Epidemiological Impact of Expedited Partner Therapy for Men Who Have Sex With Men: A Modeling Study

• Type of Material: Article
• Authors: Kevin M. Weiss, Emory University; Jeb Jones, Emory University; David A. Katz, University of Washington; Thomas L. Gift, Centers for Disease Control and Prevention; Kyle Bernstein, Centers for Disease Control and Prevention; Kimberly Workowski, Emory University; Eli Rosenberg, Emory University; Samuel Jenness, Emory University
• Language: English
• Date: 2019-11-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019, Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/OLQ.0000000000001058
• Title of Journal or Parent Work: SEXUALLY TRANSMITTED DISEASES
• Volume: 46
• Issue: 11
• Start Page: 697
• End Page: 705
• Grant/Funding Information: This work was supported by Centers for Disease Control and Prevention [grant number: U38 PS004646], the National Institutes of Health [grant number: R21 MH112449; grant number: R01 AI138783], and the Center for AIDS Research at Emory University [grant number: P30 AI050409]. The authors declare no conflicts of interest. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the US National Institutes of Health or Centers for Disease Control and Prevention.
• Keywords: CHLAMYDIA-TRACHOMATIS; GONORRHEA; HIV; STD; Science & Technology; Infectious Diseases; NOTIFICATION; Life Sciences & Biomedicine; SEXUALLY-TRANSMITTED INFECTIONS; UNITED-STATES; SERVICES

Abstract

Background Expedited partner therapy (EPT) is an intervention for patients with gonorrhea or chlamydia, providing index patients with prescriptions or medication to give to their partners. Expedited partner therapy is recommended for heterosexuals but not for men who have sex with men (MSM), partially due to concerns about overtreatment of uninfected partners and missed opportunities for human immunodeficiency virus (HIV) diagnosis. Methods We extended our stochastic network-based mathematical model of HIV, gonorrhea, and chlamydia among MSM to include EPT. The EPT implementation was simulated for 10 years. Counterfactual scenarios varied EPT coverage, provision, uptake, and partnership window duration. We estimated sexually transmitted infection (STI) incidence, proportion of infections averted, and process outcomes under each scenario. Results Delivery of EPT to 20% of eligible MSM index patients (coverage) reduced cumulative STI incidence by 27% (interquartile range, 13%-39%) over 10 years compared with current estimated STI screening levels. A 20% increase in providing medication to non-index partners (provision) averted 32% (interquartile range, 20%-41%) of STI infections compared with estimated STI screening levels. When targeted by partnership type, EPT solely to casual partners maximized the population-level infections averted. The proportion of partners given medication who had no current STI varied from 52% to 63%, depending on coverage level. The proportion of partners given medication with undiagnosed HIV infection was 4% across scenarios. Conclusions Expedited partner therapy could reduce bacterial STI incidence for MSM. However, this intervention could result in missed opportunities for HIV/STI prevention and a substantial increase in use of antimicrobials by STI-uninfected MSM, raising concerns about cost and antimicrobial resistance.