Strategies for partner notification for sexually transmitted diseases

Abstract

Partner notification has been practiced for decades, with substantial resources directed towards it, and with little evidence on whether it has made a public health impact on disease transmission. Most of the evaluations were not randomized controlled trials, and were conducted in the United States, prior to the HIV/AIDS epidemic. There are reasons to question whether partner notification for gonorrhoea and chlamydia is applicable to HIV. It is also questionable whether interventions for the developed world are applicable to the developing world. This review aims to compare the effects of various sexually transmitted disease (STD) partner notification strategies, including to compare provider referral with contract and patient referral, and to compare different patient referral strategies to each other. In addition to updating previous reviews, it addresses partner notification in developing countries as well as in developed countries, with particular consideration for HIV/AIDS. It attempts to address some of the methodological limitations of earlier reviews. The search strategy included MEDLINE, EMBASE, Psychological Abstracts, Sociological Abstracts, the Cochrane Controlled Trials register, the proceedings of the International AIDS Conferences and the International Society for STD Research meetings. The review includes published or unpublished randomised controlled trials (RCTs) comparing two or more partner notification strategies for people diagnosed with STDs. For each comparison within each study, the difference in the rate of partners elicited, notified, medically evaluated, harmed, etc, the 95% confidence interval, and if significant, the numbers needed to treat (NNT) were calculated. We found 11 RCTs, including 8014 participants. Only two trials were conducted in developing countries, and only two trials were conducted among HIV positive patients. There was some risk of bias in all the included trials. The review found moderately strong evidence that: 1. provider referral alone, or the choice between patient and provider referral, when compared with patient referral among patients with HIV or any STD, increases the rate of partners presenting for medical evaluation; 2. contract referral, when compared with patient referral among patients with gonorrhoea, results in more partners presenting for medical evaluation; 3. verbal, nurse-given health education together with patient-centred counselling by lay workers, when compared with standard care among patients with any STD, results in small increases in the rate of partners treated. There is a need for evaluations of interventions combining provider training and patient education, and for evaluations conducted in developing countries. All partner notification evaluations, but especially those among HIV positive patients, need to measure potential harmful effects, such as domestic violence, to ensure that partner notification does more good than harm. 性病之性伴侶通報策略 性伴侶通報已經進行數十年，而且已經為其投注相當多的資源，但是僅有少數的證據顯示這對於公共衛生的疾病傳播方面具有影響。在美國人類免疫缺乏症病毒(HIV)/愛滋病(AIDS)流行之前，施行的評估大多不是採用隨機對照實驗。因此就有理由質疑針對淋病和披衣菌感染的伴侶通報方式是否同樣適用於人類免疫缺乏症病毒感染，另外在已開發國家的處置方式是否同樣適用於開發中國家也令人感到疑慮。 這篇回顧性文章致力於比較各種各樣的由性病(STD)的伴侶通報策略作用，包括比較“提供者轉介(provider referral，由專家直接告知)”與“協定轉介”(contract referral，在疾病專家通知伴侶之前，給病患2天的時間由自己告訴伴侶。)與病患轉介間，以及不同的病人轉介策略之比較。除了更新之前的回顧文章之外，本文章主要著重在開發中國家與在已開發國家中的伴侶通報，且特別考量於人類免疫缺乏症病毒/愛滋病方面；且在本文中，更嘗試找出早期文獻回顧在方法學上的限制。 搜尋策略包括以下資料庫：MEDLINE、EMBASE、Psychological Abstracts、Sociological Abstracts、 the Cochrane Controlled Trials register、the International AIDS Conferences 以及International Society for STD Research會議的會議紀錄。 本回顧包括已發表及未發表的，比較二種以上的被診斷罹患性病的病人之伴侶告知策略的隨機對照試驗(RCTs)。 我們計算各單一研究之內的每個比較項目比率差異的95%信賴區間，如：伴侶的選取、被通報、接受醫療評估、以及被危害等等的各項比率差異。如果比率差異達到統計顯著程度，則同時計算益一需治數(NNT)。 本篇包含了11隨機對照實驗(RCTs)，包括8014 個參加者。其中只有二個研究在開發中國家進行，並且只有二個研究在人類免疫缺乏症病毒陽性患者之中進行。在所有包括的研究都有些許偏差的風險。本篇回顧發現的適度有力的證據如下：1.比較受到人類免疫缺乏症病毒感染或罹患任一性病病人之中的病患轉介模式，單一的提供者轉介或在病患和提供者轉介之間的選擇可以增加伴侶的醫療評估出現比率。2.在罹患淋病病人之中的病患轉介模式的比較中，合約轉介會有更多伴侶出現接受醫療評估。3.相較於任何一種性病病人之中的標準照顧，同時在給予言語上和護理上的衛生教育配合由給予以病患為中心的諮詢建議可以少量地增加伴侶治療率。...