Background: Partner Notification(PN) is a core public health activity aimed at preventing syphilis by ensuring that sexual contacts of reported cases are notified and treated. In this analysis, we compare outcomes between three PN models utilized by the Los Angeles County(LAC) Department of Public Health(DPH) for residents living in a high early syphilis (ES) morbidity region, Service Planning Area 4(SPA4-Metro).
Methods: Using STD surveillance data, we examined the records of 657 ES cases among SPA 4 residents reported in 2012 and assigned to one of the following PN models: 1) a community-embedded disease intervention specialist(CEDIS) located at one of two non-county high-morbidity clinics (n=187); 2) a District Public Health Investigator(PHI) assigned to one of the twelve public STD clinics (n=73) and 3) a DPH PHI working cases countywide (n=397). Type of PN services was compared by timely interview of the index case defined as the number of days between specimen collection and interview, and three indices that measure the number of contacts elicited, examined and treated per 100 cases assigned.
Results: The CEDIS interviewed 32% (n=60) of their cases within 7 days and 88% (n=164) overall. By comparison, district PHIs interviewed 18% (n=13) of their cases within 7 days and 84% (n=61) overall. DPH PHIs interviewed 7% (n=26) of their cases within 7 days and 77% (n=305) overall. For every 100 cases assigned, CEDIS elicited 104 contacts, examined 47 contacts and treated 35 contacts. The respective indices were 45, 21 and 12 for District PHIs and 28, 9 and 6 for DPH PHIs.
Conclusions: The CEDIS model in high-morbidity non-county sites augments traditional PHI approaches to PN services. Reasons for CEDIS success may include efficiencies associated with co-location of PN and clinical services and improved patient trust associated with the delivery of PN services from a known health care provider.