Healthcare providers and community perspectives on expedited partner therapy (EPT) for use with gay, bisexual and other men who have sex with men

Abstract

ObjectivesExpedited partner therapy (EPT) is an effective strategy to reduce rates of chlamydia and gonorrhoea infection and ensure sexual partners are treated. Currently, EPT is provided to heterosexual patients; however, EPT is not routinely recommended for use with gay, bisexual and other men who have sex with men (GBMSM) because of concerns about HIV coinfection. The objective of the qualitative study was to understand provider and community views on the use of EPT with GBMSM.MethodsUsing convenience sampling methods, we recruited a sample of 18 healthcare providers and 21 GBMSM to participate in in-depth, semistructured interviews. Interviews were conducted over the phone and included questions about knowledge, experiences and potential barriers and facilitators to the use of EPT with GBMSM.ResultsMost providers wanted to provide EPT to GBMSM and believed that the potential barriers and concerns to EPT use were not unique to a patient’s sexual orientation. Several providers noted that they were currently providing EPT to GBMSM as part of HIV prevention services. Community members were generally unaware of EPT as a service and most indicated that they would only use EPT if they were in a committed relationship. Barriers included partner allergies and resistance, pharmacy protocols, structural concerns (eg, insurance coverage, pharmacists onsite and transportation) and potential disclosure issues. Facilitators included cultural humility and telemedicine with patients’ partners to overcome these barriers.ConclusionsAcceptability of EPT use for both chlamydia and gonorrhoea was high among providers and community members. Barriers to EPT use, including concerns about patients’ partners’ allergies and resistance, disclosure concerns and linkage to HIV prevention services can be overcome through cultural humility trainings and telemedicine. Changing EPT recommendations at the national level to be inclusive of GBMSM is critical to curtail the rising STI and HIV epidemic.

A National Study of Expedited Partner Therapy Use in Emergency Departments: A Survey of Medical Director Knowledge, Attitudes and Practices

“…This study also identified unique barriers to antibiotic overuse in presumptive or symptomatic treatment without laboratory confirmation, as well as concern for increasing traffic to the ED for STI patients. 23,24…”

“…We developed a 21-item survey instrument (Appendix X) including the following sections: demographics, knowledge, attitudes, and behaviors, followed by barriers and facilitators of EPT implementation. The survey instrument was created following a published framework for developing questionnaires 21 and began with discussions with EPT content experts alongside a literature review of published manuscripts on EPT implementation in other practice settings, [22][23][24][25] after which new questions were developed as necessary. We refined the design and content in an iterative process-editing survey versions as needed after each step -through the following steps: (1) a discussion with a survey methodologist expert;…”

Evaluation of Strategies to Improve Uptake of Expedited Partner Therapy for Chlamydia trachomatis Treatment in Minnesota: A Decision Analytic Model

“…We built on work identifying barriers and facilitators to EPT provision by estimating how proposed policy alternatives might increase the number of partners treated. 8,18,19 As the number of partners treated with EPT increased, partners treated in simple partner referral decreased, which could reduce the number of partners who would receive STI testing. Successful partner referral may be more effective at only treating those partners who are positive for chlamydia, but EPT has the potential to reach more partners who would not otherwise seek testing and treatment.…”

Reducing Barriers for Expedited Partner Treatment in Adolescents and Young Adults: A Quality Improvement Initiative

“…Prior studies have identified gaps at the provider, clinic, pharmacy, and patient levels, including clinician and pharmacist awareness of laws and knowledge about EPT prescribing and dispensing, lack of standard protocols and counseling to streamline evidence-based patient care, and access barriers for patients, such as cost. [10][11][12] Provider's uptake and offer of EPT are often rate-limiting steps, 13 highlighting the possible benefit of centralizing STI notification and EPT counseling and provision among experienced clinicians and care sites. In this quality improvement (QI) initiative, we aimed to address identified barriers to offering and provision of EPT across 3 care settings.…”