Electronic partner notification (ePN) platforms for gonorrhea and chlamydia should be customizable at each possible step, according to a recent study published in AIDS Patient Care and STDs.
Takeaways
- The study underscores the importance of customizable features in electronic partner notification (ePN) platforms for gonorrhea and chlamydia, allowing for adaptability to various user preferences and needs at each step of the process.
- Nationwide, there has been a significant increase in gonorrhea and chlamydia diagnoses, with particularly notable spikes in Massachusetts. This highlights the urgent need for effective strategies in partner notification and STI management.
- The consequences of untreated chlamydia and gonorrhea are severe, including infertility, chronic pelvic pain, and increased transmission of other STIs. Effective partner notification methods are crucial in preventing these outcomes.
- While technology-based partner notification methods like ePN hold promise, there are mixed perceptions of their acceptability among patients and healthcare providers. This suggests the importance of refining and optimizing these platforms to enhance their effectiveness and acceptance.
- The study identified 6 key themes for improving ePN platforms, including the relational nature of partner notification, the need for customization to accommodate diverse user preferences, and concerns regarding stigmatization, trust, privacy, and legitimacy. Addressing these themes is vital for enhancing the quality and effectiveness of ePN platforms.
Nationwide rises in gonorrhea and chlamydia diagnoses have been observed, with gonorrhea cases increasing by 45% from 2016 to 2020. Spikes were especially prominent in Massachusetts, (MA) at 251% and 381%, respectively, for chlamydia and gonorrhea between 2000 and 2020.
Adverse outcomes of untreated chlamydia and gonorrhea include infertility, chronic pelvic pain, and increased transmission of other sexually transmitted infections (STIs). In MA, field epidemiologists (FEs) provide partner services to patients with STIs. However, this method is too resource-intensive for chlamydia and gonorrhea.
Technology-based partner notification may improve partner service outcomes, but data has indicated mixed results regarding acceptability. One of these methods is ePN, where partners are anonymously notified to STI exposure through text message or email. This method may improve the reach among patients with chlamydia and gonorrhea.
Investigators conducted a study to evaluate ePN designs and implementation among patients in MA. Participants were recruited from the Massachusetts General Hospital (MGH) sexual health clinic (SHC) between August and November 2022.
Participants were English-speaking adults diagnosed with, exposed to, or with a treatment history of an STI within the previous 5 years. This population expanded to all enrolled adult MGH SHC patients regardless of STI history in September 2022.
SHC staff and Massachusetts Department of Public Health (MDPH) FEs were also eligible for participation in focus groups. Data was collected through semistructured interviews, with questions based on features of existing ePN platforms, literature about partner notification, and discussions between MDPH leadership and researchers.
Participants were presented with a mockup ePN platform designed to send anonymous SMS notifications to partners. Options for clinician-directed and self-directed notifications were available, as well as an option to specify the STI to which the partner had been exposed.
The ePN platform also included 2 example ePN notification messages with varying levels of information about the specific STI discussed, the platform’s affiliation with MDPH, and potential steps if the recipient felt the message was sent as a form of harassment.
Interviews focused on comfort with technology, barriers to STI care, perceptions and experiences with the current notification process, acceptability of ePN, and preferred location for ePN use. Questions about the potential role of ePN in the partner notification process were also posed to the focus group.
There were 20 patient participants, 8 SHC staff focus group members, and 9 MDPH focus group members in the final cohort. Six themes were developed to contextualize data, the first being that partner notification is a relational process and the second that user needs for a platform are situation dependent.
The third theme was stigmatization vs inclusivity, the fourth distrust versus trust, the fifth privacy versus information sharing, and the sixth a need for customization to respond to all user needs. For relationality, investigators noted there are dynamics between index patients, their partners, health care providers, and FEs during the notification process.
Relational factors may impact how patients use ePN to notify their partners, with many patients feeling a need to notify their partners directly. Experiences with clinicians were the driving factor for patients’ preferences for sending and receiving ePN messages.
Individual preferences were impacted by situational factors such as emotional states, preferred ways to connect with partners, and geographic locations. Participants who did not collect phone numbers from their partners or met them in a more casual context perceived ePN as less relevant.
Stigmas surrounding STIs were cited as a significant barrier to engaging in the existing notification process and ePN perceptions. Patients concerned about stigma often preferred ePN, emphasizing the need for a nonstigmatized platform.
Distrust in the legitimacy of the ePN platform was expressed by participants in all study groups, as well as concerns about harassment. To avoid assumptions the messages are spam or harassment, participants recommended emphasizing the platform’s connection to the MDPH.
Some participants noted a cultural fear surrounding government involvement if a connection to the MDPH was mentioned. Therefore, fears about platform usage or surveillance must be relieved.
Protecting patient privacy was also a vital topic. Patients wanted to share specific information with their partners but expressed concern about privacy. One example given was a fear that future employers could search them in the database and discover they had syphilis. FEs believed the notification should provide as little information about the patient as possible, and no consensus on how much information should be shared was reached.
Finally, customizability was valued by participants for accommodating to different users’ needs. This includes creating more notification options, allowing patients the choice to send notifications independently or with a provider, and deciding the level of information provided to partners.
This data indicated 6 themes for improving the quality of ePN platforms. Investigators concluded “these factors are best accommodated by a platform that adapts to users' preferences and needs.”
Reference
Iyer S, Zionts DL, Psaros C, et al. Electronic partner notification for sexually transmitted infections: A qualitative assessment of patient, clinical staff, and state field epidemiologist perspectives. AIDS Patient Care and STDs. 2024;38(2). doi:10.1089/apc.2023.0184
