Achieving successful partner notification: putting together the pieces of the puzzle

The diverse nature of our patient populations, the complexities of their sexual relationships, their varied emotional responses to a sexually transmitted infection (STI) diagnosis, issues of guilt and blame, and perhaps geographical separation from their partners make it unsurprising that successful partner notification is difficult to achieve. In addition, when health-care professionals lack confidence, experience or funding it is easy for partner notification to be sidelined, especially when STI care occurs outside the specialist setting.

A systematic review of partner notification strategies ¹ concluded that a number of relatively cheap and easy elements of care, such as provision of infection-specific information, improved partner notification outcomes, and these can, for most of us, be easily integrated into routine practice. However, patient-delivered partner therapy (PDP), the intervention most likely to improve partner notification outcomes, in which antibiotics are given to the index to give to their sex partner(s) without an intervening health assessment of the partner, presents greater challenges. PDP does not comply with existing professional and legislative guidance in many countries and states, despite being popular with, and utilized by some groups of patients and clinicians ^2,3 in those areas.

The very real challenge therefore remains to develop innovative, acceptable and feasible partner notification methods that satisfy current legislation and have potential to improve partner notification outcomes and that are applicable to a wide range of both specialist and non-specialist health-care settings. ⁴ In view of these complexities there is unlikely to be a quick fix.

In this issue we report on a qualitative study of genitourinary medicine (GU) clinic attenders in outer London (Sutcliffe et al.) whose views on partner notification and individual elements of putative partner notification interventions shaped the development of two partner notification strategies which we have termed accelerated partner therapy (APT). We define APT as partner notification strategies that include assessment of the sex partner by an appropriately qualified health-care professional, but that do not require clinic attendance. These include telephone assessments by a clinic-based sexual health professional and treatment by community pharmacists and include the provision of a postal urine testing kit for Chlamydia trachomatis and Neisseria gonorrhoeae. These APT strategies satisfy current UK prescribing guidance and are undergoing evaluation in an exploratory trial, which will be reported later this year. The qualitative findings reported here reinforce the need for us to offer patients a choice of method as preference may depend more on relationship type and issues of trust than on more easily categorizable factors such as age, gender, ethnicity or sexual behaviour.

A recent report from the (UK) National Chlamydia Screening Project (NCSP) highlights a lack of capacity and training to provide partner notification in general practice and community pharmacies. ⁵ It is easy to underestimate the difficulties health-care professionals outside the specialist setting perceive in implementing effective partner notification. ⁶ For these reasons, it is particularly important that any new partner notification strategies meet with support from primary care colleagues. Pilot work from our group ⁷ with general practitioners (GPs) and practice nurses in our deprived inner London borough suggests that GPs and practice nurses welcome new approaches to partner notification, recognize the importance of partner notification methods tailored to their settings and perceive that APT could provide a feasible and acceptable partner notification solution within their current practice. GPs particularly valued how APT approaches could use an existing network of health providers in novel ways, bypassing barriers to attending services and avoiding attrition as patients move between health-care providers. This network model of partner notification fits well with the NCSP recommendations for an integrated system of community and clinic-based partner notification. ⁵

As STI care diversifies, the challenges for delivery of effective partner notification become more complex. We must continue to develop, implement and evaluate inclusive and creative solutions, applicable to all aspects of the sexual health provider market without losing sight of the powerful but often subtle factors that guide patients’ choice of partner notification method.