Article type
Year
Abstract
Introduction:
Objectives: To assess the effects of alternative sexually transmitted disease (STD) partner notification strategies, including patient referral, provider referral, contract referral and service provider oriented strategies.
Methods: We included randomised controlled trials (RCTs) with STD patients as the participants, and which measured any of the following outcomes: partners identified, notified, presented for care, tested positive and treated, index patient re-infection rates, incidence of STDs in the population, changes in index patient's or partner's risk behaviour, and harms to the patient or partner. We conducted searches in MEDLINE, EMBASE, Psychological Abstracts, Sociological Abstracts, the Cochrane Controlled Trials register, and register of the relevant Cochrane Review Groups. Experts were contacted. The methodological quality of the trials was assessed independently by two reviewers.
Results: We identified 7 studies that met our inclusion criteria. For patients with gonorrhoea, two studies conducted in the USA found contract referral was no better at identifying partners with a positive culture than patient referral. For patients with chlamydia, one study conducted in the USA found provider referral was more effective than patient referral, and would have to be offered to 17 index patients (95% CI: 10 to 50) to identify one additional partner with a positive culture. For syphilis, one RCT conducted in the USA found that provider referral, using disease intervention specialists, was no more effective that contract referral in the number of partners located, tested and treated. For HIV infection, one study conducted in the USA found that only two index patients (95% CI: 2 to 3) would have to be offered provider referral, compared with using patient referral, for one additional partner to be notified. The number of HIV infections in partners that were prevented or treated was not evaluated. Various strategies to improve patient referral have been compared in 4 studies. One study in the USA found that the use of counseling, referral cards and telephone follow-up of the index patient, compared with counseling alone, was more effective. Three patients (95% CI: 2 to 8) would have to be offered cards and telephone follow up for one additional partner to present for care.
Discussion: There is no sound evidence of the harms resulting from the various strategies of partner notification. Thus, in the few studies where there is evidence that a partner notification strategy increases the number of infected partners who are notified or treated, it is not possible to weigh these benefits against harms.
Objectives: To assess the effects of alternative sexually transmitted disease (STD) partner notification strategies, including patient referral, provider referral, contract referral and service provider oriented strategies.
Methods: We included randomised controlled trials (RCTs) with STD patients as the participants, and which measured any of the following outcomes: partners identified, notified, presented for care, tested positive and treated, index patient re-infection rates, incidence of STDs in the population, changes in index patient's or partner's risk behaviour, and harms to the patient or partner. We conducted searches in MEDLINE, EMBASE, Psychological Abstracts, Sociological Abstracts, the Cochrane Controlled Trials register, and register of the relevant Cochrane Review Groups. Experts were contacted. The methodological quality of the trials was assessed independently by two reviewers.
Results: We identified 7 studies that met our inclusion criteria. For patients with gonorrhoea, two studies conducted in the USA found contract referral was no better at identifying partners with a positive culture than patient referral. For patients with chlamydia, one study conducted in the USA found provider referral was more effective than patient referral, and would have to be offered to 17 index patients (95% CI: 10 to 50) to identify one additional partner with a positive culture. For syphilis, one RCT conducted in the USA found that provider referral, using disease intervention specialists, was no more effective that contract referral in the number of partners located, tested and treated. For HIV infection, one study conducted in the USA found that only two index patients (95% CI: 2 to 3) would have to be offered provider referral, compared with using patient referral, for one additional partner to be notified. The number of HIV infections in partners that were prevented or treated was not evaluated. Various strategies to improve patient referral have been compared in 4 studies. One study in the USA found that the use of counseling, referral cards and telephone follow-up of the index patient, compared with counseling alone, was more effective. Three patients (95% CI: 2 to 8) would have to be offered cards and telephone follow up for one additional partner to present for care.
Discussion: There is no sound evidence of the harms resulting from the various strategies of partner notification. Thus, in the few studies where there is evidence that a partner notification strategy increases the number of infected partners who are notified or treated, it is not possible to weigh these benefits against harms.