| Excerpt from The WHO Reproductive Health Library | Published by Update Software Ltd. |
This Cochrane review compared the effectiveness of partner notification strategies for the treatment of sexually transmitted infections (STIs). Three main referral strategies were compared: provider referral (partner notification by health care personnel), contract referral (health personnel notifying partners who fail to visit the health clinic by an agreed date) and patient referral (the index patient notifying his/her partner or partners). Educational strategies to improve patient referral were also evaluated.
There is some evidence that provider referral is more effective than patient referral in patients with non-specific urethritis. One trial found provider referral yielded higher rates of receiving treatment and chlamydia detection compared with patient referral. Giving patients a choice between provider and patient referral also appears to be more effective than just assigning the notification task to the patient. In one study in patients with HIV, more partners were notified and more partners tested positive for HIV when patients were offered the choice between provider and patient referral.
Another trial compared the effectiveness of the choice between patient and provider referral plus counseling and contact cards versus patient referral alone in patients with an STI. In the group that was offered the choice between patient and provider referral plus counseling and cards, male index patients reported more partner notifications and more partners came forward for treatment than in the case of those assigned to the patient referral group only; however, in the former group there was also a higher rate of domestic quarrels. No differences were found for women index patients.
There is also some evidence that compared with patient referral alone, contract referral results in more partners of gonorrhoea patients presenting for care. The results of the review did not provide sufficient information for conclusions to be reached about the relative efficacy of contract versus provider referral strategies.
One trial sought to improve patient referral through education (of the index patient) by a nurse plus counseling by lay workers. This intervention resulted in a small increase in the number of partners being treated compared with standard patient referral.
A comprehensive search strategy was used to identify published and unpublished randomized trials. Independent reviewers applied eligibility criteria, extracted data and assessed methodological quality of included studies. None of the trials identified was excluded from the review; however, the reviewers noted that there was a risk of bias in all of them.
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