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.

Article history

The research reported in this issue of the journal was funded by the HTA programme as project number 07/42/02. The contractual start date was in March 2009. The draft report began editorial review in July 2012 and was accepted for publication in November 2013. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.

Declared competing interests of authors

Christian L Althaus received salary support from the Swiss National Science Foundation (PZ00P3_136737). Katherine M E Turner received salary support from the UK National Institute for Health Research Post-Doctoral Fellowship programme (project number: PDF 2009-02-055) and consultancy fees from the Department of Health Office for Sexual Health, University Hospitals Bristol NHS Foundation Trust and National Institute for Health and Care Excellence. Catherine H Mercer received funding from the UK Medical Research Council (grant number: G0601685). Sereina A Herzog received salary support from the Swiss National Science Foundation (grant numbers: PDFMP3_124952, 320030_135654). Jackie A Cassell received grant funding from the National Institute for Health Research Health Technology Assessment programme (project number: 07/42/01) and consultancy fees from the European Centre for Disease Prevention and Control. Peter J White received support from the UK Medical Research Council Centre for Outbreak Analysis and Modelling. Helen Ward received grant funding from the UK Medical Research Council (G0601699) and the Wellcome Trust (090285/Z/09/Z). Nicola Low received funding from the Swiss National Science Foundation (grant numbers: PDFMP3_124952, 320030_135654) and from GlaxoSmithKline to chair a scientific advisory board meeting about chlamydia vaccines in September 2010. She is on the editorial board of the Cochrane Sexually Transmitted Infections Review Group and co-author of a systematic review of partner notification strategies, which will be published in the Cochrane Database of Systematic Reviews.