Can we improve partner notification rates through expedited partner therapy in the UK? Findings from an exploratory trial of Accelerated Partner Therapy (APT)

Abstract

Objectives To develop two new models of expedited partner therapy for the UK, and evaluate them for feasibility, acceptability and preliminary outcome estimates to inform the design of a randomised controlled trial (RCT). Methods Two models of expedited partner therapy (APTHotline and APTPharmacy), known as 'Accelerated Partner Therapy' (APT) were developed. A nonrandomised comparative study was conducted of the two APT models and routine partner notification (PN), in which the index patient chose the PN option for his/her partner(s) in two contrasting clinics. Results The proportion of contactable partners treated when routine PN was chosen was 42/117 (36%) and was significantly higher if either APT option was chosen: APTHotline 80/135 (59%), p¼0.003; APTPharmacy 29/44 (66%) p¼0.001. However, partner treatment was often achieved through other routes. Although 40e60% of partners in APT groups returned urine samples for sexually transmitted infection (STI) testing, almost none accessed HIV and syphilis testing. APT options appear to facilitate faster treatment of sex partners than routine PN. Preferences and recruitment rates varied between sites, related to staff satisfaction with existing routine PN; approach to consent; and possibly, characteristics of local populations. Conclusions Both methods of APT were feasible and acceptable to many patients and led to higher rates of partner treatment than routine PN. Preferences and recruitment rates varied greatly between settings, suggesting that organisational and cultural factors may have an important impact on the feasibility of an RCT and on outcomes. Mindful of these factors, it is proposed that APT should now be evaluated in a cluster RCT.

Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling

“…20 APT is based on expedited partner therapy (EPT), which was developed in the USA to increase efficient use of partner notification resources for the most common STIs, chlamydia and gonorrhoea. 21 EPT and APT can be considered as a specific type of enhanced patient referral; 22 the enhancement is the provision of antibiotics or prescriptions for index cases to give to partners.…”

The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK

“…In addition, we included the cost of condoms and a STI leaflet as these are routinely given to patients in such consultations. In contrast to the previous APT study, 96,101 for routine partner notification we did not include costs relating to capturing details for research purposes, as such costs were not included for the other study arms.…”

“…101 However, there were important differences in the design, inclusion criteria and exact nature of the interventions, which make direct comparisons inappropriate. Our initial APT study allowed index patients to select the method of partner notification that they thought would best suit each sex partner, whereas this study randomised patients.…”

“…This was based on a similar tool used in a previous trial 101 and a tool used in a related study of the primary care management of STIs. 102 It relies on a secure website, compliant with NHS encryption and data transfer protocols.…”

Barriers and facilitators of partner treatment of chlamydia: A qualitative investigation with prescribers and community pharmacists

“…A telephone-based model of partner treatment, similar to what was described by prescribers in our study, was trialled by Estcourt et al in 2011; called APTHotline, the notified sexual partner called a hotline number and had a telephone consultation with a health adviser, senior nurse or doctor [16]. The index patient or sexual partner were then able to collect an APT pack from the clinic's reception.…”