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. 2023 Dec;31(1):2220188.
doi: 10.1080/26410397.2023.2220188.

"It's not safe for me and what would it achieve?" Acceptability of patient-referral partner notification for sexually transmitted infections to young people, a mixed methods study from Zimbabwe

Joni Lariat  1 , Chido Dziva Chikwari  2 , Ethel Dauya  3 , Valentine T Baumu  4 , Victor Kaisi  5 , Laura Kafata  6 , Esnath Meza  7 , Victoria Simms  8 , Constance Mackworth-Young  9 , Helena Rochford  10 , Anna Machiha  11 , Tsitsi Bandason  12 , Suzanna C Francis  13 , Rashida A Ferrand  14 , Sarah Bernays  15
Affiliations

"It's not safe for me and what would it achieve?" Acceptability of patient-referral partner notification for sexually transmitted infections to young people, a mixed methods study from Zimbabwe

Joni Lariat et al. Sex Reprod Health Matters. 2023 Dec.

Abstract
in English, French, Spanish

Partner notification (PN) is considered integral to the management of sexually transmitted infections (STI). Patient-referral is a common PN strategy and relies on index cases notifying and encouraging their partners to access treatment; however, it has shown limited efficacy. We conducted a mixed methods study to understand young people's experiences of PN, particularly the risks and challenges encountered during patient-referral. All young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered PN slips, which enabled their partners to access free treatment at the service. PN slip uptake and partner treatment were recorded. Among 1807 young people (85.0% female) offered PN slips, 745 (41.2%) took up ≥1 PN slip and 103 partners (5.7%) returned for treatment. Most participants described feeling ill-equipped to counsel and persuade their partners to seek treatment. Between June and August 2021, youth researchers conducted in-depth interviews with 41 purposively selected young people diagnosed with an STI to explore their experiences of PN. PN posed considerable social risks, threatening their emotional and physical safety. Except for a minority in long-term, publicly acknowledged relationships, participants did not expect PN would achieve successful outcomes. Public health discourse, which constructs PN as "the right thing to do", influenced participants to adopt narratives that concealed the difficulties of PN and their unmet needs. Urgent interrogation is needed of whether PN is a suitable or constructive strategy to continue pursuing with young people. To improve the outcomes of preventing reinfection and onward transmission of STIs, we must consider developing alternative strategies that better align with young people's lived experiences.Plain language summary Partner notification is a public health strategy used to trace the sexual partners of people who have received a sexually transmitted infection (STI) diagnosis. It aims to interrupt the chains of STI transmission and prevent reinfection by treating both the person diagnosed and their sexual partners. The least effective but most common partner notification strategy used in many resource-limited settings is called "patient referral". This involves a sexual healthcare provider encouraging the person diagnosed to give a "partner notification slip" to their potentially exposed sexual partner/s and persuading them to access treatment. This research sought to better understand young people's experiences of partner notification, particularly the risks and challenges they faced during patient-referral.All young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered PN slips, which enabled their partners to access free treatment at the service. Young people trained as researchers interviewed 41 young people who had received a STI diagnosis to explore their experiences of partner notification.Only a small number (5.7%) of the partners of those who took a slip attended the service for treatment. Most participants felt they did not have the preparation, skills, or resources to persuade their partners to seek treatment. Many described negative experiences during and after partner notification, including relationship breakdown, reputation damage, and physical violence.These findings suggest that we should reconsider if partner notification is suitable or effective for use with young people. We should explore alternative approaches that do not present risks to young people's social, emotional, and physical safety and well-being.

