Patient-Delivered Partner Therapy: Elicitation Research Using a Mixed-Method Study Design to Support the Development of a Behavioral Intervention for Sexually Transmitted Infection Clinic Patients

Abstract

The transmission of sexually transmitted infections (i.e., STIs) remains a preventable public health problem within the United States. Repeatedly acquired STIs are highly prevalent despite efficacious treatment options, and mechanisms to increase partner notification are paramount to decreasing reinfections. One mechanism to accelerate the time to partner treatment, increase partner treatment, reduce repeat infections, and reduce community prevalence of STIs is the use of patient-delivered partner therapy (PDPT). PDPT is the practice of providing patients diagnosed with a bacterial STI medication to give directly to their partner for treatment without requiring the partner to participate in diagnostic testing, screening, or an interaction with a healthcare professional. Despite a growing body of research in support of PDPT, further research was needed to: 1) propose and test a theoretical model to understand interpersonal-behavior outcomes, and 2) develop a theoretically-guided behavioral intervention to increase the likelihood that patients will deliver PDPT. In this study, I used a mixed-method data collection strategy that resulted in the collection of interview and survey data from 210 STI clinic patients in support of a revised version of the Interpersonal-Behavioral (I-B) model, and recommendations are provided for behavioral interventions to be experimentally tested in future research based on this model and patient feedback. PDPT was found to be an acceptable method of partner treatment for clinic patients, and several structural-level factors that could be addressed in future research and clinical practice were associated with PDPT acceptability, including the normative influences of healthcare providers and the packaging and materials of PDPT kits. When I-B model indicators were regressed on PDPT intentions, factors from primary constructs of information, motivation, social support, and behavioral skills were found to be significantly associated with higher PDPT intentions. Moreover, the I-B model was found to have significantly better model fit than the previously published Information-Motivation-Behavioral Skills model in predicting PDPT intentions. Ample evidence was found to foster the development of behavioral interventions to be experimentally tested in future research to improve PDPT delivery, including the potential for distributing rapid HIV test kits with PDPT. Participants suggested intervention mechanisms for clinic patients, including the need for an updated one-on-one counseling strategy, the use of peer health educators, offering peer support groups, and redesigning the STI clinic structure. Important findings related to the potential for intimate partner violence were also found, which could prevent full implementation of PDPT within STI clinic settings. Encouraging communication between healthcare providers and their patients about the potential for intimate partner violence could facilitate patient triaging that results in the consideration of alternatives to PDPT for patients or partners at risk of harm, and better outcomes for patients and their partners.