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Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: the Washington State community-level randomized trial of EPT.

Golden MR, Kerani RP, Stenger M, Hughes JP, Aubin M, Malinski C, Holmes KK - PLoS Med. (2015)

Bottom Line: Heterosexual individuals with gonorrhea or chlamydial infection were eligible for the intervention.The intervention increased the percentage of persons receiving PDPT from clinicians (from 18% to 34%, p < 0.001) and the percentage receiving partner services (from 25% to 45%, p < 0.001).Study findings were potentially limited by inadequate statistical power, by the institution of some aspects of the study intervention outside of the research randomization sequence, and by the fact that LHJs did not constitute truly isolated sexual networks.

View Article: PubMed Central - PubMed

Affiliation: Center for AIDS and STD,, University of Washington, Seattle, Washington, United States of America; Department of Medicine, University of Washington, Seattle, Washington, United States of America; Public Health-Seattle & King County, Seattle, Washington, United States of America.

ABSTRACT

Background: Expedited partner therapy (EPT), the practice of treating the sex partners of persons with sexually transmitted infections without their medical evaluation, increases partner treatment and decreases gonorrhea and chlamydia reinfection rates. We conducted a stepped-wedge, community-level randomized trial to determine whether a public health intervention promoting EPT could increase its use and decrease chlamydia test positivity and gonorrhea incidence in women.

Methods and findings: The trial randomly assigned local health jurisdictions (LHJs) in Washington State, US, into four study waves. Waves instituted the intervention in randomly assigned order at intervals of 6-8 mo. Of the state's 25 LHJs, 24 were eligible and 23 participated. Heterosexual individuals with gonorrhea or chlamydial infection were eligible for the intervention. The study made free patient-delivered partner therapy (PDPT) available to clinicians, and provided public health partner services based on clinician referral. The main study outcomes were chlamydia test positivity among women ages 14-25 y in 219 sentinel clinics, and incidence of reported gonorrhea in women, both measured at the community level. Receipt of PDPT from clinicians was evaluated among randomly selected patients. 23 and 22 LHJs provided data on gonorrhea and chlamydia outcomes, respectively. The intervention increased the percentage of persons receiving PDPT from clinicians (from 18% to 34%, p < 0.001) and the percentage receiving partner services (from 25% to 45%, p < 0.001). Chlamydia test positivity and gonorrhea incidence in women decreased over the study period, from 8.2% to 6.5% and from 59.6 to 26.4 per 100,000, respectively. After adjusting for temporal trends, the intervention was associated with an approximately 10% reduction in both chlamydia positivity and gonorrhea incidence, though the confidence bounds on these outcomes both crossed one (chlamydia positivity prevalence ratio = 0.89, 95% CI 0.77-1.04, p = 0.15; gonorrhea incidence rate ratio = 0.91, 95% CI .71-1.16, p = 0.45). Study findings were potentially limited by inadequate statistical power, by the institution of some aspects of the study intervention outside of the research randomization sequence, and by the fact that LHJs did not constitute truly isolated sexual networks.

Conclusions: A public health intervention promoting the use of free PDPT substantially increased its use and may have resulted in decreased chlamydial and gonococcal infections at the population level.

Trial registration: ClinicalTrials.gov NCT01665690.

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Related in: MedlinePlus

Washington State local health jurisdictions instituting an expedited partner therapy intervention in four temporally defined waves.
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pmed.1001777.g002: Washington State local health jurisdictions instituting an expedited partner therapy intervention in four temporally defined waves.

Mentions: Of WA State’s 25 LHJs, 23 participated in the study (Figs. 1 and 2). Table 1 presents data from clinics participating in the WA State IPP program in the year prior to the start of the study; these clinics include all clinics in which we measured chlamydia positivity, one of our main study outcomes, and is stratified by study wave. Chlamydia outcome data were available at baseline and for each of the four steps for 22 of the 23 participating LHJs (one LHJ had no clinical site providing data). Table 2 compares the age, race, and ethnicity of women tested for chlamydial infection in clinics participating in the IPP program with those of women ages 14–25 y in the areas of WA State participating in the study. Women tested at sentinel clinical sites were younger than the overall population of sexually active women in the areas served by the clinics. The study had data on the incidence of newly diagnosed and reported gonorrhea for all LHJs at each step.


Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: the Washington State community-level randomized trial of EPT.

Golden MR, Kerani RP, Stenger M, Hughes JP, Aubin M, Malinski C, Holmes KK - PLoS Med. (2015)

Washington State local health jurisdictions instituting an expedited partner therapy intervention in four temporally defined waves.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4295847&req=5

pmed.1001777.g002: Washington State local health jurisdictions instituting an expedited partner therapy intervention in four temporally defined waves.
Mentions: Of WA State’s 25 LHJs, 23 participated in the study (Figs. 1 and 2). Table 1 presents data from clinics participating in the WA State IPP program in the year prior to the start of the study; these clinics include all clinics in which we measured chlamydia positivity, one of our main study outcomes, and is stratified by study wave. Chlamydia outcome data were available at baseline and for each of the four steps for 22 of the 23 participating LHJs (one LHJ had no clinical site providing data). Table 2 compares the age, race, and ethnicity of women tested for chlamydial infection in clinics participating in the IPP program with those of women ages 14–25 y in the areas of WA State participating in the study. Women tested at sentinel clinical sites were younger than the overall population of sexually active women in the areas served by the clinics. The study had data on the incidence of newly diagnosed and reported gonorrhea for all LHJs at each step.

Bottom Line: Heterosexual individuals with gonorrhea or chlamydial infection were eligible for the intervention.The intervention increased the percentage of persons receiving PDPT from clinicians (from 18% to 34%, p < 0.001) and the percentage receiving partner services (from 25% to 45%, p < 0.001).Study findings were potentially limited by inadequate statistical power, by the institution of some aspects of the study intervention outside of the research randomization sequence, and by the fact that LHJs did not constitute truly isolated sexual networks.

View Article: PubMed Central - PubMed

Affiliation: Center for AIDS and STD,, University of Washington, Seattle, Washington, United States of America; Department of Medicine, University of Washington, Seattle, Washington, United States of America; Public Health-Seattle & King County, Seattle, Washington, United States of America.

ABSTRACT

Background: Expedited partner therapy (EPT), the practice of treating the sex partners of persons with sexually transmitted infections without their medical evaluation, increases partner treatment and decreases gonorrhea and chlamydia reinfection rates. We conducted a stepped-wedge, community-level randomized trial to determine whether a public health intervention promoting EPT could increase its use and decrease chlamydia test positivity and gonorrhea incidence in women.

Methods and findings: The trial randomly assigned local health jurisdictions (LHJs) in Washington State, US, into four study waves. Waves instituted the intervention in randomly assigned order at intervals of 6-8 mo. Of the state's 25 LHJs, 24 were eligible and 23 participated. Heterosexual individuals with gonorrhea or chlamydial infection were eligible for the intervention. The study made free patient-delivered partner therapy (PDPT) available to clinicians, and provided public health partner services based on clinician referral. The main study outcomes were chlamydia test positivity among women ages 14-25 y in 219 sentinel clinics, and incidence of reported gonorrhea in women, both measured at the community level. Receipt of PDPT from clinicians was evaluated among randomly selected patients. 23 and 22 LHJs provided data on gonorrhea and chlamydia outcomes, respectively. The intervention increased the percentage of persons receiving PDPT from clinicians (from 18% to 34%, p < 0.001) and the percentage receiving partner services (from 25% to 45%, p < 0.001). Chlamydia test positivity and gonorrhea incidence in women decreased over the study period, from 8.2% to 6.5% and from 59.6 to 26.4 per 100,000, respectively. After adjusting for temporal trends, the intervention was associated with an approximately 10% reduction in both chlamydia positivity and gonorrhea incidence, though the confidence bounds on these outcomes both crossed one (chlamydia positivity prevalence ratio = 0.89, 95% CI 0.77-1.04, p = 0.15; gonorrhea incidence rate ratio = 0.91, 95% CI .71-1.16, p = 0.45). Study findings were potentially limited by inadequate statistical power, by the institution of some aspects of the study intervention outside of the research randomization sequence, and by the fact that LHJs did not constitute truly isolated sexual networks.

Conclusions: A public health intervention promoting the use of free PDPT substantially increased its use and may have resulted in decreased chlamydial and gonococcal infections at the population level.

Trial registration: ClinicalTrials.gov NCT01665690.

Show MeSH
Related in: MedlinePlus