Who's practicing expedited partner therapy and why? Insights from providers working in high STI-volume specialties.

McCool-Myers, Megan; Wickham, Peggy G; Henn, Megan C; Sheth, Anandi N; Kottke, Melissa J

BACKGROUND Expedited partner therapy (EPT), the practice of prescribing antibiotics for sexual partners of patients, is underutilized in Georgia. This qualitative study in a large urban institution aimed to: 1) characterize the clinical specialties that predominantly treat STIs, 2) identify perceived barriers to EPT, and 3) describe strategies to advance routine EPT use. METHODS Providers in Obstetrics/Gynecology (OB/GYN), Infectious Disease (ID) and Emergency Medicine (EM) were interviewed using a structured discussion guide. Transcripts were double-coded and iteratively analyzed using qualitative content analysis. Barriers and strategies were summarized and supported with quotes from providers (n=23). RESULTS Perceived EPT barriers overlapped across OB/GYN, ID and EM, yet the settings were diverse in their patient populations, resources and concerns. OB/GYNs were the only providers practicing EPT, yet there was a lack of standardization. ID providers noted that an EPT prescription from an ID provider could inadvertently disclose HIV status of a patient to a sexual partner, posing an ethical dilemma. EM providers exhibited readiness for EPT, although routine empiric treatment of index patients in EM (est. at 90%) gave some providers pause in prescribing for partners: "I don't know what I'm treating." Point-of-care testing could increase providers' confidence in prescribing EPT, yet some worried it could contribute to overutilization of the ER as an STI clinic. All settings prioritized setting-specific training and protocols. CONCLUSIONS OB/GYN, ID and EM providers report unique hurdles, specific to their settings and patient populations; tailored EPT implementation strategies, particularly provider training, are urgently needed to improve patient/partner outcomes.