PROSPERO International prospective register of systematic reviews
Implementation of expedited partner therapy (EPT) interventions for sexually transmitted infections (STIs): a systematic review
Fiona Mapp, Maria Pothoulaki, Paul Flowers, Gabriele Vojt, Melvina Woode-Owusu, Sonali Wayal, Jackie Cassell, Tavishi Kanwar, Krish Patel, Claudia Estcourt
Fiona Mapp, Maria Pothoulaki, Paul Flowers, Gabriele Vojt, Melvina Woode-Owusu, Sonali Wayal, Jackie Cassell, Tavishi Kanwar, Krish Patel, Claudia Estcourt. Implementation of expedited partner therapy (EPT) interventions for sexually transmitted infections (STIs): a systematic review.
Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016051178
The aim of this review is to provide a more detailed understanding of the implementation of expedited partner therapy (EPT) interventions to optimise current partner notification practice in specialist sexual health clinics in Britain. The specific review objectives are:
Describe the nature and range of EPT delivery approaches
Describe the nature and range of intervention components within EPT
Describe the patterning of intervention effects by intervention components
Describe the extent and nature of the theoretical base underpinning EPT interventions
The review is based on two main concepts: expedited partner therapy interventions and STIs. We seek to include both peer-reviewed journal articles of primary research and grey literature.
We examined existing search strategies from previous systematic reviews (for example Ferreira et al., 2013) and conducted initial scoping searches of MEDLINE. We then developed a revised search strategy in consultation with a subject librarian. Searches were conducted in two stages: 1) electronic databases were searched for published and grey literature and 2) reference lists of published studies were searched and citation searches of key studies (tracked through Web of Science) were conducted.
We searched the following electronic databases: CINAHL Plus, Cochrane Library (including Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Cochrane Methodology Register), EMBASE, MEDLINE, NHS Evidence, Open Grey, Scopus, and Web of Science
We limited searches to English language only. We made three attempts to contact the corresponding author of each included study for further information, where necessary (for example training manuals, intervention manuals, detailed descriptions, study protocols).
Types of study to be included
No restrictions on study design - we are looking for process and outcome data from empirical studies.
Condition or domain being studied
Sexually Transmitted Infections
The review is considering patients diagnosed with a STI and their sex partners. By the nature of the intervention it excludes those who do not seek healthcare or do not have contactable sex partners.
This review focuses on interventions which are classified as Expedited Partner Therapy (EPT). EPT interventions are defined as the practice of treating sex partners of persons with STIs without requiring the partners' prior clinical evaluation (Golden et al. Sexually Transmitted Diseases, 2007). They are designed to expedite treatment of individuals exposed to STIs, improving partner notification outcomes through prevention of onward transmission and reinfection. EPT originated in the USA and has been adapted for other contexts, most notably to meet UK prescribing guidelines where the adapted version has been labelled Accelerated Partner Therapy (APT). Interventions often encompass patient-delivered partner therapy (PDPT) as the medication is given to the index patient to give to their sexual partner(s). EPT interventions exclude care-seeking to services and treatment mechanisms that require the partner to attend in person.
This review focuses on existing empirical EPT interventions and links intervention processes and outcomes therefore it excludes studies that do not report both types of data. We also excluded studies primarily concerned with mathematical modelling of outcomes, cost-effectiveness of the intervention or hypothetical data about attitudes or intended behaviour. As the aim of this review is to improve partner notification for STIs in Britain, we excluded studies about low-income countries (as defined by the OECD).
This review will consider all studies which have relevant short, medium or long-term outcomes related to EPT implementation including: EPT uptake, acceptability of EPT for healthcare professionals and patients and sex partners, partner treatment rates (measured directly/indirectly), STI reinfection rates (measured from two weeks up to 12 months after initial diagnosis), time from patient diagnosis to partner treatment, other STI testing, patient satisfaction, all partners treated, partner STI positivity, gender differences, reasons for non-delivery of EPT or non-treatment of partners, reasons for refusal of intervention, and use of a theoretical framework. We will also be examining behaviour change techniques (Michie et al. 2013) within interventions.
The review will consider unanticipated or negative consequences of interventions designed to improve STI treatment options (such as, but not limited to: increased STI morbidity, inappropriate or delayed treatment, inappropriate use of treatment, and emotional aspects of delivering the intervention to sex partners). The search will include the primary outcome measures only, but secondary outcomes data will be extracted and included in the analysis.
Data extraction, (selection and coding)
Inclusion and exclusion criteria will be applied successively to titles and abstracts. Full reports will be obtained for those studies that appear to meet the criteria or where there is insufficient information from the title and abstract. Screening of titles and abstracts and full texts will be performed by a team of reviewers. Decisions will be double-checked and a third reviewer will be asked to resolve any discrepancies where consensus cannot be reached between the two reviewers at this stage.
