Alternative approaches to partner notification, diagnosis, and treatment: perspectives of New York County Health Departments, 2007.

OBJECTIVES: The Centers for Disease Control and Prevention is encouraging states to consider patient-delivered partner therapy (PDPT) as a treatment option for Chlamydia and gonorrhea. We sought to assess current sexually transmitted disease (STD) control practices in New York State county health departments, and gather their perspectives on PDPT and alternative interventions. METHODS: A cross-sectional study reviewed county websites to assess STD service information provided. County STD programs were surveyed from January to March 2007 by telephone to determine conditions diagnosed and treated, current partner notification practices, and to assess perspectives on PDPT and alternative interventions. Descriptive statistics were computed. RESULTS: County officials were divided about legalizing PDPT, with 45% for, 45% against, and 10% undecided. Reasons for support included the perception PDPT would result in more infections treated (61%) and improved STD control (29%). Reasons for lack of support included potential contraindication/side effects (28%), potential for medication not reaching partners (28%), and malpractice risk (20%). Stratified analysis by STD morbidity levels showed high morbidity counties were against legalization (67%). PDPT with health department follow-up of partners was the most preferred strategy, followed by patient distribution of educational materials and express care for partners in STD clinics; PDPT alone was the least preferred. New York State County officials' perspectives on PDPT are polarized along lines of program size and morbidity. CONCLUSIONS: Further research on alternative partner intervention strategies and discussion of PDPT is necessary to develop a forward-thinking strategic plan for STD control in the state.

Alternative approaches to partner notification, diagnosis, and treatment: pharmacists' perspectives on proposed patient delivered partner therapy in New York State, 2007.

BACKGROUND: Supported by the American Medical Association, patient delivered partner therapy (PDPT) is becoming legal in many states. For some individuals exposed to sexually transmitted infections, the pharmacist may become the sole point of contact with the medical system. METHODS: To determine pharmacists' perceptions about PDPT, education on sexually transmitted infections, and potential barriers that need to be addressed in pharmacies for successful implementation of PDPT, we conducted a survey of pharmacists and observed privacy-related spaces in pharmacies. In 8 counties of the Capital Region, all community pharmacies were invited to participate. In 8 additional counties convenience sampling was utilized. The response proportion was 67.3% overall. RESULTS: Of the 193 pharmacists responding to the survey, 63% supported PDPT for Chlamydia and 78% do not want a behind-the-counter status for Chlamydia antibiotics. The majority (88%) of pharmacists want prescriptions marked as PDPT to alert them to counseling needs. About half the pharmacists reported they would automatically submit PDPT prescriptions to insurance company, a confidentiality issue. The barrier cited most often to patient counseling was time (49%). CONCLUSIONS: Pharmacists are open to considering PDPT as part of their professional functions. Although pharmacists need additional sexually transmitted infections education in general, capacity for this training can be developed. Confidentiality issues remain a priority issue to address to protect individuals treated through PDPT.

Molecular analysis in support of an investigation of a cluster of HIV-1-infected women.

An investigation of a possible single-source sexual transmission case was conducted in upstate New York in 1997-1998 (MMWR 1999;48:413-416). Of 42 primary female contacts with the putative male index case, 13 tested positive for HIV infection. Blood was available for DNA sequencing (C2V3C3 region of the env gene and the p17-coding region of gag) from 10 of the 13 women, 1 HIV-infected secondary contact, and 2 HIV-infected persons from the community, but not from the index cam. Phylogenetic and distance analyses were performed with the inclusion of reference HIV subtype strains for both the env and gag gene regions, as was the two regions combined. A high degree of relatedness was found among DNA sequences of the 10 primary contacts that excluded reference strains, the secondary contact, and the community HIV control subjects. In conclusion, phylogenetic analysis of HIV strains in an epidemiologic investigation is highly useful in support of cluster identification, even without sampling from the putative index patient.