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

Abstract

BackgroundPatient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings.ObjectiveThis randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: a Web-based notification system and patient-delivered partner referral cards.MethodsDuring 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment.ResultsThe median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%).ConclusionsBoth new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts.Trial RegistrationClinicalTrials.gov NCT01720641; https://clinicaltrials.gov/ct2/show/NCT01720641 (Archived by WebCite at http://www.webcitation.org/70A89rJL4)

A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men

“…Meanwhile, the second trial offered a personalized and interactive web application so-called "Game plan" and standard post-evaluation counseling [91]. As compared to the control group (receiving only standard of care), both studies successfully achieved preferable outcomes in the intervention group, including higher likelihood of notifying sex partners (odds ratio, OR = 2.18, 95% CI 1.30-3.66; p = 0.003) in the former study [95], or significant reduction of alcohol use (risk ratio, RR = 0.83, p = 0.047) and number of sex partners (RR = 0.50, p < 0.001) in the latter intervention [91].…”

“…Two recent web-based pilot RCTs were conducted by Clark et al to test partner notification for syphilis diagnosis Fig. 3 Mean retention rates by different duration of follow-ups [95], and by Wray et al to examine trial's effectiveness in reducing alcohol use problem and sexual risk behaviors [91]. The first trial employed a web-based partner notification with or without referral cards, which informed available testing and treatment resources for syphilis testing [95].…”

“…3 Mean retention rates by different duration of follow-ups [95], and by Wray et al to examine trial's effectiveness in reducing alcohol use problem and sexual risk behaviors [91]. The first trial employed a web-based partner notification with or without referral cards, which informed available testing and treatment resources for syphilis testing [95]. Meanwhile, the second trial offered a personalized and interactive web application so-called "Game plan" and standard post-evaluation counseling [91].…”

A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study

“…The use of emails and text messages to notify contacts has been used most frequently in partner notification for HIV and other sexually transmitted diseases (STDs), such as gonorrhea, syphilis, and chlamydia [4][5][6][7][8][9][10][11]. Previous studies on both patient-initiated (where the individual positive for the disease alerts their contacts) and health care provider-initiated digital contact or partner notification have concluded that the use of emails and/or text messages to notify contacts increases the total number of contacts alerted when used in addition to traditional in-person, telephone-based, or written partner notification [5][6][7][8][9]. This method allows for the ability to reach populations that are inaccessible or hard to reach with traditional partner notification [5][6][7].…”

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

“…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].…”