Standardized frameworks will be used for data extraction. The frameworks will be applied to all full text papers that fulfil the eligibility criteria. There will be two separate data extraction processes:
1) Descriptive study information will be extracted based on principles of the TiDIER framework (Hoffman et al., 2014) including: Location, Time period, Participant characteristics (demographic information including number recruited, age range, sex/gender, STIs diagnosed), Service characteristics (type of service, access, staff mix, legislation/prescribing guidelines), Study design, Aim/objectives, Data collection methods, data analysis (primary and secondary outcomes, statistical tests used, software), Outcomes (primary and secondary - short, medium and long-term as described above), Conclusions, and Quality Appraisal (using CASP toolkits).
2) Intervention coding information will be extracted: Theoretical basis (application of the Theory Coding Scheme (Michie and Prestwich, 2010), Intervention used, Intervention definition, Intervention processes (what happens, when and how?), Intervention components, Who needs to do what to whom?, Behavioural domains, BCTs identified (Michie et al. 2009), EPT intervention stage 1, 2, 3, additional stages, Observations from coding interventions, Positive intervention effects and related components, and Negative effects and related components.
Data extraction will be undertaken by a team of reviewers and double checked by other team members. Any discrepancies will be resolved through discussion between the two reviewers and by adjudication by a third reviewer when necessary. Analyses using the two data extraction frameworks will be compared in a second stage of analysis. Three attempts will be made to contact study authors and request further study information as described above.
Risk of bias (quality) assessment
The risk of bias in individual studies will be assessed by one reviewer and checked by the second reviewer using the Critical Appraisal Skills Programme (CASP) checklists (http://www.casp-uk.net/casp-tools-checklists) relevant to each study type. Eligible studies will not be excluded based on the quality assessment but the strengths and limitations of the evidence base will be highlighted in a narrative discussion.
Strategy for data synthesis
Narrative synthesis of evidence will be carried out on the descriptive attributes of the data to summarise and explain the studies we have included in this review. We will focus on the location and setting of existing EPT interventions, STIs targeted through EPT, types of outcomes measured and reported, contents of the intervention and the fidelity of all EPT interventions.
Classification of behavioural change techniques (BCTs) will be coded using a 93-item revised version of the taxonomy of generally applicable BCTs proposed by Michie et al. (2009). There is no 'off the shelf' methodology available for analysing public health studies for BCT components and we will be drawing on the expertise and experience of Professor Paul Flowers to take a systematic yet pragmatic approach to analyses and synthesis of findings. We propose to conduct a series of further analyses to elucidate new and useful knowledge for intervention development. These are concerned with the associations of the number, clustering and role of individual BCTs with effectiveness and the role of theory in relation to effectiveness. Theory coding analysis will involve the Theory Coding Scheme (Michie and Prestwich, 2010). A descriptive summary of the BCTs for the interventions in each study will be provided and compared across all of the studies.
It is unlikely statistical meta-analysis will be appropriate for this review given the inclusivity of study designs, focus on processes which lead to specified outcomes, and the potential variation in intervention components and protocols.
Analysis of subgroups or subsets
Contact details for further information
Centre for Sexual Health and HIV, Research Department of Infection and Population Health, Mortimer Market Centre, Capper Street, London WC1E 6JB, UK
Organisational affiliation of the review
Ms Fiona Mapp, UCL Dr Maria Pothoulaki, GCU Professor Paul Flowers, GCU Dr Gabriele Vojt, GCU Dr Melvina Woode-Owusu, UCL Dr Sonali Wayal, UCL Professor Jackie Cassell, Brighton and Sussex Medical School Ms Tavishi Kanwar, University of Cambridge Mr Krish Patel, QMUL Professor Claudia Estcourt, GCU; UCL
Dr Cath Mercer, UCL Professor Tracy Roberts, University of Birmingham Dr John Saunders, UCL Mr Merle Symonds, Barts Professor Nicola Low, University of Bern Dr Rak Nandwani, NHS Greater Glasgow Professor Anne Johnson, UCL
Anticipated or actual start date
16 June 2016
Anticipated completion date
31 January 2017
Review funded by the NIHR under a Programme Grant for Applied Research, Reference Number RP-PG-0614-20009.
Conflicts of interest
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Humans; Sexual Partners; Sexually Transmitted Diseases
Stage of review
Date of registration in PROSPERO
18 November 2016
Date of publication of this revision
18 November 2016
Stage of review at time of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.