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Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling
Open accessAbstract
BACKGROUND: Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new interventions to enhance the outcomes of partner notification. OBJECTIVE: To study the effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections (STIs). DESIGN: Secondary data analysis of clinical audit data; systematic reviews of randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA)] published from 1 January 1980 to 31 December 2011; static models of clinical effectiveness and cost-effectiveness; and dynamic modelling studies to improve parameter estimation and examine effectiveness. SETTING: General population and genitourinary medicine clinic attenders. PARTICIPANTS: Heterosexual women and men. INTERVENTIONS: Traditional partner notification by patient or provider referral, and new partner notification by expedited partner therapy (EPT) or its UK equivalent, accelerated partner therapy (APT). MAIN OUTCOME MEASURES: Population prevalence; index case reinfection; and partners treated per index case. RESULTS: Enhanced partner therapy reduced reinfection in index cases with curable STIs more than simple patient referral [risk ratio (RR) 0.71; 95% confidence interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The median number of partners treated for chlamydia per index case in UK clinics was 0.60. The number of partners needed to treat to interrupt transmission of chlamydia was lower for casual than for regular partners. In dynamic model simulations, >10% of partners are chlamydia positive with look-back periods of up to 18 months. In the presence of a chlamydia screening programme that reduces population prevalence, treatment of current partners achieves most of the additional reduction in prevalence attributable to partner notification. Dynamic model simulations show that cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence of both STIs. APT has a limited additional effect on prevalence but reduces the rate of index case reinfection. Published quality-adjusted life-year (QALY) weights were of insufficient quality to be used in a cost-effectiveness study of partner notification in this project. Using an intermediate outcome of cost per infection diagnosed, doubling the efficacy of partner notification from 0.4 to 0.8 partners treated per index case was more cost-effective than increasing chlamydia screening coverage. CONCLUSIONS: There is evidence to support the improved clinical effectiveness of EPT in reducing index case reinfection. In a general heterosexual population, partner notification identifies new infected cases but the impact on chlamydia prevalence is limited. Partner notification to notify casual partners might have a greater impact than for regular partners in genitourinary clinic populations. Recommendations for future research are (1) to conduct randomised controlled trials using biological outcomes of the effectiveness of APT and of methods to increase testing for human immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data should be a priority to determine QALYs associated with the sequelae of curable STIs; and (3) standardised parameter sets for curable STIs should be developed for mathematical models of STI transmission that are used for policy-making. FUNDING: The National Institute for Health Research Health Technology Assessment programme.
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Accelerated partner therapy: a promising new partner treatment option
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Self-citation
Flagged first, then by citations
4 of the 132 references couldn’t be matched to a known paper.
Research works printed but not linked: 14
