Background: Whether treatment, engagement in partner notification (PN), and PN outcomes differ between clients of Internet-based and clinic-based testing services is poorly understood. We compared these outcomes between people diagnosed with chlamydia and/or gonorrhea (CT/GC) through a sexually transmitted infection (STI) clinic service and GetCheckedOnline (GCO), an Internet-based testing service in British Columbia. Methods:We conducted a retrospective matched cohort study among CT/GC cases where each case diagnosed through GCO in 2016 to 2017 was matched to 2 STI clinic cases by diagnosis, sex, age group, and specimen collection date. Data were collected through chart review, with outcomes compared using appropriate statistical tests. Results: Of 257 GCO and 514 matched clinic cases, case treatment was high and did not differ between GCO (254 of 257 [98.9%]) and clinic (513 of 514 [99.8%]) cases, as was engagement in PN (250 of 257 [97.2%] vs. 496 of 514 [96.5%]). There was no difference in the proportion of notified partners between GCO (159 of 270 [58.9%]) and clinic (253 of 435 [58.2%]) cases, although a greater proportion of partners reported by clinic cases were notified by STI nurses (43 of 435 [9.9%]) versus GCO cases (6 of 270 [2.2%]).Conclusions: GetCheckedOnline clients diagnosed with CT/GC demonstrated similar treatment uptake and engagement in PN to clinic clients, and PN outcomes did not differ. The greater reliance on STI clinic nurses for PN among clinic clients may be related to having had an initial in-person testing visit.
Background Expedited partner therapy (EPT) is an intervention for patients with gonorrhea (NG) or chlamydia (CT), through which index patients are provided with medication to give to their partner. While EPT is recommended for heterosexuals, EPT is not recommended for men who have sex with men (MSM), partially due to concerns about overtreatment of uninfected partners and missed opportunities for HIV diagnosis. In this study, we used modeling to investigate the potential impact of EPT implementation on STI incidence among MSM in the United States. Methods We extended our stochastic network-based mathematical model of HIV, NG, and CT among MSM to include partner-delivered EPT for NG and CT. EPT implementation was simulated for 10 years. Counterfactual scenarios varied EPT coverage, provision, uptake, and partnership window duration. We estimated STI incidence, percent of infections averted (PIA), and process outcomes under each scenario, compared to a reference scenario that included routine and symptomsbased STI screening at current empirical levels among US MSM. Results Delivery of EPT to 20% of eligible MSM index patients (coverage) was projected to reduce cumulative STI infections among MSM by 22% over 10 years compared to current estimated STI screening levels. A 20% increase in providing medication to non-index partners (provision) averted 29% of STI infections compared to STI screening. By partnership type, intervention benefits were greatest when EPT was restricted to casual partners. The proportion of partners given medication who had no current STI varied from 55% to 65%, depending on coverage. The proportion of partners given medication with undiagnosed HIV infection was 4%. Conclusion EPT could substantially reduce bacterial STI incidence for MSM. However, this intervention could result in a substantial increase in unnecessary use of antibiotic medication by STI-uninfected MSM, raising concerns about cost and antimicrobial resistance in absence of additional medical evaluation. Disclosure No significant relationships.
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