1. Expedited Partner Therapy The Denver Experience Cornelis A. Rietmeijer, MD, PhD Denver Public Health Department

2. Expedited Partner Therapy Approach whereby partners are treated without an intervening clinical assessment – Patients delivering medications to partners – Patients delivering prescriptions to partners – Field treatment by DIS or outreach workers (with or without testing)

3. EPT Studies Schillinger et al. Sex Transm Dis 2003;30:49-56 – 20% reduction in CT re-infection of 20% among women (P = 0.102) Golden et al. New Engl J Med 2005;352:676-85 – 73% reduction in GC re-infection among men and women (P < 0.01) – 17% reduction in CT re-infection (P = 0.17) Kissinger et al. Clin Infect Dis 2005; 41:623-9 – 46% reduction in GC and/or CT infection among men with urethritis (P<0.001)

4. EPT and the CDC 2006 STD Treatment Guidelines “….patient delivered therapy (i.e., via medications or prescriptions) can prevent re-infection of index case and has been associated with a higher likelihood of partner notification, compared with unassisted patient referral of partners” EPT recommendations are limited to GC and CT contacts only EPT is not recommended for MSM

5. In Colorado, EPT has been endorsed by the state’s medical and pharmacy boards

6. EPT Legal Status in Colorado No legal impediments to provide EPT EPT specifically endorsed by: – Colorado State Board of Medical Examiners Policy 40-10, issued 5/10/2001 – “It is the position of the Colorado Board of Medical Examiners that the public risk of untreated sexually transmitted infection is greater than the risk of complications from prescribing in this less than ideal setting” – Colorado State Board of Pharmacy Policy 40-4, issued 7/19/2007 – “It is the position of the Colorado Pharmacy Board that the public risk of untreated sexually transmitted infection is greater than the risk of complications from dispensing in this less than ideal setting”

7. EPT in Colorado http://www.dora.state.co.us/Medical/policies/40-10.pdf

8. EPT in Colorado www.dora.state.co.us/pharmacy/policies/40-4.pdf

9. EPT in the Denver STD Clinic Between 11/9/2006 and 12/31/2007* – 549 heterosexual patients with documented GC or CT eligible for EPT – 87 (15.8%) received EPT Median: 1 Range: 1-3 – No demographic or risk differences between those who did or did not accept EPT *No EPT dispensed between March and September, 2007 pending review by the Colorado Pharmacy Board

10. EPT in the Denver STD Clinic 11/2006 – 12/2007* CT GC Either Positive9473301172 Eligible368 (38.8)251 (76.1)549 (46.8) EPT Received 57 (15.5) 36 (14.3) 87 (15.8) Declined 37 (10.0) 25 (9.9) 56 (10.2) Not Given231 (62.8)169 (67.4)345 (62.8) Missing 43 (11.7) 21 (8.4) 61 (11.1) *No EPT dispensed between March and September, 2007 pending review by the Colorado Pharmacy Board

11. Partner Pack Chlamydia

12. EPT in the Denver STD Clinic Main reasons for not receiving EPT – Partners already treated or in clinic concurrently (48.1%) – Patients preferred partners come to the clinic (25.3%) – No contact info (17.5%) Among clinicians, provision of EPT varied from 5% to 45%

13. EPT Resources http://www.cdc.gov/std/ept/