Use of expedited partner therapy for pregnant women treated for sexually transmitted infections in Gaborone, Botswana

Abstract

Abstract: Background Partner notification and treatment for sexually transmitted infections is critical to prevent reinfection and reduce transmission. However, partner treatment rates are low globally. Expedited Partner Therapy (EPT), in which the patient delivers treatment directly to their partner, may result in more partners treated. We assessed partner notification and treatment outcomes among pregnant women in Gaborone, Botswana, including EPT intent, uptake, and effectiveness. Methods The Maduo study was a cluster-controlled trial evaluating the effect of antenatal C. trachomatis (CT) and N. gonorrhoeae (NG) infection screening in pregnant women. The intervention arm received screening at first antenatal care (ANC), third-trimester, and postnatal care (PNC) visits. The standard-of-care arm received screening postnatally. Participants screening positive were given options for partner treatment: contact slips, in-clinic treatment, or EPT. Self-reported partner notification and treatment outcomes were assessed at test-of-cure visit. Results Of 51 women who screened positive for CT/NG at first ANC and returned for test-of-cure, 100% reported notifying their partner and 48 (94.1%) reported their partner received treatment. At third trimester 100% (n = 5) reported partners were treated. Prior to testing, EPT intent was lower than EPT uptake at all timepoints (first ANC: 17.9% vs. 80.4%; third-trimester 57.1% vs. 71.4%; PNC: 0% vs. 80.0%). Partner treatment success was 100% among EPT users compared to 70% among non-users (p = 0.006). Conclusions Partner notification and treatment success was high in this population. Despite low pre-test intent to use EPT, uptake was high and associated with greater partner treatment success. Our findings suggest that EPT may be a successful partner treatment strategy to pursue in LMICs.