Article Text

Original research
Going beyond ‘regular and casual’: development of a classification of sexual partner types to enhance partner notification for STIs
  1. Claudia S Estcourt1,2,
  2. Paul Flowers3,
  3. Jackie A Cassell4,
  4. Maria Pothoulaki1,
  5. Gabriele Vojt1,
  6. Fiona Mapp5,
  7. Melvina Woode-Owusu5,
  8. Nicola Low6,
  9. John Saunders5,7,
  10. Merle Symonds8,
  11. Alison Howarth5,
  12. Sonali Wayal9,
  13. Rak Nandwani2,
  14. Susie Brice10,
  15. Alex Comer11,
  16. Anne M Johnson12,
  17. Catherine H Mercer13
  1. 1 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
  2. 2 Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, UK
  3. 3 School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
  4. 4 Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
  5. 5 Institute for Global Health, University College London, London, UK
  6. 6 Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
  7. 7 Blood Safety, Hepatitis, STI & HIV Division, Public Health England, London, UK
  8. 8 Department of Sexual Health, West Sussex Health and Social Care NHS Trust, Worthing, West Sussex, UK
  9. 9 Development Media International CIC, London, UK
  10. 10 Barts Health NHS Trust, London, UK
  11. 11 Central and North West London NHS Foundation Trust, London, UK
  12. 12 Department of Infection & Population Health, University College London, London, UK
  13. 13 Centre for Sexual Health and HIV Research, University College London, London, UK
  1. Correspondence to Professor Claudia S Estcourt, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK; claudia.estcourt{at}gcu.ac.uk

Abstract

Objectives To develop a classification of sexual partner types for use in partner notification (PN) for STIs.

Methods A four-step process: (1) an iterative synthesis of five sources of evidence: scoping review of social and health sciences literature on partner types; analysis of relationship types in dating apps; systematic review of PN intervention content; and review of PN guidelines; qualitative interviews with public, patients and health professionals to generate an initial comprehensive classification; (2) multidisciplinary clinical expert consultation to revise the classification; (3) piloting of the revised classification in sexual health clinics during a randomised controlled trial of PN; (4) application of the Theoretical Domains Framework (TDF) to identify index patients’ willingness to engage in PN for each partner type.

Results Five main partner types emerged from the evidence synthesis and consultation: ‘established partner’, ‘new partner’, ‘occasional partner’, ‘one-off partner’ and ‘sex worker’. The types differed across several dimensions, including likely perceptions of sexual exclusivity, likelihood of sex reoccurring between index patient and sex partner. Sexual health professionals found the classification easy to operationalise. During the trial, they assigned all 3288 partners described by 2223 index patients to a category. The TDF analysis suggested that the partner types might be associated with different risks of STI reinfection, onward transmission and index patients’ engagement with PN.

Conclusions We developed an evidence-informed, useable classification of five sexual partner types to underpin PN practice and other STI prevention interventions. Analysis of biomedical, psychological and social factors that distinguish different partner types shows how each could warrant a tailored PN approach. This classification could facilitate the use of partner-centred outcomes. Additional studies are needed to determine the utility of the classification to improve measurement of the impact of PN strategies and help focus resources.

  • sexual health
  • contact tracing
  • chlamydia infections
  • gonorrhea
  • HIV

Data availability statement

Data are available on reasonable request from Professor Claudia Estcourt (corresponding author): claudia.estcourt@gcu.ac.uk. The data consist of anonymised qualitative interview and focus group data and may be used with permission for research and/or clinical purposes. More information about the LUSTRUM research programme is available on the study website www.lustrum.org.uk and in the trial protocol paper: doi:10.1136/bmjopen-2019-034806.

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Data availability statement

Data are available on reasonable request from Professor Claudia Estcourt (corresponding author): claudia.estcourt@gcu.ac.uk. The data consist of anonymised qualitative interview and focus group data and may be used with permission for research and/or clinical purposes. More information about the LUSTRUM research programme is available on the study website www.lustrum.org.uk and in the trial protocol paper: doi:10.1136/bmjopen-2019-034806.

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Footnotes

  • Handling editor Joseph D Tucker

  • Twitter @nicolamlow

  • Contributors not applicable.

  • Funding This work presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (reference number RP-PG-0614–20009).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, collection, management, analysis and interpretation of data; writing of the report and the decision to submit the report for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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