Predictors of time spent on partner notification in four US sites.

OBJECTIVE: To identify determinants of time spent on partner notification clients in four STD programmes in the United States. METHODS: 11 disease intervention specialists (DIS) in each of three urban sites (n = 33) and seven DIS in one rural site recorded their activities and clients for 14 working days. The total amount of time for partner notification activities was computed for each client. Data were analysed using random effects regression. RESULTS: Across sites, 429 of 2506 (37.4%) recorded hours were spent on partner notification (PN) activities with 1148 clients. Client type, STD diagnosis, outcome, demographic characteristics, mileage, and study site explained 33.7% of the variance in the total time spent on partner notification clients. Clients who took significantly more time than the reference case included those who were both contacts and original patients, HIV/AIDS clients, non-primary and secondary (P&S) syphilis clients, STD clients who were infected and treated, and clients for whom travel was necessary. Demographic characteristics of both client and worker were not associated with the time spent on partner notification. CONCLUSIONS: These data document the labour intensive nature of partner notification, especially for HIV and non-P&S syphilis clients. STD programmes that have a higher number of these clients are probably dedicating more resources to partner notification. More research is needed on additional predictors so that programmes can better understand and allocate staff and financial resources to partner notification activities.

Partner notification in the United States: an evidence-based review.

INTRODUCTION: To conduct an evidence-based review of the literature on the effectiveness of partner notification strategies for syphilis, gonorrhea, chlamydia, and human immunodeficiency virus (HIV) in the United States. METHODS: Systematic literature searches of available databases yielded 212 English language articles on partner notification, 13 of which met the inclusion criteria. These 13 articles were systematically reviewed, abstracted, and rated for quality of study methods, analysis, and generalizability. RESULTS: Partner notification can newly detect HIV and other sexually transmitted diseases among partners. Of the six 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. None of the 13 studies examined the consequences of partner notification, such as infections or health consequences averted or changes in behavior and partnerships for infected persons or their partners. 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.

Partner notification in the real world: a four site time-allocation study.

BACKGROUND AND OBJECTIVES: Although partner notification has been a long-standing intervention and prevention strategy for sexually transmitted diseases (STD), variations in partner notification practices across sites have never been documented. GOALS OF THE STUDY: To describe provider-assisted partner notification practices in four STD programs in the United States. STUDY DESIGN: Eleven disease intervention specialists (DIS) in each of three urban sites and seven DIS in one rural site documented their activities and clients for 14 working days using a personal digital assistant. RESULTS: Of 2,506 recorded activity hours across sites, 37.4% of the recorded time was spent on partner notification (PN) activities with 1148 clients. Field visits to locate contacts accounted for the largest proportion of time spent on PN. Overall, PN clients were cases of or were contacts to nonprimary and secondary (P&S) syphilis (39.6%), gonorrhea (25.5%), chlamydia (18.0%), HIV/AIDS (10.4%), and P&S syphilis (6.5%). CONCLUSION: The activities which constitute PN, the diseases for which PN is used, and the time spent on each PN client vary across sites. More research is needed on the determinants of these variations and their association with the ultimate goal of disease prevention.

Ethnicity and the use of health services in Belize.

Data from the 1991 Belize Family Health Survey show differentials in the use of maternal and child health services between ethnic groups (Creole, Mestizo, Maya/Ketchi and Garifuna). Multivariate analysis is used to explore whether such differentials can truly be attributed to ethnicity or to other characteristics that distinguish the ethnic groups. Health services considered are: family planning, place of delivery (hospital/other), postpartum and newborn check-ups after a birth, and immunisations for children. The language usually spoken in the household is found to be important for interpreting ethnic differentials. Mayan-speaking Maya/Ketchis are significantly less likely to use family planning services or to give birth in a hospital. Spanish-speakers (Mestizos and Maya/Ketchis) are less likely to use newborn and postpartum check-ups, after controlling for other characteristics. There are no ethnic differentials for immunisations. Programmatic implications of these results are discussed.