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
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
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DOI：
10.1371/journal.pmed.1001777
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发表时间：
2015-01-01
期刊：
影响因子：
15.8
通讯作者：
Holmes, King K.
中科院分区：
文献类型：
--
作者：
Golden, Matthew R.;Kerani, Roxanne P.;Holmes, King K.
背景加急伴侣治疗（EPT）是在没有进行医学评估的情况下对性传播感染者的性伴侣进行治疗的做法，可以增加伴侣的治疗并降低淋病和衣原体的再感染率。我们进行了一项阶梯楔形、社区级随机试验，以确定促进 EPT 的公共卫生干预措施是否可以增加其使用并降低衣原体检测阳性率和女性淋病发病率。方法和结果该试验将美国华盛顿州的地方卫生管辖区 (LHJ) 随机分配为四轮研究。 Waves 以随机指定的顺序开始干预，间隔时间为 6-8 个月。在该州 25 名 LHJ 中，有 24 名符合资格，23 名参与。患有淋病或衣原体感染的异性恋个体有资格接受干预。该研究向临床医生提供免费的患者提供的合作伙伴治疗（PDPT），并根据临床医生的转介提供公共卫生合作伙伴服务。主要研究结果是 219 个哨点诊所 14-25 岁女性的衣原体检测阳性率，以及报告的女性淋病发病率，两者都是在社区层面进行测量的。在随机选择的患者中评估临床医生接受 PDPT 的情况。 23 名和 22 名 LHJ 分别提供了淋病和衣原体结果的数据。干预措施增加了接受临床医生 PDPT 的人数百分比（从 18% 增加到 34%，p < 0.001）以及接受合作伙伴服务的百分比（从 25% 增加到 45%，p < 0.001）。研究期间，女性衣原体检测阳性率和淋病发病率分别从每 10 万人中的 8.2% 下降到 6.5%，从 59.6 下降到 26.4。调整时间趋势后，干预措施与衣原体阳性率和淋病发病率降低约 10% 相关，尽管这些结果的置信区间均交叉（衣原体阳性患病率 = 0.89，95% CI 0.77-1.04，p = 0.15；淋病发病率比 = 0.91，95% CI.71-1.16，p = 0.45）。研究结果可能受到统计功效不足、研究随机序列之外的研究干预某些方面的制度以及 LHJ 并未构成真正孤立的性网络这一事实的限制。 结论 促进使用免费 PDPT 的公共卫生干预措施大大增加了其使用，并可能导致人群中衣原体和淋球菌感染的减少。
BackgroundExpedited 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.Methods and FindingsThe 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.ConclusionsA 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.