Evaluation of Expedited Partner THERAPY for Chlamydial INFECTION In Rural COMMUNITIES In Tennessee

Background:  Expedited partner therapy (EPT) for Chlamydia has been permissible in Tennessee (TN) since 2002.

Objectives: Evaluate the delivery of EPT and other possible outcomes for Chlamydia in eight rural county health departments

Methods:  In 2002, TN implemented Chlamydia EPT which allows for treatment of sex partners without a prior clinical evaluation. Eight rural health departments were assessed for their use of EPT. All counties chosen have low morbidity, allowing them to interview all STD patients. Data were obtained from a state surveillance database from January 1 through December 31, 2010.

Results:  In 2010, Bradley County reported 918 cases of Chlamydia with 106 patients (11.5%) given 186 (1.8%) EPT doses for their partners. In Northeast Tennessee, 575 Chlamydia cases were reported with 178 patients (31%) given 187 (1.1%) EPT doses.  With the convenience of dispensing EPT packs by nurses, the investigators were less likely to interview the patient with Bradley County interviewing 27% and NE TN 33% respectively. The nurses and PHAs were not taking the time to conduct interviews, but only give EPT. Data review also highlighted recidivism with 70 patients presenting with an STD two or more times. Also of note, were 41 pregnancies with five miscarriages and one stillbirth. It is not known if this is from chlamydial infection, but with the incidence of Chlamydia these two factors are increased.

Conclusions:  An interview still is a necessity to educate the patient as well as to obtain demographics, history of prior pregnancies and STDs, and partner information. Recidivism rates of both patients and partners should also be tracked.

Implications for Programs, Policy, and Research: An evaluation is essential for EPT programs to measure if 1) patient interviewing is being conducted; 2) what percentage of contacts are receiving and taking the medication; 3) recidivism; and 4) effects on pregnancy.