La notification au partenaire est considérée comme faisant partie intégrante de la prise en charge des infections sexuellement transmissibles (IST). L’orientation des patients est une stratégie fréquemment utilisée de notification au partenaire qui suppose que le patient zéro informe ses partenaires et les encourage à se faire traiter; néanmoins, elle a montré une efficacité limitée. Nous avons mené une étude à méthodologie mixte pour comprendre l’expérience des jeunes en matière de notification au partenaire, en particulier les risques et les obstacles rencontrés pendant l’orientation des patients. Tous les jeunes (16–24 ans) fréquentant un service de santé sexuelle et reproductive communautaire au Zimbabwe chez qui une IST avait été diagnostiquée ont été conseillés et se sont vu proposer des formulaires de notification au partenaire permettant à leurs partenaires d’avoir accès à un traitement gratuit dans le service. Le recours à ces formulaires et au traitement par les partenaires a été comptabilisé. Parmi les 1807 jeunes (dont 85.0% de femmes) à qui on a proposé un formulaire de notification des partenaires, 745 (41.2%) ont accepté ≥ 1 formulaire et 103 partenaires (5.7%) sont revenus pour se faire traiter. La plupart des participants ont indiqué qu’ils se sentaient mal préparés pour conseiller leurs partenaires et les persuader de demander un traitement. Entre juin et août 2021, de jeunes chercheurs ont réalisé des entretiens approfondis avec 41 jeunes sélectionnés à dessein chez qui une IST avait été diagnostiquée afin d’étudier leur expérience en matière de notification au partenaire. Cette notification posait des risques sociaux considérables, menaçant leur sécurité psychique et physique. À l’exception d’une minorité engagée dans des relations reconnues publiquement et de longue durée, les participants ne pensaient pas que la notification au partenaire obtiendrait des résultats satisfaisants. Le discours de santé publique, qui présente la notification au partenaire comme « la chose à faire », incitait les participants à adopter des récits cachant les difficultés de la notification au partenaire et leurs besoins insatisfaits. Il est nécessaire de se demander sans délai si la notification au partenaire est une stratégie adaptée ou constructive qu’il convient de continuer à appliquer avec les jeunes. Pour améliorer la prévention des réinfections et la transmission ultérieure des IST, nous devons envisager l’élaboration de stratégies de substitution, plus alignées sur l’expérience vécue par les jeunes.

La notificación a la pareja (NP) se considera fundamental para el manejo de infecciones de transmisión sexual (ITS). La referencia de pacientes es una estrategia común de NP, que consiste en que casos índice notifiquen y animen a sus parejas a conseguir tratamiento; sin embargo, ha mostrado eficacia limitada. Realizamos un estudio de métodos mixtos para entender las experiencias de NP de las personas jóvenes, en particular los riesgos y retos encontrados durante la referencia de pacientes. A todas las personas jóvenes (de 16 a 24 años) que asistieron a un servicio comunitario de salud sexual y reproductiva en Zimbabue y a quienes se les diagnóstico una ITS, se les brindó consejería y se les ofrecieron fichas de NP, que permitieron que sus parejas obtuvieran tratamiento gratuito en el servicio. Se registraron la aceptación de las fichas de NP y el tratamiento de las parejas. De 1807 jóvenes (85.0% mujeres) a quienes se les ofrecieron fichas de NP, 745 (41.2%) aceptaron ≥1 ficha de NP y 103 parejas (5.7%) regresaron para recibir tratamiento. La mayoría de las personas participantes describieron sentirse mal preparadas para asesorar y persuadir a sus parejas a que buscaran tratamiento. Entre junio y agosto de 2021, jóvenes investigadores realizaron entrevistas a profundidad con 41 personas jóvenes seleccionadas intencionalmente a quienes se les diagnosticó una ITS, con el fin de explorar sus experiencias de NP. La NP planteó considerables riesgos sociales, y puso en peligro su seguridad emocional y física. Salvo por una minoría que estaba en una relación a largo plazo reconocida públicamente, las personas participantes no esperaban que la NP tuviera buenos resultados. El discurso de salud pública, que construye la NP como “lo que es justo hacer”, influenció a las personas participantes para que adoptaran narrativas que ocultaron las dificultades de la NP y sus necesidades insatisfechas. Se necesita interrogación urgente para determinar si la NP es una estrategia idónea o constructiva que se debe continuar aplicando con las personas jóvenes. Para mejorar los resultados de prevención de reinfección y futura transmisión de ITS, debemos considerar formular otras estrategias que estén mejor alineadas con las vivencias de las personas jóvenes.

Keywords: partner notification; patient-referral; risk hierarchies; risk landscape; sexually transmitted infections; social harms; young people.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Selection of participants from community clusters in the CHIEDZA parent and STICH trials
Figure 2.
Figure 2.
The risk landscape and partner notification
See this image and copyright information in PMC

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