Population Briefs | September 2006, Vol. 12, No. 3 | Partner-Delivered Therapy Viable in Resource-Poor Areas

September 2006, Vol. 12, No. 3

Reproductive Health
Partner-Delivered Therapy Viable in Resource-Poor Areas

In South Africa and Brazil, the Population Council has recently studied alternative methods of notifying partners of women with sexually transmitted infections (STIs) that they need treatment. These studies have verified that offering women with STIs the option of bringing medicines to their partners, rather than requiring partners to come to the clinic, results in high treatment rates.

Notifying partners of infection
Notifying people that their sexual partners have an STI is an important means of reducing the transmission of infection. The practice of partner-delivered medicine has been shown to increase the number of partners contacted and to decrease the rate of re-infection in resource-rich settings, but little work has been done to demonstrate its effectiveness in resource-poor settings. It is in these places, however, where the strategy might be most useful; partner notification methods that rely upon outreach by health professionals are difficult to maintain in resource-poor settings, which often have shortages of providers.

Population Council researchers Heidi E. Jones, Juan Diaz, and Sheri A. Lippman collaborated with colleagues from Santa Casa Medical School and the University of Cape Town to study partner-delivered treatment programs in São Paulo, Brazil and Gugulethu, Cape Town, South Africa. These investigations were part of two larger studies of home-based STI testing. The studies tested for the presence of trichomoniasis, chlamydia, and gonorrhea among participating women. These infections may increase the risk of HIV infection and contribute to infertility, pelvic inflammatory disease, obstetric complications, and illness in newborns. Further, they can all be treated with a single dose of medication.

São Paulo
In Brazil, women who had trichomoniasis were offered three options for partner notification: notifying their partners themselves, having a health professional notify their partners, or bringing medication and instructions on use to their partners. Women with chlamydia or gonorrhea were offered only the first two options because study clinicians felt that direct counseling of the partners was a priority. Of the 787 women in the larger study, 108 had at least one of the three infections.

Twenty-eight women had trichomoniasis. Four of them reported no sexual partners in the last three months, so partner notification was not conducted. Eighty-one percent of the partners of the remaining women were treated, 91 percent receiving partner-delivered medicine.

Eighty-five women had gonorrhea and/or chlamydia, four of whom reported having no sex partners in the last three months. Forty-four percent of the partners of the remaining women came to the clinic for treatment, and 31 percent received partner-delivered medication. Although the latter option was offered initially only to women with trichomoniasis, providers later began offering this option to women with other infections whose partners did not come to the clinic. The majority of partners who were not treated were those of patients who refused to contact the partner, usually because they were no longer a couple.

Gugulethu
In South Africa, all women who were found to have any of these three infections were given a choice between bringing clinic referral slips to their partners or bringing medicine and instructions on use to their partners. Of the 626 women in the larger study, 106 were found to have at least one STI. The women chose to take medication to 85 percent of their partners and a referral slip to 13 percent of their partners. The most common reason women elected to get the medication was their concern that their partners might initially agree to visit a clinic, but would not follow through. The second most common reason given was that a woman’s partner was too busy to attend a clinic or would refuse to attend for other reasons.

“The high rates of STIs we found in these studies confirm the urgent need for improved methods of preventing disease transmission,” says Jones. “Patient-delivered medicine was the preferred method of partner notification in both studies, and it resulted in high rates of partner treatment.”

A barrier to partner notification in general is the lack of highly accurate and inexpensive STI diagnostic tests in resource-poor settings, say the researchers. Additionally, says Diaz, “we need to reach out to providers and educate them about the benefits of this strategy. In the Brazil study, and in studies in other countries, physicians have expressed reservations about using partner-delivered medication. Their understanding and approval are crucial to the method’s success.”

Sources
Young, T., A. de Kock, H. Jones, L. Altini, T. Ferguson, and J.H.H.M. van de Wijgert. “A comparison of two methods of partner notification for sexually transmitted infections in South Africa: Patient-delivered partner medication and patient-based partner referral,” forthcoming in International Journal of STD & AIDS.

Jones, Heidi E., Sheri A. Lippman, Adriana A. Pinho, Carla Gianni Luppi, Janneke H.H.M. van de Wijgert, and Juan Diaz. 2006. “Partner-delivered medication for sexually transmitted infections: Findings from Brazil,” Gaceta Médica de México 142(S2): 69–76.

Outside funding
US Agency for International Development

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