Barriers to the implementation of expedited partner therapy

INTRODUCTION Beginning in the late 1990s, investigators in the USA and UK began evaluating new approaches to ensure the treatment of sex partners of persons with curable sexually transmitted infections (STI). Both countries had longstanding partner services programmes affecting at least some STI, but confronted a mismatch between the resources available to provide partner services and the scale of the STI problem. Moreover, although systematic reviews of partner services interventions are often cited as showing that traditional partner services are effective, the evidence supporting the intervention comes almost entirely from studies of male sexually transmitted disease (STD) clinic patients, e3 and studies evaluating partner services provided to women and outside of STD clinics have not consistently found them to be effective. Over the past decade, four randomised controlled trials, three of which were conducted in the USA, have evaluated expedited partner therapy (EPT) as a means to increase partner treatment among persons with gonorrhoeal and chlamydial infection. e7e10 In most instances, these studies focused on patient-delivered partner therapy (PDPT), the practice of giving patients medication to give to their partners. All three US trials found that EPT increased the number of partners treated and all reported lower rates of persistent or recurrent infection in EPT recipients, although this difference was statistically significant in only two trials. The sole UK trial found that PDPT significantly increased the number of persons who notified all partners, but did not show an increase in partner treatment or an effect on re-infection rates. However, the trial was very much smaller than the US studies, and was consequently substantially underpowered. Here we address some of the major outstanding issues affecting the development of new, lower cost approaches to partner services, considering the USA, UK and Australia, and lower income nations.