Breakdown in the expedited partner therapy treatment cascade: from reproductive healthcare provider to the pharmacist

Mmeje, Okeoma; Qin, Jennifer Z.; Wetmore, Marisa; Kolenic, Giselle; Diniz, Clarissa P.; Coleman, Jenell S.

doi:10.1016/j.ajog.2020.02.038

Cited by 13 publications

(13 citation statements)

References 19 publications

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“…With similar concerns regarding compliance, a recent study in the USA looking at the efficacy of expedited partner therapy (EPT) for chlamydia discovered that less than 50% of their prescriptions were filled, even when the medication was free of charge [31]. While drug-in-hand EPT seems at odds with our recommendations, it is driven by the fact that STI rates remain high despite interventions and may appear more cost-effective in the debate of 'limited inconsistent treatment versus no treatment' [9,23,32,33]. Summarising this, a recent Cochrane review evaluating enhanced patient referral, EPT, contract referral and provider referral did not identify a single optimal strategy for any particular STI [34].…”

Section: Discussionmentioning

confidence: 91%

Ten-year review of a shared care approach in the management of ocular chlamydia trachomatis infections

Shah¹,

Gishkori²,

Edington³

et al. 2020

Eye

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Introduction Since 2007, the ocular 4:1 multiplex PCR assay in NHS Greater Glasgow and Clyde includes Chlamydia trachomatis (ocular chlamydia (OC)) testing. OC can be identified following routine 'viral' ophthalmic testing, including in asymptomatic patients. A published audit from 2008 identified only 25% of our OC patients attended and completed sexual health management, particularly when ophthalmologists initiated treatment. We subsequently created a shared care network between ophthalmology, virology and sexual health (including a designated sexual health advisor) to address these clinical issues. Methods A 10-year retrospective service review audit from January 2010 to December 2019 was performed to evaluate this approach.Results A total of 86 patients were identified (49 males (57%), median age 23 years (range 16-77)). Ophthalmologists initiated treatment for 37 patients (43%) prior to onward sexual health referral. Of this group, 5 (13.5%) received sub-optimal treatments, and 15 (40.5%) subsequently failed to attend sexual health services for partner notification. Of the 49 (57%) patients who attended sexual health, 25 (51%) had genital chlamydia co-infection, and 98% received adequate systemic treatment. All were offered full sexual health screening and 46 (93.9%) completed partner notification. Conclusions This shared care approach more than doubled the proportion of OC patients attending sexual health services over this 10-year period (previously 25%, now 57%). Ophthalmologists could defer treatment to sexual health for more effective OC management; however, challenges remain to address real-world issues of non-attendance, inadequate treatment and incomplete contact tracing. We recommend a multi-disciplinary approach to best manage OC cases identified following ophthalmic testing.

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Section: Discussionmentioning

confidence: 91%

Ten-year review of a shared care approach in the management of ocular chlamydia trachomatis infections

Shah¹,

Gishkori²,

Edington³

et al. 2020

Eye

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“… 53 , 54 Providers may advocate for integration of EPT order sets into the EHR and education of local pharmacists to facilitate increased EPT access. 55 Safer sexual practices, including the use of condoms, should be discussed with patients who are at increased risk for STIs. The use of HIV preexposure prophylaxis (PrEP) should be discussed with HIV-uninfected patients who are at increased risk of HIV acquisition.…”

Section: Sexual Healthmentioning

confidence: 99%

Special ambulatory gynecologic considerations in the era of coronavirus disease 2019 (COVID-19) and implications for future practice

