Transcript EPT in the Denver STD Clinic

Expedited Partner Therapy
The Denver Experience
Cornelis A. Rietmeijer, MD, PhD
Denver Public Health Department
Expedited Partner Therapy
• Approach whereby partners are treated
without an intervening clinical assessment
– Patients delivering medications to partners
– Patients delivering prescriptions to partners
– Field treatment by DIS or outreach workers (with or
without testing)
EPT Studies
•
Schillinger et al. Sex Transm Dis 2003;30:49-56
– 20% reduction in CT re-infection of 20% among
women (P = 0.102)
•
Golden et al. New Engl J Med 2005;352:676-85
– 73% reduction in GC re-infection among men and
women (P < 0.01)
– 17% reduction in CT re-infection (P = 0.17)
•
Kissinger et al. Clin Infect Dis 2005; 41:623-9
– 46% reduction in GC and/or CT infection among men
with urethritis (P<0.001)
EPT and the CDC 2006 STD
Treatment Guidelines
• “….patient delivered therapy (i.e., via
•
•
medications or prescriptions) can prevent
re-infection of index case and has been
associated with a higher likelihood of
partner notification, compared with
unassisted patient referral of partners”
EPT recommendations are limited to GC
and CT contacts only
EPT is not recommended for MSM
In Colorado, EPT has been
endorsed by the state’s medical
and pharmacy boards
EPT
Legal Status in Colorado
•
•
No legal impediments to provide EPT
EPT specifically endorsed by:
– Colorado State Board of Medical Examiners
• Policy 40-10, issued 5/10/2001
– “It is the position of the Colorado Board of Medical Examiners
that the public risk of untreated sexually transmitted infection is
greater than the risk of complications from prescribing in this
less than ideal setting”
– Colorado State Board of Pharmacy
• Policy 40-4, issued 7/19/2007
– “It is the position of the Colorado Pharmacy Board that the
public risk of untreated sexually transmitted infection is greater
than the risk of complications from dispensing in this less than
ideal setting”
EPT in Colorado
EPT in Colorado
EPT in the Denver STD Clinic
• Between 11/9/2006 and 12/31/2007*
–549 heterosexual patients with
documented GC or CT eligible for EPT
–87 (15.8%) received EPT
• Median: 1 Range: 1-3
–No demographic or risk differences
between those who did or did not accept
EPT
*No EPT dispensed between March and September, 2007 pending review by the
Colorado Pharmacy Board
EPT in the Denver STD Clinic
11/2006 – 12/2007*
CT
Positive
Eligible
EPT
Received
Declined
Not Given
Missing
GC
Either
947
368 (38.8)
330
251 (76.1)
1172
549 (46.8)
57 (15.5)
37 (10.0)
231 (62.8)
43 (11.7)
36 (14.3)
25 (9.9)
169 (67.4)
21 (8.4)
87 (15.8)
56 (10.2)
345 (62.8)
61 (11.1)
*No EPT dispensed between March and September, 2007 pending review by the
Colorado Pharmacy Board
Partner Pack
Chlamydia
EPT in the Denver STD
Clinic
• Main reasons for not receiving EPT
– Partners already treated or in clinic
concurrently (48.1%)
– Patients preferred partners come to the clinic
(25.3%)
– No contact info (17.5%)
• Among clinicians, provision of EPT varied
from 5% to 45%
EPT Resources
http://www.cdc.gov/std/ept/