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Sexually Transmitted Disease Partner Services Costs, Other Resources, and Strategies Across Jurisdictions to Address Unique Epidemic Characteristics and Increased Incidence

Silverman, Rachel A. PhD, ScM*; Katz, David A. PhD, MPH*†; Levin, Carol PhD, MSc*; Bell, Teal R. MPH; Spellman, Dawn MA; St. John, Lisa MBA, MEd§; Manley Rodriguez, Evelyn; Golden, Matthew R. MD, MPH†∥; Barnabas, Ruanne V. MBChB, MSc, DPhil*∥**

doi: 10.1097/OLQ.0000000000001010
Original Studies
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Background Sexually transmitted disease (STD) partner services (PS) are a core component of STD programs. Data on costs are needed to support PS programming.

Methods In Washington State STD PS programs, disease intervention specialists (DIS) conduct telephone-based interviews and occasional field visits, offer expedited partner therapy to heterosexuals with gonorrhea or chlamydia, and promote human immunodeficiency virus (HIV) testing, preexposure prophylaxis, and HIV care. We conducted activity-based microcosting of PS, including: observational and self-reported time studies and interviews. We analyzed cost, surveillance, and service delivery data to determine costs per program outcomes.

Results In King, Pierce, and Spokane counties, respectively, DIS allocated 6.5, 6.4, and 28.8 hours per syphilis case and 1.5, 1.6, and 2.9 hours per gonorrhea/chlamydia case, on average. In 2016, each full-time DIS investigated 270, 268, and 61 syphilis and 1177, 1105, and 769 gonorrhea/chlamydia cases. Greater than 80% of syphilis cases in King and Pierce were among men who have sex with men versus 38% in Spokane. Disease intervention specialists spent 12% to 39% of their time actively interviewing cases and notifying partners (clients), and the remaining time locating clients, coordinating and verifying care, and managing case reports. Time spent on expedited partner therapy, HIV testing, and referrals to HIV treatment or preexposure prophylaxis, was minimal (<5 minutes per interview) at locations with resources outside PS staff. Program cost-per-interview ranged from US $527 to US $2210 for syphilis, US $219 to US $484 for gonorrhea, and US $164 to US $547 for chlamydia.

Discussion The STD PS resource needs depended on epidemic characteristics and program models. Integrating HIV prevention objectives minimally impacted PS-specific program costs. Results can inform program planning, future budget impact, and cost-effectiveness analyses.

Cost assessment of partner services for sexually transmitted diseases found high variability in activities and costs across Washington State health jurisdictions. Human immunodeficiency virus prevention and treatment interventions had minimal impact on program costs.

From the *Department of Global Health, University of Washington, Seattle, WA, USA;

Public Health – Seattle & King County, Seattle, WA, USA;

Washington State Department of Health, Olympia;

§Spokane Regional Health District, Spokane;

Tacoma-Pierce County Health Department, Tacoma, WA;

Department of Medicine, and

**Department of Epidemiology, University of Washington, Seattle, WA

Acknowledgements: The authors are grateful to the STD partner services staff at Public Health-Seattle & King County, Tacoma-Pierce County Health Department, Spokane Regional Health District for their participation in this study. The authors also thank the Health Economic Study Team (HEIST) at the University of Washington.

Sources of Funding: This work was supported by the U.S. Centers for Disease Control and Prevention [H25PS004364 and H25PS005108] and by the University of Washington / Fred Hutch Center for AIDS Research (CFAR), an NIH-funded program under award number AI027757 which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of interest: none declared.

Correspondence: Ruanne V. Barnabas, DPhil, MBChB, MSc, 325 Ninth Ave, Box 359927, Seattle, WA 98104. E-mail: rbarnaba@uw.edu.

Received for publication January 17, 2019, and accepted April 11, 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (http://www.stdjournal.com).

Online date: June 11, 2019

© Copyright 2019 American Sexually Transmitted Diseases Association