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

淋病奈瑟菌和沙眼衣原体是两种最常见的细菌性传播 在美国，艾滋病毒/艾滋病感染（STI）每年影响约400万人，费用超过30亿美元。 在发病率下降一段时间后，衣原体感染的流行率在世界一些地区正在上升。 美国，而淋病发病率保持稳定，但不再下降。需要新的公共卫生干预措施 以降低这些感染的发病率。改进的伴侣通知和治疗可能是这样一个 干预最近的随机对照试验表明，快速伴侣治疗（EPT）， 治疗患有可治愈性传播感染者的性伴侣而不事先由医生进行强制性检查的做法 临床医生，可以增加淋病或衣原体感染者的伴侣数量，并可以 降低性病再感染率。研究人员表明，公共卫生EPT计划可以 在一个城市建立，以增加合作伙伴的治疗，但更大规模的公共卫生EPT的可行性 计划尚未建立，更大的EPT的人口水平影响和成本效益 节目不明。本申请提出了一项阶梯楔形社区水平的随机对照试验， 华盛顿州淋病和衣原体感染的EPT。基于人口的EPT计划 仿照国王郡已经实施的一项计划，西澳大利亚州将以随机选择的时间顺序， 在西澳州的28个卫生区。将向患者提供免费药物，以提供给他们的性伴侣， 新的病例报告表将对公共卫生伙伴通知援助进行分类， 通知合作伙伴。免费药物将通过每个卫生区的大型诊所直接分发给患者 并通过签约参与该计划的商业药房网络。该研究将评估 EPT对在接受CDC检查的诊所接受检测的妇女中衣原体感染患病率的影响 不孕症预防项目资金，以及该州妇女报告的淋病发病率。的 在EPT计划实施前后接受治疗的性伴侣比例将根据以下因素进行估计： 对报告病例的随机样本进行访谈：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控制淋病措施的有效性 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.