Authors' objectives

To conduct an evidence-based review of the literature on the effectiveness of partner notification strategies in terms of eliciting, locating, notifying, referring and medically evaluating partners to newly detect and treat syphilis, gonorrhoea, chlamydia and human immunodeficiency virus (HIV) in the United States (US). The review aims to answer 3 questions:

1. Are health care professionals able to elicit partner information from infected persons?

2. Are more partners informed of their exposure and the need for evaluation by health care professionals or by infected persons?

3. What are the positive consequences (e.g. newly detected infections, cured incubating infections, prevention of sexually transmitted disease (STD) transmission and sequelae, strengthening of a relationship, reduction of risky behaviour) and the negative consequences (e.g. domestic violence, relationship disruption, increase in risky behaviour such as unsafe sex) of partner notification as it is currently practised?

Searching

MEDLINE, Current Contents and PsycLIT were searched from 1980 through August 1997 for articles published in the English language. Conference abstracts and other unpublished sources were not included. Search terms used were 'contact tracing', 'partner notification', 'partner elicitation', 'partner evaluation', 'STD', 'sexually transmitted disease', 'HIV', 'AIDS', 'chlamydia', 'gonorrhea', 'nongonococcal urethritis', 'NGU' and 'syphilis'. Additional material was located by contacting experts in the field and by examining the reference lists of retrieved articles. Studies conducted outside of the US were excluded.

Study selection

Assessment of study quality

The quality of included studies was assessed by four criteria: study methods (definition of strategies [A:in comparative studies], inclusion criteria for participants, reporting of demographic characteristics, and allocation or randomisation in comparative studies), data analysis (reporting of infected persons and of partners notified, adjustment for confounders in comparative studies, statistical tests), generalisability with respect to study population, and generalisability of the partner notification procedure. Studies were rated strong, moderate or weak on each criterion. One author was the primary reviewer for the HIV articles and one for the non-HIV articles, but extensive discussions were held throughout the review process to ensure that the quality ratings were applied consistently.

Data extraction

The authors do not state how the data were extracted for the review, or how many of the reviewers performed the data extraction. Data were extracted in the categories: study design, hypotheses, setting, participants, and the feasibility and outcomes of elicitation, notification and medical evaluation procedures.

Methods of synthesis

Results of the review

Thirteen studies were included (n=21,922)[A:21,353 infected persons]: 5 comparative (n=6,720)[A:6,151 infected persons] and 8 cohort design (n=15,202)[A:infected persons].

The 13 studies comprised 1 syphilis, 3 gonorrhoea, 1 NGU, 2 chlamydia and gonorrhoea, 1 gonorrhea and NGU, and 5 HIV studies.

None of the included studies examined the consequences of partner notification beyond the detection and treatment of infections among the partners. None of the studies reported data on the reduction in risk behaviours among infected persons or partners as a result of education or counselling efforts, on changes in partnerships, or on other potential adverse consequences of partner notification, e.g. domestic violence.

Three of the 5 comparative studies were rated strong or moderate in terms of study methods, analysis, generalisability of population and generalisability of procedure. Three of the 8 cohort studies were rated strong or moderate in terms of study methods, analysis, generalisability of population and generalisability of procedure.

Partner notification can newly detect HIV and other STDs among partners. Of the 6 high quality studies, the highest numbers of infections per infected person, 0.23 and 0.24, were detected by provider referral while the lowest number of infections per infected person, 0.03, was detected by self-referral.

Authors' conclusions

There is good evidence that partner notification is a means of newly detecting infections. In addition, there is fair evidence that provider referral generally ensures that more partners are notified and medically evaluated than does self-referral. More research is needed to improve elicitation and notification procedures and tailor them to specific populations, to assess the effect of new testing technologies on partner notification, and to understand the consequences of partner notification for infected persons and their partners.

CRD commentary

The review question is stated clearly and the inclusion criteria seem appropriate, although not very detailed. The search was reasonably comprehensive, and restriction to English language articles of US studies was probably appropriate given the aim of the review (to assess the intervention in the US), although the searching of only three databases, together with the difficulty in selecting appropriate search terms may have resulted in some studies being missed. The exclusion of grey and unpublished literature may have led to publication bias. Validity was assessed and the results of the assessment used appropriately to weight the findings. The validity assessment review process is described, but details of how many reviewers were involved in the selection and data extraction processes are not reported. Study details are well reported and narrative pooling was appropriate given the variation in interventions assessed in the studies. The authors' conclusions are supported by the results as presented.

Implications of the review for practice and research

Practice: The authors state that the number of infected partners found per infected person was low and providers should not necessarily expect one or more infections detected per infected person. The authors recommend that partner notification be provided as a service and that provider referral by trained persons (typically at a local health department) be encouraged.

Research: The authors state that more research is needed to improve elicitation and notification procedures and tailor them to specific populations, to assess the effect of new testing technologies on partner notification, and to understand the consequences of partner notification for infected persons and their partners. Larger studies, including randomised controlled trials, are needed to compare elicitation strategies, especially those comparing the effectiveness of different elicitation styles and interview periods, to assess their appropriateness and feasibility. Studies in which technology is used as an aid to partner notification are also needed.

Bibliographic details

Macke B A, Maher J E. Partner notification in the United States: an evidence-based review. American Journal of Preventive Medicine 1999; 17(3): 230-242. [PubMed: 10987639]

Other publications of related interest

Errata. Am J Prev Med 2000;18(3):269.

Indexing Status

Subject indexing assigned by NLM

MeSH

Chlamydia Infections /prevention & control /transmission; Contact Tracing; Evaluation Studies as Topic; Gonorrhea /prevention & control /transmission; HIV Infections /prevention & control /transmission; Humans; Referral and Consultation; Sexually Transmitted Diseases /prevention & control /transmission; Syphilis /prevention & control /transmission; United States

AccessionNumber

11999001938

Database entry date

31/12/2001

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.