Cohen

Powell

Coleman

et al. 2020

American Journal of Obstetrics and Gynecology

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The coronavirus disease 2019 pandemic has altered medical practice in unprecedented ways. Although much of the emphasis in obstetrics and gynecology to date has been on the as yet uncertain effects of coronavirus disease 2019 in pregnancy and on changes to surgical management, the pandemic has broad implications for ambulatory gynecologic care. In this article, we review important ambulatory gynecologic topics such as safety and mental health, reproductive life planning, sexually transmitted infections, and routine screening for breast and cervical cancer. For each topic, we review how care may be modified during the pandemic, provide recommendations when possible on how to ensure continued access to comprehensive healthcare at this time, and discuss ways that future practice may change. Social distancing requirements may place patients at higher risk for intimate partner violence and mental health concerns, threaten continued access to contraception and abortion services, affect prepregnancy planning, interrupt routine screening for breast and cervical cancer, increase risk of sexually transmitted infection acquisition and decrease access to treatment, and exacerbate already underlying racial and minority disparities in care and health outcomes. We advocate for increased use of telemedicine services with increased screening for intimate partner violence and depression using validated questionnaires. Appointments for long-acting contraceptive insertions can be prioritized. Easier access to patient-controlled injectable contraception and pharmacist-provided hormonal contraception can be facilitated. Reproductive healthcare access can be ensured through reducing needs for ultrasonography and laboratory testing for certain eligible patients desiring abortion and conducting phone follow-up for medication abortions. Priority for in-person appointments should be given to patients with sexually transmitted infection symptoms, particularly if at risk for complications, while also offering expedited partner therapy. Although routine mammography screening and cervical cancer screening may be safely delayed, we discuss society guideline recommendations for higher-risk populations. There may be an increasing role for patient-collected human papillomavirus self-samples using new cervical cancer screening guidelines that can be expanded considering the pandemic situation. Although the pandemic has strained our healthcare system, it also affords ambulatory clinicians with opportunities to expand care to vulnerable populations in ways that were previously underutilized to improve health equity.

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“…1 As has been well described, there are potential barriers at all levels of implementation of EPT, including concerns about partner adverse events, physician liability and malpractice, payment for medications, intimate partner violence, and the fact that most community pharmacists were unaware of EPT per a recent assessment. 2 Golden et al 3 also acknowledged that EPT was less effective in reducing persistent or recurrent chlamydia compared with gonorrhea in their 2005 randomized trial of men and nonpregnant women.Indeed, although we agree that EPT is 1 of many strategies needed to address the rising rates of sexually transmitted infections in the United States, 4 we felt that an evaluation of our EPT program-which included a direct method for treating partners with azithromycin tablets instead of a prescription-was necessary in real-world practice. We reported our outcomes and acknowledged both the limitations of our observational study and the strengths of our standardized practices in a high-risk, urban population.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Reply: Regarding “Effectiveness of Chlamydia trachomatis expedited partner therapy in pregnancy”

Zofkie

Adhikari

2021

American Journal of Obstetrics and Gynecology

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We appreciate the interest in our recent report on the realworld effectiveness of Chlamydia trachomatis expedited partner therapy (EPT) in pregnancy. 1 As has been well described, there are potential barriers at all levels of implementation of EPT, including concerns about partner adverse events, physician liability and malpractice, payment for medications, intimate partner violence, and the fact that most community pharmacists were unaware of EPT per a recent assessment. 2 Golden et al 3 also acknowledged that EPT was less effective in reducing persistent or recurrent chlamydia compared with gonorrhea in their 2005 randomized trial of men and nonpregnant women.Indeed, although we agree that EPT is 1 of many strategies needed to address the rising rates of sexually transmitted infections in the United States, 4 we felt that an evaluation of our EPT program-which included a direct method for treating partners with azithromycin tablets instead of a prescription-was necessary in real-world practice. We reported our outcomes and acknowledged both the limitations of our observational study and the strengths of our standardized practices in a high-risk, urban population. Without this assessment, we would have no baseline for comparison with future efforts. We suspect that the practice of providing EPT for chlamydial infection in a real-world prenatal setting is more likely to resemble our own, rather than that of a clinical trial, and we hope that the general obstetrician-gynecologists find our report informative and motivating. As we described, additional solutions, including but not limited to EPT, are needed to make progress in reducing the surge in sexually transmitted infections in the United States.

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Breakdown in the expedited partner therapy treatment cascade: from reproductive healthcare provider to the pharmacist

Cited by 13 publications

References 19 publications

Ten-year review of a shared care approach in the management of ocular chlamydia trachomatis infections

Ten-year review of a shared care approach in the management of ocular chlamydia trachomatis infections

Special ambulatory gynecologic considerations in the era of coronavirus disease 2019 (COVID-19) and implications for future practice

Reply: Regarding “Effectiveness of Chlamydia trachomatis expedited partner therapy in pregnancy”

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