Partner notification for sexually transmitted infections in developing countries: a systematic review

Abstract

BackgroundThe feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs) in developing countries was assessed through a comprehensive literature review, to help identify future intervention needs.MethodsThe Medline, Embase, and Google Scholar databases were searched to identify studies published between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5) PN approaches that were evaluated in developing countries.ResultsOut of 609 screened articles, 39 met our criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, and infrastructural factors related to the limited number of STD clinics, and trained providers and reliable diagnostic methods. Client-oriented counselling was found to be effective in improving partner referral outcomes.ConclusionsSTD clinics can improve PN with client-oriented counselling, which should help clients to overcome perceived barriers. The authors speculate that well-designed PN interventions to evaluate the impact on STI prevalence and incidence along with cost-effectiveness components will motivate policy makers in developing countries to allocate more resources towards STI management.

Partner notification for sexually transmitted infections and perception of notified partners

“…The negative feelings expressed by index patients and sexual partners show how complex notifying an STI diagnosis can be to both groups. In this study, the initial idea of index patients of not going to a healthcare center was mentioned, in agreement with the results of other studies (12)(13)(14) . In this study, the initial dilemma of whether to notify the infection to partners or not was similar to the result of another study conducted with patients with HIV infection, which indicated conflicts of interest in partner notification, related to the resulting negative impact and the moral responsibility of notification (7) .…”

“…In agreement with this study, the results of an investigation showed that the intention to notify partners is a challenge to be overcome, due to the stigma associated with STIs, whose failure or success may be influenced by factors such as extramarital sexual relationships, gender identity, structure of power and type of affectional-sexual bond (12) .…”

“…The embarrassment of index patients at partner notification and fear of partner reaction to the possibility of having an STI are feelings associated with important obstacles to partner notification (12)(13) . However, in this study, the concern about the partner's health and self-reflection contributed to the index patient's decision to notify his/her partners.…”

“…Confirmation of betrayal causes heartbreak and discomfort, with an impact on the relationship. Therefore, a health professional should be prepared to refrain from judgments and discuss with the index patient the best way to notify the diagnosis, especially because the fear of being rejected by the partner is one of the main obstacles to partner notification (12) . When notifying the diagnosis to an index patient, the health professional should offer emotional support and equal care without judgments, providing guidance about the importance of an early diagnosis and treatment of sexual partners, aiming to empower index patients to make safe decisions in terms of partner notification and ensure the diagnosis will be effectively notified (7) .…”

“…Thus, health administrators should consider an organizational structure of healthcare centers aiming to ensure human and material resources, coverage of an integrated service network, and opportunities for permanent education to allow successful partner notification (12) . In this study, the participants did not mention any structural obstacle to notification.…”