OBJECTIVE: To document partner referral rates at health centres with improved STD services, and to determine factors contributing to successful referral. METHODS: Partner referral was initiated as part of the upgrading of STD services in primary care health facilities in two semi-urban Rwanda towns. After syndromic management of the presenting complaint, index patients received prevention education and condom demonstration, and were urged to refer sexual partners to the health centre for a free examination. Partner referral coupons linked by code number to the symptomatic index patient were given to facilitate referral; no identifying information was collected on partners from the index patients. RESULTS: Three quarters of the symptomatic patients seen at the two primary health care facilities were women. Overall, the ratio of referred partners to index patients was 26%. Only 58% of index patients accepted partner referral coupons. The referral rate for those who did accept coupons was 45%. Partner referral worked best for regular partners. Most index patients and partners were married and only four index patients referred more than one partner. Women index patients, especially when pregnant, were more successful in referring partners than men. Index patients who referred partners tended to be older than those who did not. Awareness of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of partner referral. CONCLUSIONS: Efforts to improve rates of partner referral should begin at the clinic level with improved counselling to convince more index patients of the importance of partner referral. Partner symptom recognition may be useful for increasing rates of partner referral. Supplementary strategies are needed to reach non-regular partners. When syndromic management is used, counselling should take into account the lower predictive values of identifying STD in women in order to avoid partner accusation. Despite limitations, patient referral of sexual partners can be an effective strategy for reaching a population at high risk for STD with minimal additional investment in health worker staff time.
OBJECTIVE: To document partner referral rates at health centres with improved STD services, and to determine factors contributing to successful referral. METHODS: Partner referral was initiated as part of the upgrading of STD services in primary care health facilities in two semi-urban Rwanda towns. After syndromic management of the presenting complaint, index patients received prevention education and condom demonstration, and were urged to refer sexual partners to the health centre for a free examination. Partner referral coupons linked by code number to the symptomatic index patient were given to facilitate referral; no identifying information was collected on partners from the index patients. RESULTS: Three quarters of the symptomatic patients seen at the two primary health care facilities were women. Overall, the ratio of referred partners to index patients was 26%. Only 58% of index patients accepted partner referral coupons. The referral rate for those who did accept coupons was 45%. Partner referral worked best for regular partners. Most index patients and partners were married and only four index patients referred more than one partner. Women index patients, especially when pregnant, were more successful in referring partners than men. Index patients who referred partners tended to be older than those who did not. Awareness of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of partner referral. CONCLUSIONS: Efforts to improve rates of partner referral should begin at the clinic level with improved counselling to convince more index patients of the importance of partner referral. Partner symptom recognition may be useful for increasing rates of partner referral. Supplementary strategies are needed to reach non-regular partners. When syndromic management is used, counselling should take into account the lower predictive values of identifying STD in women in order to avoid partner accusation. Despite limitations, patient referral of sexual partners can be an effective strategy for reaching a population at high risk for STD with minimal additional investment in health worker staff time.
Entities:
Keywords:
Africa; Africa South Of The Sahara; Behavior; Developing Countries; Diseases; Eastern Africa; French Speaking Africa; Infections; Integrated Programs; Notification; Organization And Administration; Programs; Reproductive Tract Infections; Research Methodology; Research Report; Rwanda; Sampling Studies; Sex Behavior; Sexual Partners; Sexually Transmitted Diseases--prevention and control; Studies; Surveys
Authors: Jennifer Mark; John Kinuthia; Alfred O Osoti; Molly A Gone; Victor Asila; Daisy Krakowiak; Monisha Sharma; Saloni Parikh; Quy T Ton; Barbra A Richardson; Carey Farquhar; Alison C Roxby Journal: Sex Transm Dis Date: 2019-11 Impact factor: 2.830
Authors: Ayesha Khan; J Dennis Fortenberry; Beth E Juliar; Wanzhu Tu; Donald P Orr; Byron E Batteiger Journal: Sex Transm Dis Date: 2005-04 Impact factor: 2.830
Authors: Nazmul Alam; Peter Kim Streatfield; Sharful Islam Khan; Dalia Momtaz; Sibylle Kristensen; Sten H Vermund Journal: Soc Sci Med Date: 2010-09-29 Impact factor: 4.634
Authors: Nazmul Alam; Eric Chamot; Sten H Vermund; Kim Streatfield; Sibylle Kristensen Journal: BMC Public Health Date: 2010-01-18 Impact factor: 3.295
Authors: Seth C Kalichman; Catherine Mathews; Moira Kalichman; Mark N Lurie; Sarah Dewing Journal: J Public Health (Oxf) Date: 2017-06-01 Impact factor: 2.341