Knowledge and Attitudes towards Expedited Partner Therapy in Family Planning and Sexual Health Service Settings of a Local Health Department

Background: Expedited partner therapy (EPT), is a strategy that allows providers to prescribe treatment for the partners of patients infected with certain sexually transmitted infections (STIs) without first examining these partners. EPT has been found to increase rates of partner treatment and decrease rates of repeat gonorrhea and chlamydial infection. EPT for heterosexual partners of chlamydia patients has been permitted in North Carolina and supported by the North Carolina Medical Board since 2009; however, studies have shown that it has not been widely utilized by providers in North Carolina local health departments. The aim of this study is to assess the current state of EPT in Forsyth County, a North Carolina county with a high STI morbidity, as a pilot site to assess patient and provider barriers inhibiting EPT utilization and to improve EPT prescribing practices among providers. Ultimately, this data may be used to determine whether there are specific areas within the North Carolina healthcare system that can be adjusted to accommodate EPT usage and thus increase EPT uptake among patients and providers working both within and outside of Forsyth County. 

Hypothesis: 1) Providers will express gaps in their knowledge of EPT criteria or some other disinhibition for prescribing EPT.  2) Clients will report a lack of knowledge about EPT and will have specific barriers to receiving EPT. 3) There will be a lack of uptake of EPT amongst eligible clients.

Methods: Forsyth County Department of Public Health (FCDPH) team members who provide sexual health and family planning services and key opinion leaders were given a choice of either a phone or self-administered online survey. Knowledge gaps in current EPT criteria/guidelines as well as attitudes pertaining to EPT utilization were assessed. A paper survey was administered on a voluntary basis to clients presenting for sexual health and family planning services at the same FCDPH clinic to assess opinions surrounding and barriers to EPT. Knowledge and understanding of the availability of EPT among this client population was assessed, as well as the significance of common barriers to utilizing EPT among this population. 

Results: 95 participants were enrolled from October 2020 – June 2021 including 7 providers and 88 Family Planning and sexual health clients. The median age of clients was 28.5 and 62.5% were female, 36.36% male, and 1.14% intersex. Clients were Black/African American 67.5%, White 15.7%, Asian/Pacific Islander 4.81%, and reported other race 12.05%. Among providers, 85.71% were unaware of guidelines restricting EPT to heterosexual partners of chlamydia-positive clients and 28.57% were unaware of guidelines supporting treating multiple partners per client within 60 days. 33.33% of providers reported that prescribing EPT requires a significant amount of their time compared to only treating the client. Among clients, 91.57% of responders report no barriers to using or obtaining EPT. 98.7% of clients report no knowledge of EPT despite 48.81% of responders having a history of chlamydia infection. 82.5% of clients with prior history of chlamydia report that they have never been given EPT for their partner.

Conclusions: There are knowledge gaps related to EPT guidelines among providers in our study. The studied client population lacks knowledge or prior usage to EPT. Further investigation of effective interventions for increasing the uptake of EPT and decreasing provider time burden for prescribing EPT would be beneficial. Education on EPT guidelines may aid in maximizing EPT screening and prescription.

Source of mentor’s funding or other support that funded this research:  This project was supported by Grant Number 2020-063001 from the National Association of County and City Health Officials.