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Taylor C, Ratnayake A, Lederer A, Gomes G, He H, Kissinger PJ. Ability to Recontact Sex Partners and Partner Treatment Success Among Young Heterosexual Black Men With Chlamydia. J Adolesc Health 2024; 75:673-679. [PMID: 39066755 DOI: 10.1016/j.jadohealth.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Patient-delivered partner therapy (PDPT) allows index patients who test positive for Chlamydia trachomatis (Ct) to provide treatment to partners directly. PDPT is contingent upon an index being able to contact their partner. The aims of this study were to assess factors related to being able to contact a partner and being able to successfully deliver their treatment. METHODS Participants were Black men who have sex with women aged 15-26 enrolled in a community Ct screening/treatment program in New Orleans, LA who tested positive for Ct and completed a computer-assisted survey. Factors associated with the index's ability to contact their recent sex partner(s) and to successfully deliver PDPT to his partner(s) were compared by characteristics of the relationship. RESULTS Of 104 young men who tested positive for Ct, the median age was 20.3 years and information was reported on 184 female partners, of whom 143 (77.7%) were deemed contactable by the index. Only the index wanting to have sex with the partner again was significantly associated with their ability to contact the partner (odds ratio [OR] 5.38, 95% confidence interval [CI] 2.18, 13.23). Only 72/184 (39.1%) partners received PDPT. The index being interested in sex with partner again (OR 2.54, 95% CI 1.23-5.27) was associated with greater odds of successful PDPT delivery whereas if index believed their partner had other partners, successful PDPT was less likely (OR 0.51, 95% CI 0.26-0.99). There was low agreement between an index's ability to contact their partner and the delivery of PDPT (kappa = 0.04 [-0.062, 0.143). DISCUSSION Asking patients if they can recontact prior sexual parters may be insufficient to ensure that their partners receive PDPT.
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Affiliation(s)
- Christopher Taylor
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Aneeka Ratnayake
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Alyssa Lederer
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
| | - Gérard Gomes
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Patricia J Kissinger
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
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McMahon BL, Buitendam E, Symonds M, Estcourt CS, Saunders J. Use of a five-category partner-type classification within a chlamydia and gonorrhoea service evaluation highlights opportunities for targeted partner notification to improve STI control. Sex Transm Infect 2024:sextrans-2024-056108. [PMID: 39237136 DOI: 10.1136/sextrans-2024-056108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/17/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVES Partner notification (PN) is a key component of sexually transmitted infection control. British Association for Sexual Health and HIV guidelines now recommend partner-centred PN outcomes using a five-category partner classification (established, new, occasional, one-off, sex worker). We evaluated the reporting of partner-centred PN outcomes in two contrasting UK sexual health services. METHODS Using the electronic patient records of 40 patients with a positive gonorrhoea test and 180 patients with a positive chlamydia test, we extracted PN outcomes for the five most recent sexual contacts within the appropriate lookback period. RESULTS 180 patients with chlamydia reported 262 partners: 220 were contactable (103 established, 9 new, 43 occasional, 52 one-off, 13 unknown/unrecorded). 40 patients with gonorrhoea reported 88 partners: 53 were contactable (7 established, 1 new, 14 occasional, 10 one-off and 21 unknown/not recorded). No sex worker partners were reported. Most established partners of people with chlamydia (96/103) or gonorrhoea (7/7) were notified but fewer (60/103 and 6/7, respectively) attended for testing. Of those, 39 had a positive chlamydia test and two had a positive gonorrhoea test. For both chlamydia and gonorrhoea, most occasional and new partners were reported to be notified but there was a sharper decline in those tested. For both infections, one-off partners had the lowest rates of accessing services and testing. For chlamydia, 81% were notified (42/52), 23% accessed services (12/52) and 21% tested (11/52). However, 91% of those tested were positive (10/11). The number of contactable one-off gonorrhoea contacts was small and few attended. CONCLUSIONS Measuring partner-centred PN outcomes was feasible. There were differences in partner engagement with PN between the different infections and partner types. If these findings are replicated in larger samples, it suggests that interventions to target one-off partners who have low rates of PN engagement yet high levels of positivity could play a key role in reducing infection at population level.
