A community-level RCT of expedited partner treatment for gonorrhea and chlamydia

淋球菌和沙眼衣原体是两种最常见的性传播细菌 在美国，每年约有400万人受到性传播感染的影响，造成的损失超过30亿美元。 在经历了一段时间的发病率下降之后，衣原体感染的流行率现在在一些地区有所上升。 美国，虽然淋病发病率稳定，但不再下降。需要新的公共卫生干预措施 以减少这些感染的发病率。改进的合作伙伴通知和处理可能是这样的 干预。最近的随机对照试验表明，快速伴侣疗法(EPT)，即 治疗可治愈的性传播感染患者的性伴侣而不进行强制性事先检查的做法 临床医生，可以增加淋病或衣原体感染患者治疗的伴侣数量，并可以 降低性传播感染再感染率。研究人员已经表明，公共卫生EPT计划可以 在单一城市建立，以增加伙伴治疗，但更大规模公共卫生EPT的可行性 方案尚未建立，较大的EPT在人口层面的影响和成本效益 程序是未知的。本申请提出了一项阶梯式楔形社区水平随机对照试验 华盛顿州淋病和衣原体感染的EPT。一种基于人口的EPT计划 仿照金县已经存在的一个，华盛顿州将在#年随机选择时间顺序建立 佤邦的28个卫生区。将向患者提供免费药物，以便交付给他们的性伴侣，并提供 新的病例报告表格将对公共卫生合作伙伴的通知援助进行分类，以帮助高危人群 通知合作伙伴。免费药物将通过每个卫生区的较大诊所直接分发给患者 并通过签约参与该计划的商业药店网络。这项研究将评估 EPT对疾病预防控制中心门诊妇女衣原体感染流行率的影响 不孕不育预防项目资金，以及该州报告的妇女淋病发病率。这个 在EPT计划实施前后接受治疗的性伴侣比例将根据 对报告病例的随机抽样采访：调查人员将评估干预的成本- 从社会角度和相对于其他公共资助的淋病控制措施的有效性 和衣原体感染。

Neiserria gonorrhoeae and Chlamydia trachomatis are the two most common bacterial sexually transmitted infections (STI) in the United States, affecting an estimated 4 million persons annually at a cost of over $3 billion. After a period of declining morbidity, the prevalence of chlamydial infection is now rising in some areas of the U.S., while rates of gonorrhea are stable, but no longer decreasing. New public health interventions are needed to decrease morbidity from these infections. Improved partner notification and treatment might be such an intervention. Recent randomized controlled trials have demonstrated that expedited partner therapy (EPT), the practice of treating the sex partners of persons with curable STI without their mandatory prior examination by a clinician, can increase the number of partners of persons with gonorrhea or chlamydial infection treated, and can decrease rates of STI reinfection. Study investigators have shown that a public health EPT program can be instituted in a single city to increase partner treatment, but the feasibility of wider scale public health EPT programs has not been established, and the population-level impact and cost-effectiveness of larger EPT programs is unknown. This application proposes a stepped-wedge community-level randomized controlled trial of EPT for gonorrhea and chlamydial infection in Washington (WA) State. A population-based EPT program modeled after one already in place in King County, WA will be instituted in a randomly selected temporal order in 28 health districts in WA State. Free medication will be provided to patients to deliver to their sex partners, and a new case-reporting form will triage public health partner notification assistance to persons at high-risk for not notifying partners. Free medications will be distributed directly to patients via larger clinics in each health district and through a network of commercial pharmacies contracted to participate in the program. The study will assess the impact of EPT on the prevalence of chlamydial infection among women tested in clinics receiving CDC Infertility Prevention Project funding, and on the incidence of reported gonorrhea among women in the state. The proportion of sex partners treated before and after the institution of the EPT program will be estimated based on interviews with a random sample of reported cases: Investigators will evaluate the intervention's cost- effectiveness both from a societal perspective and relative to other publicly funded measures to control gonorrhea and chlamydial infection.