Beyond Legalizing Patient-Delivered Partner Therapy (PDPT) – Successes and Setbacks in Implementing Statewide Access in the California Project Area (CPA)

Background:  Chlamydia and gonorrhea (CT/GC) reinfection is common, and PDPT has demonstrated effectiveness in reducing reinfection rates.  California legalized PDPT in 2001, however clinical practices still experience barriers to partner treatment, including lack of reimbursement.  California Title X (TX) clinics can obtain a 6-month supply of free PDPT medication through a web-based program we developed.  Assessing PDPT uptake and ongoing barriers can inform strategies for maximizing PDPT utilization.

Methods:  We used 2015 case reports to estimate minimum PDPT utilization among CT/GC cases in the CPA.  We used Family Planning Annual Report data and PDPT program records to estimate PDPT coverage within CPA TX settings.  Medication procurement challenges required the free PDPT program to close from February-August 2015, thus 5 months of program records were available for analysis.  In March 2016, 66% (N=25) of CPA TX agencies completed a survey about barriers that had to be addressed before participating in the free program.

Results:  Partner treatment information was completed on 42% of 129,277 chlamydia and 53% of 33,347 gonorrhea case reports.  Among these, 15% (N=8,368) of chlamydia cases and 1.5% (N=272) of gonorrhea cases received PDPT.  Despite program interruptions, 67% (N=139) of eligible CPA TX clinics ordered 14,921 chlamydia and 3,756 gonorrhea free medication doses.  At one dose per case, this represents PDPT for up to 42% of 35,140 chlamydia and 48% of 7,807 gonorrhea annual CPA TX cases.  Clinics reported barriers related to program requirements for on-site treatment of index patients (32%), administrative approvals (12%), provider concerns (12%), and legality questions (8%).

Conclusions:  Obtaining legal status for PDPT has not led to widespread use in California.  Addressing reimbursement barriers with a free program has improved coverage rates; however, additional barriers remain.  Policy solutions are needed to bring PDPT to scale for population-level impact, in particular to assure sustainable payment sources outside of public health.