Acceptability and efficacy of partner notification for curable sexually transmitted infections in sub-Saharan Africa: A systematic review

Abstract

Comprehensive case management of sexually transmitted infections (STIs) includes partner notification. We reviewed the recent literature evaluating the acceptability and efficacy of partner notification strategies (i.e. direct patient referral, provider referral, or expedited partner treatment) for curable STIs in sub-Saharan Africa. We conducted a systematic search following PRISMA guidelines: published January 2008 to June 2017 in the English language, study in sub-Saharan Africa, and discussion of any curable STI with an outcome on partner notification. We searched six electronic databases, conference abstracts, online clinical trial registries, and article bibliographies. The results showed that out of the 74 identified articles, 55 did not meet inclusion criteria. Of the 11 studies evaluating direct patient referral, the proportion of index cases (n = 4163) who successfully notified sex partner(s) was 53% (range 23–95%). Among those who notified (n = 1727), 25% (range 0–77%) had partner(s) that sought evaluation (95% CI 0.51–0.54; 95% CI 0.23–0.27). Both provider referral and expedited partner treatment had higher proportions of partner(s) who sought treatment (n = 208, 69% and n = 44, 84%, respectively). Direct patient referral is the most commonly used and evaluated partner notification strategy for STIs in sub-Saharan Africa with mixed success. We recommend future research to investigate other strategies such as expedited partner treatment.

Partner notification and treatment for sexually transmitted infections among pregnant women in Cape Town, South Africa

“…9 Of those who successfully notified their partner, 25% (range 0-77%) had partners that sought treatment. 9 In another study at a community-based clinic in South Africa, participants reported notifying only 64% of partners of their STI diagnosis. 10 Among South Africans, fears of intimate partner violence and relationship dissolution have been identified as barriers to partner notification following diagnosis with a STI.…”

“…5,8 However, in a recent systematic review of studies conducted in sub-Saharan Africa, the proportion of index STI patients who notified their partner using this strategy was only 53% (range 23-95%). 9 Of those who successfully notified their partner, 25% (range 0-77%) had partners that sought treatment. 9 In another study at a community-based clinic in South Africa, participants reported notifying only 64% of partners of their STI diagnosis.…”

High Willingness to Participate in Partner Notification among Women Attending Reproductive Health and STI Clinics in Shenzhen, China: A Cross-Sectional Study

“…In CT intervention programs and guidelines in several countries, including the United Kingdom [7], Canada [8], the Netherlands [9], and Germany [9], partner notification (PN) is an essential individual and public health strategy to avoid re-infection of a treated index patient and reduce the burden of infections [10,11]. To expand the active screening of CT, a program in China called Shenzhen Gonorrhea and Chlamydia intervention pilot (SGCIP) was launched by the Health and Family Planning Commission of Shenzhen Municipality in 2017.…”

“…The rate of PN varies in different studies: 53% successful direct patient referral in sub-Saharan Africa [11], 73% successful PN in Sweden [18], 76.4% successful PN in the United States [19], and 51% successful PN by patient referral card in Peru [20]. Also, improving the efficacy of PN was found to be more cost-effective than increasing the coverage of CT screening [10].…”

“…Also, improving the efficacy of PN was found to be more cost-effective than increasing the coverage of CT screening [10]. From a systematic review, factors of partner notification were reported, such as female, higher education level, and regular partner as facilitators, and being married, stigma, fear of adverse reaction, and risk of intimate partner violence as barriers [11].…”