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Affiliation(s)
| | - Erna Buitendam
- Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, London, UK
| | - Merle Symonds
- West Sussex Health and Social Care NHS Trust, Worthing, UK
| | - Claudia S Estcourt
- Sandyford Sexual Health Service, Glasgow, UK
- Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - John Saunders
- Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, London, UK
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3
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Woodward C, Bloch S, McInnes-Dean A, Lloyd KC, McLeod J, Saunders J, Flowers P, Estcourt CS, Gibbs J. Digital interventions for STI and HIV partner notification: a scoping review. Sex Transm Infect 2024; 100:242-250. [PMID: 38754986 PMCID: PMC11187395 DOI: 10.1136/sextrans-2023-056097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/21/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Partner notification (PN) is key to the control of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Digital interventions have been used to facilitate PN. A scoping review was conducted to describe the interventions used, user preferences and acceptability of digital PN interventions from patient and partner perspectives. METHODS A systematic literature search was conducted of eight databases for articles published in English, available online with digital PN outcome data. Articles were assessed using the Mixed Methods Appraisal Tool. Quantitative and qualitative data were synthesised and analysed using thematic analysis. RESULTS Twenty-six articles met the eligibility criteria. Articles were heterogeneous in quality and design, with the majority using quantitative methods. Nine articles focused solely on bacterial STIs (five on syphilis; four on chlamydia), one on HIV, two on syphilis and HIV, and 14 included multiple STIs, of which 13 included HIV. There has been a shift over time from digital PN interventions solely focusing on notifying partners, to interventions including elements of partner management, such as facilitation of partner testing and treatment, or sharing of STI test results (between index patients and tested sex partners). Main outcomes measured were number of partners notified (13 articles), partner testing/consultation (eight articles) and treatment (five articles). Relationship type and STI type appeared to affect digital PN preferences for index patients with digital methods preferred for casual rather than established partner types. Generally, partners preferred face-to-face PN. CONCLUSION Digital PN to date mainly focuses on notifying partners rather than comprehensive partner management. Despite an overall preference for face-to-face PN with partners, digital PN could play a useful role in improving outcomes for certain partner types and infections. Further research needs to understand the impact of digital PN interventions on specific PN outcomes, their effectiveness for different infections and include health economic evaluations.
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Affiliation(s)
| | - Sonja Bloch
- Institute for Global Health, University College London, London, UK
| | | | - Karen C Lloyd
- Institute for Global Health, University College London, London, UK
| | - Julie McLeod
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - John Saunders
- Institute for Global Health, University College London, London, UK
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Claudia S Estcourt
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
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4
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Kocur W, McLeod J, Bloch SCM, MacDonald JJ, Woodward C, McInnes-Dean A, Gibbs JJ, Saunders JJ, Blandford AA, Estcourt C, Flowers P. Improving digital partner notification for sexually transmitted infections and HIV through a systematic review and application of the Behaviour Change Wheel approach. Sex Health 2024; 21:SH23168. [PMID: 38402852 DOI: 10.1071/sh23168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Partner notification (PN) is key to controlling sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Digital PN options (e.g. social media, short message service (SMS), emails) are promising in increasing PN behaviour. However, their implementation is often challenging and studies report varied levels of acceptability and uptake of PN, highlighting the need to optimise digital PN interventions. METHODS A systematic review of barriers and facilitators to digital PN interventions for STIs, including HIV, across eight research databases (from 2010 to 2023) identified eight relevant studies, two of which addressed HIV. Data extraction identified 98 barriers and 54 facilitators to the use of digital PN interventions. These were synthesised into 18 key barriers and 17 key facilitators that were each deemed amenable to change. We then used the Behaviour Change Wheel approach, the Acceptability, Practicability, Effectiveness, Affordability, Side-effects and Equity criteria, and multidisciplinary expert input, to systematically develop practical recommendations to optimise digital PN. RESULTS Thirty-two specific recommendations clustered around three themes. Digital PN interventions should: (1) empower and support the index patient by providing a range of notification options, accompanied by clear instructions; (2) integrate into users' existing habits and the digital landscape, meeting contemporary standards and expectations of usability; and (3) address the social context of PN both online and offline through normalising the act of PN, combating STI-related stigma and stressing the altruistic aspects of PN through consistent messaging to service users and the public. CONCLUSIONS Our evidence-based recommendations should be used to optimise existing digital PN interventions and inform the co-production of new ones.
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Affiliation(s)
- Will Kocur
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Julie McLeod
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - Jennifer J MacDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Charlotte Woodward
- Institute for Global Health, University College London, London, England, UK
| | | | - Jo J Gibbs
- Institute for Global Health, University College London, London, England, UK
| | - John J Saunders
- Institute for Global Health, University College London, London, England, UK; and UK Health Security Agency, Colindale, England, UK
| | | | - Claudia Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Paul Flowers
- Psychological Science and Health, University of Strathclyde, Glasgow, Scotland, UK
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Hansman E, Klausner JD. Approach to Managing Sex Partners of People with Sexually Transmitted Infections. Infect Dis Clin North Am 2023; 37:405-426. [PMID: 36931992 DOI: 10.1016/j.idc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Partner management of sexually transmitted infection (STIs) is essential to identify and treat new cases, prevent reinfection in the index case, interrupt chains of transmission, reduce STI-related morbidity, and target STI screening and treatment interventions. The responsibility for partner notification and treatment falls on the health care provider. Approaches to partner management include patient referral, provider referral, contractual referral, and expedited partner therapy (EPT), with EPT and enhanced partner referral outperforming other methods. This article provides an overview of clinical recommendations regarding partner management, with particular emphasis on EPT, and an update on new and emerging evidence in the field.
