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Implementation and Effectiveness of an Expedited Partner Therapy Program in an Urban Clinic

Mickiewicz, Theresa MSPH*; Al-Tayyib, Alia PhD, MSPH*†; Thrun, Mark MD*‡; Rietmeijer, Cornelis MD, PhD, MSPH

doi: 10.1097/OLQ.0b013e3182756f20
Original Study

Background Partner notification of exposure to gonorrhea or chlamydia is traditionally conducted by the index case or a disease intervention specialist. However, a significant proportion of partners remain untreated and thus are at risk for continued transmission. Expedited partner therapy (EPT) obviates the requirement for a health care visit by the partner: the index case delivers medications to the partner. Although shown to be efficacious in randomized control trials, effectiveness studies of delivering EPT in real-world situations are needed. We describe the implementation, patient characteristics, and clinical impact of an EPT program at the Denver Metro Health Clinic (DMHC).

Methods We identified 2578 patient visits eligible for EPT (heterosexual men or women diagnosed as having chlamydia or gonorrhea) from November, 2006, to April, 2011. We examined EPT acceptance rates over clinical process improvements. To measure clinical impact, we assessed the association between initial acceptance of EPT and infection status among 351 patients who returned for retesting.

Results Requiring complete documentation of EPT in the clinic electronic medical record increased EPT acceptance from 20% to 48%. Expedited partner therapy acceptance was associated with a reduced risk of chlamydial reinfection (odds ratio, 0.7; 95% confidence interval, 0.3–1.6) and a reduced risk of gonorrheal reinfection (odds ratio, 0.5; 95% confidence interval, 0.2–1.4); however, these changes were not statistically significant.

Conclusions Expedited partner therapy at the DMHC was substantially enhanced by process changes in the clinic and may be associated with a decreased risk of reinfection.

Process improvements resulted in a 48% expedited partner therapy acceptance rate among clinic patients with sexually transmitted infection. Acceptance varied by diagnosis and sex and may be associated with a lower risk of reinfection.

From the *Department of Public Health, Denver Health and Hospital Authority; †Department of Epidemiology, ‡Division of Infectious Diseases, School of Medicine, and §Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Denver, CO

The authors thank Lynn Hoskins, RN, of the Denver Metro Health Clinic for her assistance with the implementation of the expedited partner therapy program and Christie Mettenbrink, MSPH, Statistical Research Specialist at Denver Public Health, for her assistance with the analysis.

The authors state no conflict of interest with any academic, research, or funding entities.

Results of this study were presented at the 19th Meeting of the International Society of STD Research; Quebec City; July10–13, 2011.

This publication was made possible, in part, through the Centers for Disease Control and Prevention and the Association for Prevention Teaching and Research Cooperative Agreement No. 5U50CD300860-21, Project TS-1400.

Correspondence: Theresa Mickiewicz, MSPH, Denver Public Health, 605 Bannock St, Denver, CO 80204. E-mail:

Received for publication March 1, 2012, and accepted August 9, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association