Strategies for partner notification for sexually transmitted diseases.
BACKGROUND
Partner notification has been practiced for decades, with substantial resources directed towards it, and with little evidence on whether it has made a public health impact on disease transmission. Most of the evaluations were not randomized controlled trials, and were conducted in the United States, prior to the HIV/AIDS epidemic. There are reasons to question whether partner notification for gonorrhoea and chlamydia is applicable to HIV. It is also questionable whether interventions for the developed world are applicable to the developing world.


OBJECTIVE
This review aims to compare the effects of various sexually transmitted disease (STD) partner notification strategies, including to compare provider referral with contract and patient referral, and to compare different patient referral strategies to each other. In addition to updating previous reviews, it addresses partner notification in developing countries as well as in developed countries, with particular consideration for HIV/AIDS. It attempts to address some of the methodological limitations of earlier reviews.


METHODS
The search strategy included MEDLINE, EMBASE, Psychological Abstracts, Sociological Abstracts, the Cochrane Controlled Trials register, the proceedings of the International AIDS Conferences and the International Society for STD Research meetings.


METHODS
The review includes published or unpublished randomised controlled trials (RCTs) comparing two or more partner notification strategies for people diagnosed with STDs.


METHODS
For each comparison within each study, the difference in the rate of partners elicited, notified, medically evaluated, harmed, etc, the 95% confidence interval, and if significant, the numbers needed to treat (NNT) were calculated.


RESULTS
We found 11 RCTs, including 8014 participants. Only two trials were conducted in developing countries, and only two trials were conducted among HIV positive patients. There was some risk of bias in all the included trials. The review found moderately strong evidence that: 1. provider referral alone, or the choice between patient and provider referral, when compared with patient referral among patients with HIV or any STD, increases the rate of partners presenting for medical evaluation; 2. contract referral, when compared with patient referral among patients with gonorrhoea, results in more partners presenting for medical evaluation; 3. verbal, nurse-given health education together with patient-centred counselling by lay workers, when compared with standard care among patients with any STD, results in small increases in the rate of partners treated.


CONCLUSIONS
There is a need for evaluations of interventions combining provider training and patient education, and for evaluations conducted in developing countries. All partner notification evaluations, but especially those among HIV positive patients, need to measure potential harmful effects, such as domestic violence, to ensure that partner notification does more good than harm.
Mathews
C
C
Centre for Epidemiologic Research, South African Medical Research Council, Cape Town, South Africa. cmathews@mrc.ac.za
Coetzee
N
N
Zwarenstein
M
M
Lombard
C
C
Guttmacher
S
S
Oxman
A
A
Schmid
G
G
D002690:Chlamydia Infections / Q000635:transmission; D016358:Contact Tracing / Q000379:methods*; D006069:Gonorrhea / Q000635:transmission; D006801:Humans; D012749:Sexually Transmitted Diseases / Q000635:transmission*