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Affiliation(s)
- Emily Hansman
- David Geffen School of Medicine University of California Los Angeles, Los Angeles, CA, USA.
| | - Jeffrey D Klausner
- University of Southern California Keck School of Medicine, 1845 North Soto Street, Health Sciences Campus, Los Angeles, CA 90032, USA
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Nguyen BH, Pham QM, Hoang L, Sansone A, Jannini EA, Tran CM. Investigating the microbial pathogens of sexually transmitted infections among heterosexual Vietnamese men with symptomatic urethritis. Aging Male 2022; 25:125-133. [PMID: 35416126 DOI: 10.1080/13685538.2022.2063272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To explore the microbial etiology of urethritis in Vietnamese men and the association with patients' characteristics, especially their sexual behaviors. METHODS This study was conducted on 349 men who presented with symptomatic urethritis and evidence of STIs (determined by multiplex PCR tests) at the Department of Andrology and Sexual Medicine-Hanoi Medical University Hospital. All information regarding medical history, sexual activities, and symptoms of urethritis was documented. RESULTS C. trachomatis and N. gonorrhoea remained the two most common causative pathogens, followed by an unexpectedly high prevalence of Mycoplasma and Ureaplasma species. Coinfection was significant with a rate of 40.7%. Men who had sex with female sex workers (FSWs) were more likely to be positive with N. gonorrhoea but less likely to be positive with C. trachomatis and M. genitalium than those having sex with only one romantic partner. CONCLUSIONS Our findings suggested the important role of other microorganisms, especially M. genitalium, in the etiology of urethritis in men besides the previously well-known causes of STIs. Since the coinfection rate is quite high, targeted treatment with clear microbial evidence should be considered rather than empiric antimicrobial therapy.
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Affiliation(s)
- Bac Hoai Nguyen
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Quan Minh Pham
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Long Hoang
- Department of Urology, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Andrea Sansone
- Endocrinology and Sexual Medicine (ENDOSEX), University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Endocrinology and Sexual Medicine (ENDOSEX), University of Rome Tor Vergata, Rome, Italy
| | - Chau Minh Tran
- Department of Microbiology and Parasitology, Hanoi Medical University's Hospital, Hanoi, Vietnam
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Accelerated partner therapy contact tracing for people with chlamydia (LUSTRUM): a crossover cluster-randomised controlled trial. THE LANCET PUBLIC HEALTH 2022; 7:e853-e865. [DOI: 10.1016/s2468-2667(22)00204-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023] Open
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Vusirikala A, Charles H, Balasegaram S, Macdonald N, Kumar D, Barker-Burnside C, Cumiskey K, Dickinson M, Watson M, Olufon O, Thorley K, Blomquist P, Anderson C, Ma T, Mohammed H, Perkins S, Paranthaman K, Manley P, Edeghere O, Sinka K, Prochazka M. Epidemiology of Early Monkeypox Virus Transmission in Sexual Networks of Gay and Bisexual Men, England, 2022. Emerg Infect Dis 2022; 28:2082-2086. [PMID: 35960543 PMCID: PMC9514371 DOI: 10.3201/eid2810.220960] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
After community transmission of monkeypox virus was identified in Europe, interviews of 45 case-patients from England indicated transmission in international sexual networks of gay and bisexual men since April 2022. Interventions targeting sex-on-premises venues, geospatial dating applications, and sexual health services are likely to be critical for outbreak control.
