Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial

Abstract

BackgroundExpedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection.MethodsWe enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up.ResultsThe median age of participants was 26 (interquartile range [IQR]: 23–31) with a median of 3 sexual partners (IQR: 2–4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0–2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68–7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0–62.0% versus 36.4%, 95% CI: 27.0–47.4%).ConclusionsProvision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks.Trial registrationClinicalTrials.gov, NCT01720654. Registered on 10/29/2012.

Traditional and Web-Based Technologies to Improve Partner Notification Following Syphilis Diagnosis Among Men Who Have Sex With Men in Lima, Peru: Pilot Randomized Controlled Trial

“…We noted signs and symptoms of primary syphilis in 36 individuals, whereas secondary infection was identified in 22 others. Of 479 MSM and TW with latent infection and positive RPR and MHA-TP assays, 74 were diagnosed with a previously treated infection that did not require additional treatment, 64 did not return for their results, and 29 were enrolled in a concomitant trial of expedited partner therapy for gonorrhea or chlamydia infection [ 42 ]. We enrolled 370 MSM or TW with recently diagnosed syphilis infection and randomly assigned each to one of the following four arms: (1) standard counseling or control (arm 1; N=94), (2) referral cards (arm 2; N=97), (3) Web-based PN (arm 3; N=95), or (4) combination Web-based PN and referral cards (arm 4; N=84).…”

“…In addition, the dissipation of the intervention effect observed as we progressed through the partner management cascade might reflect the participants’ inability to follow up on their notification messages, particularly the ones sent to casual partners through an anonymous, Web-based system. The lack of an observed effect on downstream outcomes indicates the need for additional interventions to support partner management outcomes throughout the partner management cascade, beginning with notification and culminating with a linkage to and retention in HIV or STI care [ 42 ]. While the preliminary research on potential responses to hypothetical anonymous notification messages among MSM in Peru indicated that the recipients would be motivated to seek medical attention after receiving an anonymous message, data from the United States have suggested otherwise, and this study too did not collect any partner-confirmed information on postnotification behavior [ 33 , 43 ].…”

High willingness to use novel HIV and bacterial sexually transmitted infection partner notification, testing, and treatment strategies among gay and bisexual men

“…These data support prior feasibility data about using PDPT with GBM. In a pilot study, 83.1% of GBM randomised to the PDPT arm notified at least one recent sexual partner and more than half (53.5%) notified all recent partners 13. Secondary distribution of HIVST kits is also acceptable and feasible among GBM in the USA,14 15 suggesting the integration of these two components is practical in real-world settings.…”

Traditional and Web-Based Technologies to Improve Partner Notification Following Syphilis Diagnosis Among Men Who Have Sex With Men in Lima, Peru: Pilot Randomized Controlled Trial (Preprint)

“…The dissipation of intervention effect observed as we progressed through the partner management cascade may also reflect participants' inability to follow-up on their notification messages, particularly ones sent to casual partners through an anonymous, web-based system. The lack of an observed effect on downstream outcomes indicates the need for additional interventions to support partner management outcomes throughout the partner management cascade, beginning with notification, and culminating with linkage to and retention in HIV/STI care (45). While preliminary research on potential responses to hypothetical anonymous notification messages among MSM in Peru indicated that recipients would be motivated to seek medical attention after receiving an anonymous message, data from the U.S. has suggested the opposite, and our study did not collect any partner-confirmed information on post-notification behavior (30,46).…”