to clients for their partner(s). Providers were more likely to offer PDPT for female versus male clients (73% vs. 53%, P < 0.0001). More than 90% agreed that PDPT helped provide better care for clients, was well-received, and protected against reinfection. Common concerns about PDPT included missed counseling opportunities (51%) and incomplete care for partners (42%). Over one-third (41%) identified lack of reimbursement for PDPT as an important barrier to routine use. Independent predictors of routine PDPT use included affiliation with an agency that received free prepackaged single-dose medication for on-site PDPT dispensing (adjusted odds ratio = 2.66, 95% confidence interval: 1.39-5.10) and support of the clinic's medical director (adjusted odds ratio = 4.85, 95% confidence interval: 1.57-14.96). A majority of providers in this sample reported routinely using PDPT for chlamydia-infected clients; provision of prepackaged medication to clinics facilitated use of PDPT.

Chlamydia Partner Services for Females in California Family Planning Clinics

Prompt treatment of exposed partners is critical for preventing further transmission of chlamydia, reinfection, and sequelae among females. Patient-delivered partner therapy (PDPT) has been allowable in California since 2001; however, few data are available regarding PDPT use and treatment outcomes. Eight family planning clinics participated in a partner services evaluation from 2005 to 2006. Females aged 16 to 35 years with chlamydia were interviewed to determine the partner service received and partner treatment outcomes; a subset of partners was also interviewed. Determinants of reported partner treatment were assessed using multivariate logistic regression. Selected medical records were reviewed to assess reinfection rates. Overall, 743 female patients disclosed 952 partners; 58% of whom were identified as steady partners. Reported partner services included concurrent patient-partner treatment visits (15% of partners), PDPT (19%), patient referral (55%), health department referral (0.1%), and no partner management (11%). On the basis of patient report, 82% of partners were notified and 54% received treatment. Of the 166 (17%) partners interviewed, 139 (84%) reported that they had received treatment, which correlated well with patient report. Reported partner treatment was higher for concurrent treatment visits and PDPT (79% and 80%, respectively) compared to patient referral (44%, P < 0.0001). Adjusted for clinic and relationship status, partners managed with concurrent treatment visits or PDPT were more likely to receive treatment compared with partners managed with patient referral (adjusted odds ratios, 3.5; 95% confidence interval, 2.1-5.8 and adjusted odds ratios, 4.3; 95% confidence interval, 2.6-7.2, respectively). Among the patients retested within 6 months after treatment, 18% were reinfected; reinfection rates did not differ by type of partner service. Although overall rates of reported partner treatment were low, concurrent patient-partner treatment visits and PDPT were associated with significantly higher rates of partner treatment. However, these methods may be underutilized in California family planning settings.

Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners

BackgroundGenital chlamydia is the most commonly notified sexually transmissible infection (STI) in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT) has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs) are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis.MethodsIn-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed.ResultsPerceived barriers to patients telling partners (patient referral) included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral) included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT - many felt concerned that it is not best clinical practice but many also felt that it is better than nothing.GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people.ConclusionsGPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.

Patient‐delivered partner therapy for chlamydia—a realistic public health measure in the UK

In the past decade, the UK has witnessed a dramatic rise in the number of cases of uncomplicated Chlamydia trachomatis.1 Increasingly, this is being managed in general practice and community and hospital gynaecological settings as well as in genitourinary medicine (GUM) clinics.2 Treatment of patients is usually straightforward with a single dose of azithromycin. However, ensuring that sexual partners are treated is often challenging. Timely treatment of partners is important to prevent the index patient from becoming re-infected. This is particularly important for women because repeat infection is more likely to lead to complications such as tubal infertility.3 Partner notification has been the traditional means for arranging partner treatment. This usually involves ‘patient-referral’, whereby the patients themselves inform their sexual partners of the possibility of infection and of the need to attend a clinic for treatment and testing. Usually this involves partners attending a GUM clinic where specialised staff offer testing, advice and education and often give empirical treatment at the same time.4 However, partners may be reluctant to undergo testing and treatment for an asymptomatic condition and may be deterred from attending GUM clinics in view of the stigma associated with having a sexually transmitted infection (STI).5 In many parts of the UK, patients may wait several weeks for an appointment to be seen at a GUM clinic.6 Resumption of sexual intercourse with an untreated partner during this time period to be seen can thus result in re-infection in the index woman, increasing the likelihood of infective sequelae. Furthermore, sex with an untreated partner necessitates repeat treatment that may result in a labour-intensive cycle for health professionals of treating index patient, testing and treating partner and then re-testing and re-retreating index patient. Clearly, partner notification with a consultation with specially trained staff may be the ‘gold standard’ of care. However, this is no longer a realistic option for all partners, given the number of people infected (the majority asymptomatic) and the fact that existing GUM services are struggling to cope with increasing workloads. Given the importance of preventing tubal infertility in women as a result of re-infection, novel partner interventions are now necessary. An obvious solution to prevent re-infection is to expedite partner treatment. Patient-delivered partner therapy (PDPT) is an example of such a strategy. This involves the index patient delivering a dose of antichlamydial therapy (usually azithromycin) to each sexual partner. This approach has been used in Sweden and is currently in use in some parts of the USA.7,8 Large randomised controlled trials conducted in the USA have shown that it is as least as effective as patient referral, both in terms of re-infection rates in index patients and in proportion of sexual contacts treated.9,10 Clearly, this is a controversial practice because it involves the clinician providing antibiotics for an individual they have neither laid eyes on nor been able to assess clinically. In the UK, the practice of PDPT would encounter legislative difficulties because it is in conflict with the General Medical Council guidelines on good prescribing and Medicines Act.11 Legislative change has been possible in the USA, so that PDPT is now legal in 14 states for treating partners of women with uncomplicated chlamydia.7 In the USA, PDPT is supplied with a comprehensive datasheet clearly listing the contraindications to its use and instructions on when and how to seek medical advice.12 Fortunately, azithromycin is a well-tolerated antibiotic and with a good safety record and low incidence of allergic reactions. Increased use of PDPT has raised concerns about possible increased antibiotic resistance. However, this strategy involves single dose treatment only and so may not carry the same risk of resistance from failure to complete a course of antibiotics. Indeed, a greater threat to antibiotic resistance is likely to come from veterinary medicine and animal husbandry, which account for more than half of the worldwide