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- sexually transmitted disease*:ti,ab,kw OR sexually transmissible disease*:ti,ab,kw OR sexually transmitted infection*:ti,ab,kw OR sexually transmissible infection*:ti,ab,kw OR sexually transmitted infectious disease*:ti,ab, kw OR sexually transmissible infectious disease*:ti,ab,kw OR sexually transmitted disorder*:ti,ab,kw OR sexually transmissible disorder*:ti,ab,kw OR STI:ti,ab,kw OR STIs:ti,ab,kw OR STD:ti,ab,kw OR STIs:ti,ab,kw OR venereal disease*:ti,ab,kw OR venereal infection*:ti,ab,kw OR venereal disorder*:ti,ab,kw OR genital herpes:ti,ab,kw OR herpes genitalis:ti,ab,kw OR genital infection*:ti,ab,kw OR genital disorder*:ti,ab,kw #17 herpes simplex:ti,ab,kw OR herpes virus:ti,ab,kw OR HSV-1:ti,ab,kw OR HSV-2:ti,ab,kw OR chancroid*:ti,ab,kw OR haemophilus ducreyi:ti,ab,kw OR chlamydia infection*:ti,ab,kw OR chlamydia trachomatis:ti,ab,kw OR gonorrhoea*:ti,ab,kw OR gonorrhea*:ti,ab,kw OR syphilis:ti,ab,kw OR syphillis:ti,ab,kw OR condylomata lata:ti,ab, kw OR chancre*:ti,ab,kw OR lymphogranuloma venereum:ti,ab,kw OR granuloma inguinale:ti,ab,kw OR donovania:ti,ab,kw OR donovanosis:ti,ab,kw OR calymmatobacterium granulomatis:ti,ab,kw OR klebsiella granulomatis:ti,ab,kw OR klebsiella granulomatis:ti,ab,kw OR treponema pallidum:ti,ab,kw OR genital wart*:ti,ab, kw OR venereal wart*:ti,ab,kw OR hpv-6:ti,ab,kw OR hpv-11:ti,ab,kw OR hpv6:ti,ab,kw OR human papillomavirus: ti,ab,kw OR hepatitis b:ti,ab,kw OR trichomonas vaginitis:ti,ab,kw OR genital ulcer*:ti,ab,kw OR anogenital ulcer*: ti,ab,kw OR anorectal ulcer*:ti,ab,kw OR anorectal ulcer*:ti,ab,kw OR penile ulcer*:ti,ab,kw #18 (#15 OR #16 OR #17) #19 MeSH descriptor HIV Infections explode all trees DOI: 10.3310/hta18020 HEALTH TECHNOLOGY ASSESSMENT 2014 VOL. 18 NO. 2 #1 Chlamydia.mp. or exp CHLAMYDIA/ or CHLAMYDIA TRACHOMATIS/ #2 Gonorrhea.mp. or exp GONORRHEA/ #3 Pelvic inflammatory disease.mp. or exp pelvic inflammatory disease/ #4 PID.mp. or exp pelvic inflammatory disease/ #5 Cervicitis.mp. or exp uterine cervicitis/ #6 Chronic pelvic pain.mp. #7 Ectopic pregnancy.mp. or exp ectopic pregnancy/ #8 Epididymitis.mp. #9 Economic evaluation.mp. or economic evaluation/ #10 Cost-utility analysis.mp. or "cost utility analysis"/ #11 Cost-effectiveness analysis.mp. or "cost effectiveness analysis"/ #12 Quality of life.mp. or "quality of life"/ #13 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 #14 9 or 10 or 11 #15 13 and 14 #16 14 and 15 #17 15 or 16
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Dukers–Muijrers, N. H. T. M., Schachter, J., van Liere, G. A. F. S., Wolffs, P. F. G., & Hoebe, C. J. P. A. (2015) · BMC Infectious Diseases · doi:10.1186/s12879-015-1280-6 · Cited by 108
Metadata
- Authors
- Althaus, C. L., Turner, K. M., Mercer, C. H., Auguste, P., Roberts, T. E., Bell, G., Herzog, S. A., Cassell, J. A., Edmunds, W. J., White, P. J., Ward, H., & Low, N.
- Affiliations
- University of Bern (CH)
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- University College London (GB)
- University of Birmingham (GB)
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- Brighton and Sussex Medical School (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Public Health England (GB)
- Imperial College London (GB)
- Corresponding author
- Low, Nicola
- ORCID
- Venue
- Health Technology Assessment
- Published
- 2014-01
- Volume
- 18
- Issue
- 2
- Pages
- 1-100, vii
- ISSN
- 1366-5278 (ISSN-L)
- 2046-4924
- PMC
- PMC4780998
- OpenAlex
- W2058667696
- Cited by
- 101
- References
- 132
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2 · 2023: 9 · 2022: 12 · 2021: 10 · 2020: 13 · 2019: 10 · 2018: 8 · 2017: 5 · 2016: 8 · 2015: 11 · 2014: 5
- FWCI
- 1.39
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Health Technology Assessment (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion)
- BORIS (University Library Bern) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- National Institute for Health Research
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- partner notification, expedited partner therapy, chlamydia, gonorrhea, cost-effectiveness, health-related quality of life, partner testing, STI screening, STI prevalence, transmission interruption, genitourinary medicine clinics, lookback period
- MeSH terms
- Adolescent, Adult, Cost-Benefit Analysis, Female, United Kingdom, Humans, Male, Models, Biological, Sexually Transmitted Diseases, State Medicine, Models, Statistical, Contact Tracing, Quality-Adjusted Life Years, Secondary Prevention, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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