Uptake of and Experiences with Expedited Partner Therapy Among African American Girls Recruited from Short-Term Juvenile Detention Centers

Background: This study describes uptake, correlates of acceptance and experiences using expedited partner therapy (EPT) among African American girls recruited from short-term juvenile detention centers. 

Methods: Ninety-five detained African American girls (13-17 years) participated in a HIV/sexually transmitted infection (STI) prevention program. At baseline, 3- and 6-month assessments participants completed audio computer-assisted self-interviews (ACASI) and self-collected vaginal swab specimens assayed for Chlamydia and gonorrhea. After each assessment, the study nurse offered EPT over the phone to STI-positive participants (n=51) and conducted follow-up phone interviews seven days after providing partner medication to participants (n=37) to assess medication delivery to partners. Summary statistics described EPT uptake. Generalized estimating equations assessed correlates of acceptance.  Nine semi-structured interviews elicited participants' EPT experiences.

Results: EPT was offered 69 times, accepted over the phone 48 times (70%) and provided 47 times (68%) to 36 girls. Phone interview data indicated the most common refusal reason was discontinued partner relationship. ACASI data showed acceptance was significantly associated with an increased likelihood of self-reported STI history (OR=5.3, 95% CI: 1.7, 17.0, p=0.005), ≥4 lifetime sex partners (OR=3.3, 95% CI: 1.0,11.0, p=0.048), infrequently discussing STI prevention with partners (OR=3.2, 95% CI: 1.0, 10.1, p=0.048), and marginally associated with a decreased likelihood of condom use at last sex (OR=0.04, 95% CI: 0.1-1.1, p=0.084). In 33 (89%) phone interviews, girls reported delivering medication to ≥1 partner. ACASI data also indicated most girls felt “very comfortable” delivering partner medication, although emergent themes in five elicitation interviews included discomfort and missed opportunities for partner education during partner notification. Sense of responsibility for care of partners was a theme in three interviews.  

Conclusions: EPT uptake was high; acceptance was associated with riskier sexual behavior.  However, partner notification training may have been insufficient. Future research is needed to determine the efficacy of EPT among this population.