Pharmacy-level barriers to implementing expedited partner therapy in Baltimore, Maryland

Abstract

BACKGROUND Addressing record high rates of Chlamydia trachomatis (Ct) incidence in the United States (U.S.) requires the utilization of effective strategies, such as expedited partner therapy (EPT), to reduce reinfection and further transmission. EPT, which can be given as a prescription or medication, is a strategy to treat the sexual partners of index patients diagnosed with a sexually transmitted infection (STI) without prior medical evaluation of the partners. OBJECTIVE There are multiple steps in the prescription-EPT cascade and we sought to identify pharmacy-level barriers to implementing prescription-EPT for Ct treatment. STUDY DESIGN We used spatial analysis and ArcGIS, a geographic information system, to map and assess geospatial access to pharmacies within Baltimore, Maryland neighborhoods with the highest rates of Ct (1180.25-4255.31 per 100,000 persons). EPT knowledge and practices were collected via a telephone survey of pharmacists employed at retail pharmacies located in these same neighborhoods. Cost of antibiotic medication in U.S. Dollars (USD) was collected. RESULTS Census tracts with the highest Ct incidence rates had lower median pharmacy density than other census tracts (26.9 per 100,000 v. 31.4 per 100,000, P<.001). We identified 25 pharmacy deserts. Areas defined as pharmacy deserts had larger proportions of Black and Hispanic or Latino populations compared to non-Hispanic whites (93.1% v. 6.3%, P<.001) and trended toward higher median Ct incidence rates (1170.0 per 100,000 v. 1094.5 per 100,000, P=.110) than non-pharmacy desert areas. Of the 52 pharmacies identified, 96% (50/52) responded to our survey. Less than a fifth of pharmacists (18%, 9/50) were aware of EPT for Ct. Most pharmacists (59%, 27/46) confirmed they would fill an EPT prescription. The cost of a single dose of azithromycin (1 gram) ranged from 5-39.99 USD (median, 30 USD). CONCLUSION Limited geographic access to pharmacies, lack of pharmacist awareness of EPT, and wide variation in EPT medication cost are potential barriers to implementing prescription-EPT. Although most Baltimore pharmacists were unaware of EPT, they were generally receptive to learning about and filling EPT prescriptions. This finding suggests the need for wide dissemination of educational material targeted to pharmacists. In areas with limited geographic access to pharmacies, EPT strategies that do not depend on partners physically accessing a pharmacy merit consideration.

A statewide mixed-methods study of provider knowledge and behavior administering Expedited Partner Therapy for chlamydia and gonorrhea

“…In the survey, we found that knowledge of EPT is incomplete among providers who treat STIs in Minnesota, who most often included pharmacists followed by nurse practitioners and physicians. This finding builds on findings in other studies detailing pharmacy-level barriers to EPT implementation 16,20 . Awareness of EPT's legality remains an issue 27 .…”

Sexually Transmitted Infections Treatment Guidelines, 2021

“…Providers should visit https://www.cdc.gov/std/ept to obtain updated information for their state. Providing patients with packaged oral medication is the preferred approach because the efficacy of EPT using prescriptions has not been evaluated, obstacles to EPT can exist at the pharmacy level ( 121 , 122 ), and many persons (especially adolescents) do not fill the prescriptions provided to them by a sex partner ( 123 , 124 ). Medication or prescriptions provided for EPT should be accompanied by educational materials for the partner, including treatment instructions, warnings about taking medications (e.g., if the partner is pregnant or has an allergy to the medication), general health counseling, and a statement advising that partners seek medical evaluation as soon as possible for HIV infection and any symptoms of STIs, particularly PID.…”

Spatial modeling of vaccine deserts as barriers to controlling SARS-CoV-2

“…Studies in Chicago, Baltimore and Los Angeles have shown a higher prevalence of low-access pharmacy deserts in minority communities and neighborhoods with higher rates of infectious disease 19 , 22 , 23 while a state-wide study in Pennsylvania showed that pharmacy deserts tend to be in rural communities 20 . Scenario modeling suggests these pharmacy disparities may result in unequal distribution of the COVID-19 vaccine 24 , but to our knowledge no studies have measured geographic accessibility to confirmed vaccine locations or attempted to account for differences in vaccine supply.…”