Evaluation of a Population-Based Program of Expedited Partner Therapy for Gonorrhea and Chlamydial Infection

To evaluate a partner notification program for gonorrhea and chlamydial infection that involves communitywide access to free patient-delivered partner therapy (PDPT) and use of case-report forms to triage patients to receive partner notification assistance. We evaluated program components in randomly selected cases and compared outcomes before and after program institution. Following institution of the program, the percentage of cases who received PDPT from their diagnosing clinician increased from 5.6% to 16% (adjusted OR 3.2, 2.5-4.1). Among randomly selected cases, those referred to the health department via the case-report form were significantly more likely than nonreferred cases to have untreated sex partners (76% vs. 35%, OR 6.0, 95% CI 4.5-8.0), to accept PDPT from the health department (36% vs. 14%, 3.3, 95% CI 2.4-4.7), and to request that health department staff notify a partner for them (11% vs. 3%, OR 3.5, 95% CI 1.8-6.7). The percentage of cases classified as having all of their partners treated increased from 39% to 65% concurrent with institution of the program. A public health program that promotes routine use of PDPT and referral of selected patients for partner notification assistance appears to have improved partner notification outcomes.

Patient-Delivered Partner Therapy for Chlamydial Infections: Attitudes and Practices of California Physicians and Nurse Practitioners

The objective of this study was to examine California clinicians' use of and attitudes toward patient-delivered partner therapy (PDPT) to treat sexual partners of patients infected with chlamydia. In 2002, a stratified random sample of primary care physicians and nurse practitioners completed a mailed, self-administered survey. Weighted frequencies were calculated to assess partner management practices, including PDPT, and attitudes toward PDPT. Multivariate models were constructed to determine independent predictors of PDPT use. Of 708 physicians and 895 nurse practitioners, approximately half (47% and 48%, respectively) reported that they use PDPT usually or always. Over 90% agreed that PDPT protects patients from reinfection and provides better care for patients with chlamydia. However, providers reported concerns that PDPT may result in incomplete care for the partner, may be dangerous without knowing the partner's medical or allergy history, is an activity the practice may not get paid for, and may get them sued. Obstetrics/gynecology and family practice physicians were more likely than internal medicine physicians to report routine use of PDPT. Concerns about adverse outcomes of PDPT were associated with less PDPT use. Although the proportion of California healthcare providers routinely using PDPT is comparatively high, further study is warranted to examine the circumstances under which this partner management strategy is used.

Concurrent Sexually Transmitted Infections (STIs) in Sex Partners of Patients with Selected STIs: Implications for Patient-Delivered Partner Therapy

Patient-delivered partner therapy (PDPT) is the practice of providing disease-specific antimicrobial agents to patients for delivery to their sex partners. Some partners who receive PDPT may forgo clinical evaluation, resulting in missed opportunities for the diagnosis and treatment of comorbid conditions. We conducted a review of electronic charts for 8623 individuals attending 4 sexually transmitted disease clinics who were sex partners of patients with selected sexually transmitted infections (STIs). We evaluated the concordance between STIs diagnosed in partners and their reported exposures for which they might have received PDPT. Among 3503 female and 4647 heterosexual male partners, 19 (0.4%) of 4716 individuals tested were newly diagnosed with human immunodeficiency virus (HIV) infection, and 61 individuals (0.7%) had syphilis. Pelvic inflammatory disease was diagnosed in 133 women (3.8%). Seventy-two (3.2%) of 2226 female and heterosexual male partners reporting exposure to patients with chlamydial infection had gonorrhea diagnosed. Chlamydial infection or gonorrhea was diagnosed in 81 heterosexual male partners (10.3%) who reported contact with women with trichomoniasis. Among 473 men who have sex with men (MSM; including bisexual men), 13 (6.3%) of 207 tested were newly diagnosed with HIV infection, and 8 (1.7%) had syphilis. Six (6.1%) of 98 MSM reporting exposure to patients with chlamydial infection had gonorrhea diagnosed. Infrequent coinfections in female and heterosexual male partners exposed to patients with chlamydial infection or gonorrhea would not preclude use of PDPT. However, PDPT for male partners of women with trichomoniasis and for MSM requires further study.