Going beyond ‘regular and casual’: development of a classification of sexual partner types to enhance partner notification for STIs

Abstract

ObjectivesTo develop a classification of sexual partner types for use in partner notification (PN) for STIs.MethodsA four-step process: (1) an iterative synthesis of five sources of evidence: scoping review of social and health sciences literature on partner types; analysis of relationship types in dating apps; systematic review of PN intervention content; and review of PN guidelines; qualitative interviews with public, patients and health professionals to generate an initial comprehensive classification; (2) multidisciplinary clinical expert consultation to revise the classification; (3) piloting of the revised classification in sexual health clinics during a randomised controlled trial of PN; (4) application of the Theoretical Domains Framework (TDF) to identify index patients’ willingness to engage in PN for each partner type.ResultsFive main partner types emerged from the evidence synthesis and consultation: ‘established partner’, ‘new partner’, ‘occasional partner’, ‘one-off partner’ and ‘sex worker’. The types differed across several dimensions, including likely perceptions of sexual exclusivity, likelihood of sex reoccurring between index patient and sex partner. Sexual health professionals found the classification easy to operationalise. During the trial, they assigned all 3288 partners described by 2223 index patients to a category. The TDF analysis suggested that the partner types might be associated with different risks of STI reinfection, onward transmission and index patients’ engagement with PN.ConclusionsWe developed an evidence-informed, useable classification of five sexual partner types to underpin PN practice and other STI prevention interventions. Analysis of biomedical, psychological and social factors that distinguish different partner types shows how each could warrant a tailored PN approach. This classification could facilitate the use of partner-centred outcomes. Additional studies are needed to determine the utility of the classification to improve measurement of the impact of PN strategies and help focus resources.

Optimising partner notification outcomes for bacterial sexually transmitted infections: a deliberative process and consensus, United Kingdom, 2019

“…The LUSTRUM team is already using the partnership classification in data collection and analysis of an RCT of PN [ 11 ]. The underpinning primary and secondary research describing the process of development is published elsewhere [ 12 ].…”

Intimate physical contact between people from different households during the COVID-19 pandemic: a mixed-methods study from a large, quasi-representative survey (Natsal-COVID)

“…There are challenges in reporting partnership type and cohabitation status, especially during a period when circumstances may change, as shown by people reporting IPCOH, with some defining themselves as single and others as in a new/casual relationship. Partnership typologies used in clinical practice or research 27 are less relevant when examining IPCOH as these are used to determine sexual risk, rather than COVID-19 risk behaviours, and do not emphasise cohabitation status.…”

How can we increase notification of exposure to STIs between gay and bisexual men?: intervention development using stakeholder engagement, qualitative methods and behavioural science

“…Although there are many actors, actions and settings involved in the whole process of PN (see Flowers et al, in preparation) here, we only focus on the "gateway step" in which GBMSM notify their partners of their exposure to an STI. Elsewhere we report on a more comprehensive approach to developing an intervention to improve PN (Flowers et al, 2021).…”

“…It is worth noting however that it is likely these digitally mediated ways of meeting are more likely to facilitate PN than meeting through public sex environments for example (e.g., see Flowers et al, 1999;Flowers et al, 2000) PN and partner type When diagnosed with an STI, people's abilities to contact sexual partners and the motivation to do so relate to the kind of relationship that connects them. Working with a range of evidence sources, to assist with considering the tailoring of PN approaches to relational contexts, we developed a typology of sexual partner types ('Established partner', 'New partner', 'Occasional partner', 'One-off partner' and 'Sex worker') (Estcourt et al, 2021). Our evidence synthesis suggested that PN was most challenging with 'one-off partners'.…”

“…Here we report on one key element of a larger, multi-stage, multi-stakeholder intervention development process which addresses the whole of the PN process from notifying partners to accessing testing and wider care (see McQueen et al, 2020 for the larger protocol; or Flowers et al, 2021). We present our analyses of data collected, after an initial stakeholder engagement event, from heterogeneous samples of GBMSM through focus groups, followed by further stakeholder input.…”