Can we improve partner notification rates through expedited partner therapy in the UK? Findings from an exploratory trial of Accelerated Partner Therapy (APT)
- Claudia Estcourt1,
- Lorna Sutcliffe2,
- Jackie Cassell3,
- Catherine H Mercer4,
- Andrew Copas4,
- Laura James4,
- Nicola Low5,
- Patrick Horner6,
- Michael Clarke7,
- Merle Symonds8,
- Tracy Roberts9,
- Angelos Tsourapas9,
- Anne M Johnson4
- 1Centre for Infectious Disease: Sexual Health & HIV, Blizard Institute of Cell and Molecular Science, Barts & The London School of Medicine & Dentistry, Barts and the London NHS Trust, Barts Sexual Health Centre, Kenton & Lucas Wing, St Bartholomew's Hospital, West Smithfield, London, UK
- 2Centre for Infectious Disease: Sexual Health & HIV, Blizard Institute of Cell and Molecular Science, Barts & The London School of Medicine & Dentistry, West Smithfield, London, UK
- 3Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- 4Research Department of Infection & Population Health, Centre for Sexual Health & HIV Research, University College London, London, UK
- 5Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- 6School of Social and Community Medicine, University of Bristol, Bristol, UK
- 7University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- 8Barts & The London School of Medicine & Dentistry, London, UK
- 9Health Economics Unit, University of Birmingham, Birmingham, UK
- Correspondence to Dr Claudia Estcourt, Centre for Infectious Disease: Sexual Health & HIV, Blizard Institute of Cell and Molecular Science, Barts & The London School of Medicine & Dentistry, Barts and the London NHS Trust, Barts Sexual Health Centre, Kenton & Lucas Wing, St Bartholomew's Hospital, West Smithfield, London EC1A 5BE, UK;
Contributors CSE was PI, led the research and was lead author; LJS was study researcher and led the conduct of the trial. Study design: CSE, JAC, CM, NML, PH, AMJ, LJS, TR, AT; statistical analysis: CM, AC, LJ; data interpretation: all authors; write up: all authors.
- Accepted 23 June 2011
- Published Online First 27 July 2011
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 non-randomised 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%), p=0.003; APTPharmacy 29/44 (66%) p=0.001. However, partner treatment was often achieved through other routes. Although 40–60% 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.
- Partner notification
- accelerated partner therapy
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- public health
See Editorial, p 2
Funding Department of Health via MRC's Sexual Health and HIV Research Strategy Committee.
Competing interests None.
Ethics approval This study was conducted with the approval of the Norfolk Research Ethics Committee, REC 06/Q0101/3.
Provenance and peer review Not commissioned; externally peer reviewed.