title: Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: the Washington State community-level randomized trial of EPT.
abstract: BACKGROUND
  Expedited partner therapy (EPT), the practice of treating the sex partners of persons with sexually transmitted infections without their medical evaluation, increases partner treatment and decreases gonorrhea and chlamydia reinfection rates. We conducted a stepped-wedge, community-level randomized trial to determine whether a public health intervention promoting EPT could increase its use and decrease chlamydia test positivity and gonorrhea incidence in women.
  
  
  RESULTS
  The trial randomly assigned local health jurisdictions (LHJs) in Washington State, US, into four study waves. Waves instituted the intervention in randomly assigned order at intervals of 6-8 mo. Of the state's 25 LHJs, 24 were eligible and 23 participated. Heterosexual individuals with gonorrhea or chlamydial infection were eligible for the intervention. The study made free patient-delivered partner therapy (PDPT) available to clinicians, and provided public health partner services based on clinician referral. The main study outcomes were chlamydia test positivity among women ages 14-25 y in 219 sentinel clinics, and incidence of reported gonorrhea in women, both measured at the community level. Receipt of PDPT from clinicians was evaluated among randomly selected patients. 23 and 22 LHJs provided data on gonorrhea and chlamydia outcomes, respectively. The intervention increased the percentage of persons receiving PDPT from clinicians (from 18% to 34%, p < 0.001) and the percentage receiving partner services (from 25% to 45%, p < 0.001). Chlamydia test positivity and gonorrhea incidence in women decreased over the study period, from 8.2% to 6.5% and from 59.6 to 26.4 per 100,000, respectively. After adjusting for temporal trends, the intervention was associated with an approximately 10% reduction in both chlamydia positivity and gonorrhea incidence, though the confidence bounds on these outcomes both crossed one (chlamydia positivity prevalence ratio = 0.89, 95% CI 0.77-1.04, p = 0.15; gonorrhea incidence rate ratio = 0.91, 95% CI .71-1.16, p = 0.45). Study findings were potentially limited by inadequate statistical power, by the institution of some aspects of the study intervention outside of the research randomization sequence, and by the fact that LHJs did not constitute truly isolated sexual networks.
  
  
  CONCLUSIONS
  A public health intervention promoting the use of free PDPT substantially increased its use and may have resulted in decreased chlamydial and gonococcal infections at the population level.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01665690.
authors.affiliation: Center for AIDS and STD,, University of Washington, Seattle, Washington, United States of America; Department of Medicine, University of Washington, Seattle, Washington, United States of America; Public Health-Seattle & King County, Seattle, Washington, United States of America.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
authors.affiliation: Center for AIDS and STD,, University of Washington, Seattle, Washington, United States of America; Public Health-Seattle & King County, Seattle, Washington, United States of America.
authors.forename: Roxanne P
authors.initials: RP
authors.lastname: Kerani
authors.affiliation: Washington State Department of Health, Olympia, Washington, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Stenger
authors.affiliation: Center for AIDS and STD,, University of Washington, Seattle, Washington, United States of America; Department of Biostatistics, University of Washington, Seattle, Washington, United States of America.
authors.forename: James P
authors.initials: JP
authors.lastname: Hughes
authors.affiliation: Washington State Department of Health, Olympia, Washington, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Aubin
authors.affiliation: Center for AIDS and STD,, University of Washington, Seattle, Washington, United States of America.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Malinski
authors.affiliation: Center for AIDS and STD,, University of Washington, Seattle, Washington, United States of America; Department of Medicine, University of Washington, Seattle, Washington, United States of America; Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002690:Chlamydia Infections / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy* / Q000635:transmission; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D016358:Contact Tracing; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy* / Q000635:transmission; D020010:Heterosexuality; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D015995:Prevalence; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy* / Q000635:transmission; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents