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Strategies for partner notification for sexually transmitted diseases
C Mathews1, N Coetzee, M Zwarenstein
1Centre for Epidemiologic Research, South African Medical Research Council, Cape Town, South Africa. cmathews@mrc.ac.za
The Cochrane Database of Systematic Reviews
|November 1, 2001
Summary
Partner notification strategies, particularly provider referral, increase the rate of partners seeking medical evaluation for sexually transmitted diseases (STDs). More research is needed in developing countries and on potential harms, especially for HIV.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Partner notification for STDs has a long history with limited evidence of public health impact on disease transmission.
- Previous evaluations often lacked robust methodology and were conducted before the HIV/AIDS epidemic, raising questions about applicability to current STDs and global contexts.
- The effectiveness of interventions developed in Western countries for STDs, including HIV/AIDS, in developing nations remains uncertain.
Purpose of the Study:
- To compare the effectiveness of various sexually transmitted disease (STD) partner notification strategies, including provider referral, contract referral, and patient referral.
- To update existing reviews on partner notification, with a specific focus on HIV/AIDS and applicability in developing countries.
- To address methodological limitations present in previous STD partner notification reviews.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, EMBASE, etc.) and conference proceedings.
- Included studies were randomized controlled trials (RCTs) comparing at least two different partner notification strategies for individuals diagnosed with STDs.
- Data extraction focused on the rate of partners elicited, notified, and medically evaluated, along with confidence intervals and numbers needed to treat (NNT).
Main Results:
- Eleven RCTs involving 8014 participants were included, with limited representation from developing countries and HIV-positive patients.
- Provider referral, compared to patient referral, significantly increases the rate of partners presenting for medical evaluation across various STDs, including HIV.
- Contract referral and health education combined with patient-centered counseling also showed benefits in increasing partner evaluation and treatment rates.
Conclusions:
- There is a need for more rigorous evaluations of partner notification strategies, particularly in developing countries and among HIV-positive populations.
- Future research should focus on interventions combining provider training and patient education, and must assess potential negative consequences, such as domestic violence.
- Ensuring that partner notification interventions 'do more good than harm' requires careful consideration of safety and ethical implications.