Reducing Barriers for Expedited Partner Treatment in Adolescents and Young Adults: A Quality Improvement Initiative

Abstract

Abstract Background Adolescents and young adults (AYA) face significant barriers to screening, testing and treatment for sexually transmitted infections (STIs). Expedited partner therapy (EPT) streamlines partner treatment for STIs but use among adolescents is low. We aimed to increase EPT offering and provision at two adolescent medicine clinics (AMC) and the emergency department (ED) in an urban children’s hospital. We addressed barriers at provider, pharmacy, and patient levels. We compared EPT offering and provision for chlamydia (CT) and trichomonas (TV) infection at baseline, and across two intervention cycles. Methods Baseline data was collected from 7/2019-3/2020 and our intervention time frame spanned from April 2020-October 2021. Laboratory codes identified patients with CT or TV infections. Cycle one allowed providers to order EPT within a patient’s chart. The second cycle targeted education and standardization for STI/EPT notification and counseling. During this cycle, notification of ED patients was centralized to the AMC nurses. Results A total of 747 CT and TV cases were identified. In the AMC, EPT offering increased from 77.3% to 87.7% (p = 0.01). EPT provision increased from 32.3% to 69.9% (p < 0.001). EPT offering for ED patients increased by 82.3%. Retesting rates remained consistent, with a significant drop in reinfection rates (p = 0.003) within patients seen in the AMC. Conclusions This QI initiative successfully increased EPT offering and provision among the cases identified. Future cycles may include longer-term follow up to confirm partner treatment and testing per guidelines.