STD partner notification and referral in primary level health centers in Nairobi, Kenya

Abstract

Background: Controlling sexually transmitted diseases requires that partners of patients with a sexually transmitted disease be notified and treated. However, many countries in the developing world lack the infrastructure and resources for effective partner referral.

Goal of this study: To provide information on rates of partner referral in primary-level health centers in Kenya, to identify characteristics of patients with sexually transmitted diseases who inform their partners about the need for treatment, and to evaluate the impact of a brief counseling intervention on rates of partner notification.

Study design: Two-hundred-fifty-four patients presenting for treatment of a sexually transmitted disease were given 5 to 10 minutes of additional counseling on the importance of referring partners for sexually transmitted disease treatment. All patients who returned for follow-up 1 week later were interviewed to determine whether they had notified their sex partners.

Results: Sixty-eight percent of patients who returned for follow-up reported they had referred their partners for treatment of a sexually transmitted disease. The highest rates of partner notification occurred among women attending maternal child health/family planning clinics and married men and women attending general outpatient clinics.

Conclusion: Strengthening and directing counseling toward women in maternal child health/family planning clinics and married men and women in general clinics may be an effective and inexpensive way to increase partner notification in the developing world.

PIP: In developing countries, patient referral is a more feasible means of notifying partners of sexually transmitted disease (STD) clients than the costly, labor-intensive provider referral approach. However, enhancement strategies such as education and counseling, contact cards, educational materials, follow-up, and monetary incentives may be necessary. To assess the impact of brief counseling on patient referral rates, a study was conducted at five primary health care centers in low-income areas of Nairobi, Kenya. All 254 STD patients who attended the clinic in a two-week period in 1992 were enrolled in the study. Subjects were given 5-10 minutes of counseling, asked to identify their sexual partners, and given a return appointment for the following week. Of the 93 patients who returned to the clinic and provided partner referral data, 63 (68%) reported they informed their partner of the need for STD treatment and 54 (58%) claimed that their partners had been treated. Multivariate analysis indicated that partner notification rates were highest for females, married individuals or those with regular partners, and maternal-child health/family planning clinic patients. Although 84% of unmarried men, 66% of unmarried women, and 47% of married men were infected by a casual sex partner, only 35% of those in the casual partner group attempted notification. Before the study, only 15% of partners presented to the clinics for treatment as a result of partner referral. This provides some evidence of the effectiveness of the counseling strategy, at least for married men and women, although more detailed guidelines on methods of partner notification are recommended.