Why Are Chlamydia-Infected Patients Not Being Offered Expedited Partner Therapy in New York City?

Mehta<sup>1</sup>, Mansi

Tuesday, March 13, 2012

Hyatt Exhibit Hall

Mansi Mehta¹, MPH¹, Tiffani Mulder ², MPH¹, Kimberly Johnson², MPH¹, Meighan Rogers ², MPH², Anne Lifflander ², MD³, Kelly Morrison Opdyke⁴, MPH⁴, Melissa Nelson⁴, MSc⁵, Sami L. Gottlieb³, MD, MSPH⁶, Catherine Satterwhite³, MSPH, MPH⁷, Susan Blank² ³, MD, MPH² and Julia Schillinger ² ³, MD, MSc⁸, 1Department of Infectious Diseases/ Bureau of Sexually Transmitted Diseases, New York City Department of Health and Mental Hygiene, Bureau of Sexually Transmitted Diseases, Queens, NY, 2Bureau of STD Control, New York City Department of Health and Mental Hygiene, New York, NY, 3Bureau of STD Control, New York City Department of Health and Mental Hygiene, Bureau of Sexually Transmitted Diseases, Queens, NY, 4Region II Infertility Prevention Project, Cicatelli Associates Inc, New York, NY, 5Cicatelli Associates, New York, NY, 6Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 7Division of STD Prevention, Epidemiology and Surevillance Branch, Centers for Disease Control and Prevention, Atlanta, GA, 8NYC DOHMH Bureau of STD Control; CDC Division of STD Prevention, The New York City Department of Health and Mental Hygiene; US Centers for Disease Control and Prevention, Queens, NY

Background: Expedited partner therapy (EPT) is the practice of providing treatment, without prior assessment, to sex partners of patients diagnosed with an STD. In March 2011, New York City (NYC) STD clinics began offering EPT to patients being treated for laboratory-confirmed Chlamydia trachomatis (CT) (excluding men who have sex with men (MSM) and patients with concurrent gonorrhea or syphilis infections).

Objectives: To examine reasons patients diagnosed with CT in NYC STD clinics are not offered EPT.

Methods: We analyzed data for CT-positive patients with clinic visits from April 1-July 31, 2011 and assessed the proportion of these patients excluded because they were: treated presumptively on the day of visit, males with a male sex partner (MSM), or had concurrent gonorrhea or syphilis infection.

Results: Among 2,110 CT-positive patients, 1,499 (71%) were documented as EPT-ineligible. Of these, 52% (783/1499) were presumptively treated before CT confirmation, 20% (299/1499) were MSM, 11% (170/1499) had gonorrhea, 1% (19/1499) had syphilis, and 15% (228/1499) had ‘other’ reason documented. Among 26 physicians, determination of EPT ineligibility for CT-infected patients ranged from 23%-94% (median 62%).

Conclusions: Over 35% of the individuals with CT diagnosed in NYC STD clinics were deemed ineligible for EPT because they were treated presumptively before CT results were available. EPT should be expanded to include this group. Provider-specific differences in proportion of patients determined to be EPT-eligible suggest differences in how criteria are understood and applied, and indicate a need for standardization and training.

Implications for Programs, Policy, and Research: Based on these findings, we adapted the STD clinics’ automated results messaging system to invite presumptively treated persons with laboratory-confirmed CT to return for the sole purpose of receiving EPT.

P61 Why Are Chlamydia-Infected Patients Not Being Offered Expedited Partner Therapy in New York City?