3B 3 Expedited Partner Therapy for Chlamydia Infection Is Underreported and Underutilized, Massachusetts 2012

Wednesday, June 11, 2014: 11:05 AM
Laura Smock, MPH, Division of STD Prevention, Massachusetts Department of Public Health, Boston, MA, Kathryn Barker, MPH, Boston University School of Public Health, Boston, MA and Katherine Hsu, MD, MPH, Division of STD Prevention and Ratelle STD/HIV Prevention Training Center of New England, Massachusetts Department of Public Health, Jamaica Plain, MA

Background:  Massachusetts Department of Public Health (MDPH) promulgated regulations in August 2011 to permit Expedited Partner Therapy (EPT) for chlamydia infection. In January 2012, MDPH revised the chlamydia case report form to capture additional information regarding partner notification and treatment (PN).

Methods:  Laboratory-confirmed chlamydia cases diagnosed in 2012 were analyzed in SAS 9.3 to describe provider usage of EPT through patient-delivered medication and/or prescription. Treatment setting, method of PN, patient sex and age were analyzed using chi-square. 

Results:  A total of 21,438 chlamydia cases were identified. 71% of the case report forms had incomplete EPT information.  We analyzed cases where PN and EPT questions were answered by providers (n=6114, n=29%).  5410 (88%) reported any form of PN, mainly patient notification of partners (n=5324, 98%). 1092 (18%) reported offering EPT; of those, 558 (51%) reported using patient-delivered prescription(s) only; 468 (43%) reported using patient-delivered medication only; 66 (6%) reported using a combination of methods. Treatment setting was reported for 4648/6114 (76%) of cases.  Community health centers (358/1275, 28%; p< 0.0001), hospital-based clinics (153/537, 28%; p=0.0149), and STD/family planning clinics (229/863, 27%, p=0.0005) reported using EPT in a larger proportion of cases, when each was compared to all others with known setting. EPT was offered more often to female cases (981/3519, 28%) than male cases (148/1388, 11%) (p< 0.0001).  Differences between age groups were not statistically significant.

Conclusions:  A minority of case report forms had complete information regarding PN. PN methods varied by patient sex and treatment setting, but overall, reported use of EPT by healthcare providers in Massachusetts is low. Newness of regulations along with varied interpretation of EPT questions on the new case report form, may have contributed to underutilization and underreporting. Further steps could be taken to promote EPT usage, to maximize impact of the policy on chlamydia control.