Experiences and preferences with sexually transmitted infection care and partner notification in Gaborone, Botswana

Abstract

Partner notification and treatment are essential to sexually transmitted infection (STI) management. However, in low- and middle-income countries, half of partners do not receive treatment. A mixed methods study was conducted to explore experiences and preferences around partner notification and treatment in patients seeking STI care in Gaborone, Botswana. Thirty participants were administered a quantitative survey, followed by a semi-structured interview on partner notification, treatment, and expedited partner therapy (EPT). Among the 30 participants, 77% were female with a median age of 28 years (IQR = 24–36), 87% notified their partner, and 45% of partners requiring treatment received treatment. Partners who received a contact slip were more likely to have been treated than those who did not (75% vs. 25%). Contact slips were identified as facilitators of notification and treatment, while asymptomatic partners and limited clinic resources were identified as barriers to treatment. Few participants expressed a preference for EPT and concerns included preference for medical supervision, a belief their partner would refuse, and an inability to explain the treatment. Despite successful notification, partner treatment was modest within this population. Information for partners, provider counseling, and improved access to services may increase partner treatment. Education on STIs and treatment options may improve EPT acceptability.

Use of Expedited Partner Therapy for Pregnant Women Treated for Sexually Transmitted Infections in Gaborone, Botswana

“…An interesting finding of this study was the high EPT uptake despite a low pretest intent to use EPT. Our EPT intent results are consistent with those reported previously in Botswana, with most participants indicating a preference for in-clinic treatment when asked about a hypothetical preference in studies in which EPT was not offered 9,10 . However, qualitative studies of EPT acceptability in other settings found that participants may ultimately accept EPT at a high rate when faced with the challenges of partner treatment in reality and the convenience that EPT offers 8,12,19 .…”

“…Partner treatment success in this study is higher than previous estimates in Botswana reported by Hansman et al 10 (45%) and Offorjebe et al 11 (63%). Partner treatment success was defined as the proportion of participants attending test of cure who reported that their partner was successfully treated.…”

“…8 In Botswana, less than half of partners were treated in 2 studies of the general population, and more than half of partners of pregnant women were treated. [9][10][11] Other studies in the southern Africa region have reported similar outcomes, including just 63% of partners treated among pregnant women in Cape Town, South Africa, and 26% of partners treated among students in Johannesburg, South Africa. 12,13 Expedited partner therapy (EPT) was developed as an option to improve partner treatment using an intervention with low intensity.…”

“…A systematic review of 19 studies of partner notification in sub-Saharan Africa found partner treatment success to be only 25%, ranging from 0% to 77% 8 . In Botswana, less than half of partners were treated in 2 studies of the general population, and more than half of partners of pregnant women were treated 9–11 . Other studies in the southern Africa region have reported similar outcomes, including just 63% of partners treated among pregnant women in Cape Town, South Africa, and 26% of partners treated among students in Johannesburg, South Africa 12,13 …”

Factors associated with partner notification intentions among symptomatic sexually transmitted infection service attendees in South Africa

“…[21] Text messaging has been shown to have some level of acceptability among SA university students [8] and highly mobile men in the minibus transport industry, [10] although the actual uptake of these services for PN was not assessed in these studies. EPT has been shown to have limited acceptability by STI patients in Botswana, [22] while uptake was high among HIV-negative female STI service attendees in KZN (87%) [23] and Kenyan women accessing HIV pre-exposure prophylaxis (94%). [24] The acceptability and uptake of EPT by heterosexual men…”