Expedited Partner Therapy (EPT): Implementation Experiences of Three Clinics in Texas (TX)

Background:  CDC and the TX Department of State Health Services recommend EPT to prevent chlamydia (CT) and gonorrhea (GC) transmission and reinfection. Since 2009, TX administrative code allows healthcare providers to give medications to infected patients to take to sex partners without the provider examining the sex partners. Despite legalization, TX clinics have been slow to adopt EPT.

Objectives:  Assess and describe three clinics’ success and challenges pioneering EPT implementation.

Methods:  The Region VI Infertility Prevention Project interviewed clinic managers and staff at diverse clinics offering EPT in three TX cities (June-November 2011). Semi-structured interviews addressed EPT protocol development, staff training and implementation, provider practices, and successes and challenges. Copies of written EPT protocols and standing orders were requested.

Results:  A large metropolitan STD clinic, a large metropolitan Family Planning clinic for teens, and a small suburban family planning clinic participated. All interviewees reported that most staff favored EPT implementation, and resistant staff followed protocols and some became proponents. All clinics developed written protocols, trained staff, and provide counseling and written information to patients. Patient eligibility criteria differed between clinic protocols and provider practice, and across clinics: providers focused on patient comprehension and behavioral risk rather than sex partners’ willingness to see a provider. Data on EPT administration is not systematically collected.

Conclusions:  Implementing EPT in TX clinics is feasible. However, protocols and practices are inconsistent within and across clinics, particularly regarding when and why patients are offered EPT. Data is not used effectively to assess program impact.

Implications for Programs, Policy, and Research:  Clear guidance from state and federal leadership is essential for EPT adoption and consistent practice. Furthermore, EPT is an important tool to combat the CT and GC epidemics in the Southwest, but clear guidance and oversight from state and federal leadership that considers antimicrobial-resistance is critical (e.g. targeted re-screening and follow-up for re-infected individuals and partners).