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9
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Sonnenberg P, Menezes D, Freeman L, Maxwell KJ, Reid D, Clifton S, Tanton C, Copas A, Riddell J, Dema E, Bosó Pérez R, Gibbs J, Ridge MC, Macdowall W, Unemo M, Bonell C, Johnson AM, Mercer CH, Mitchell K, Field N. Intimate physical contact between people from different households during the COVID-19 pandemic: a mixed-methods study from a large, quasi-representative survey (Natsal-COVID). BMJ Open 2022; 12:e055284. [PMID: 35140158 PMCID: PMC8829844 DOI: 10.1136/bmjopen-2021-055284] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/06/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Physical distancing as a non-pharmaceutical intervention aims to reduce interactions between people to prevent SARS-CoV-2 transmission. Intimate physical contact outside the household (IPCOH) may expand transmission networks by connecting households. We aimed to explore whether intimacy needs impacted adherence to physical distancing following lockdown in Britain in March 2020. METHODS The Natsal-COVID web-panel survey (July-August 2020) used quota-sampling and weighting to achieve a quasi-representative population sample. We estimate reporting of IPCOH with a romantic/sexual partner in the 4 weeks prior to interview, describe the type of contact, identify demographic and behavioural factors associated with IPCOH and present age-adjusted ORs (aORs). Qualitative interviews (n=18) were conducted to understand the context, reasons and decision making around IPCOH. RESULTS Of 6654 participants aged 18-59 years, 9.9% (95% CI 9.1% to 10.6%) reported IPCOH. IPCOH was highest in those aged 18-24 (17.7%), identifying as gay or lesbian (19.5%), and in steady non-cohabiting relationships (56.3%). IPCOH was associated with reporting risk behaviours (eg, condomless sex, higher alcohol consumption). IPCOH was less likely among those reporting bad/very bad health (aOR 0.54; 95% CI 0.32 to 0.93) but more likely among those with COVID-19 symptoms and/or diagnosis (aOR 1.34; 95% CI 1.10 to 1.65). Two-thirds (64.4%) of IPCOH was reported as being within a support bubble. Qualitative interviews found that people reporting IPCOH deliberated over, and made efforts to mitigate, the risks. CONCLUSIONS Given 90% of people did not report IPCOH, this contact may not be a large additional contributor to SARS-CoV-2 transmission, although heterogeneity exists within the population. Public health messages need to recognise how single people and partners living apart balance sexual intimacy and relationship needs with adherence to control measures.
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Affiliation(s)
- Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - Dee Menezes
- Institute of Health Informatics, University College London, London, UK
| | - Lily Freeman
- Institute for Global Health, University College London, London, UK
| | - Karen J Maxwell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - David Reid
- Institute for Global Health, University College London, London, UK
| | - Soazig Clifton
- Institute for Global Health, University College London, London, UK
- NatCen Social Research, London, UK
| | - Clare Tanton
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Julie Riddell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Emily Dema
- Institute for Global Health, University College London, London, UK
| | - Raquel Bosó Pérez
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Mary-Clare Ridge
- Institute for Global Health, University College London, London, UK
| | - Wendy Macdowall
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Magnus Unemo
- Institute for Global Health, University College London, London, UK
- Department of Laboratory Medicine, Örebro University, Orebro, Sweden
| | - Chris Bonell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, London, UK
| | | | - Kirstin Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
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Wayal S, Estcourt CS, Mercer CH, Saunders J, Low N, McKinnon T, Symonds M, Cassell JA. Optimising partner notification outcomes for bacterial sexually transmitted infections: a deliberative process and consensus, United Kingdom, 2019. Euro Surveill 2022; 27. [PMID: 35057899 PMCID: PMC8804665 DOI: 10.2807/1560-7917.es.2022.27.3.2001895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Partner notification (PN) is an essential element of sexually transmitted infection (STI) control. It enables identification, treatment and advice for sexual contacts who may benefit from additional preventive interventions such as HIV pre- and post-exposure prophylaxis. PN is most effective in reducing STI transmission when it reaches individuals who are most likely to have an STI and to engage in sexual behaviour that facilitates STI transmission, including having multiple and/or new sex partners. Outcomes of PN practice need to be measurable in order to inform standards. They need to address all five stages in the cascade of care: elicitation of partners, establishing contactable partners, notification, testing and treatment. In the United Kingdom, established outcome measures cover only the first three stages and do not take into account the type of sexual partnership. We report an evidence-based process to develop new PN outcomes and inform standards of care. We undertook a systematic literature review, evaluation of published information on types of sexual partnership and a modified Delphi process to reach consensus. We propose six new PN outcome measures at five stages of the cascade, including stratification by sex partnership type. Our framework for PN outcome measurement has potential to contribute in other domains, including Covid-19 contact tracing.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London, London, United Kingdom
| | - Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Catherine H Mercer
- Institute for Global Health, University College London, London, United Kingdom
| | - John Saunders
- Institute for Global Health, University College London, London, United Kingdom
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tamsin McKinnon
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Merle Symonds
- Western Sussex Hospitals NHS Foundation Trust, Worthing, West Sussex, United Kingdom
| | - Jackie A Cassell
- Brighton and Sussex Medical School, Falmer, East Sussex, United Kingdom
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