The decision to name sex partners: Determinants of provider referral compliance in chlamydia-infected adolescents
Description
Background. Chlamydia trachomatis is the most common bacterial sexually transmitted infection in the United States and of the estimated 4 million cases that occur annually, 90% of cases occur in persons less than 25 years old. Up to 85% of chlamydia infections in women and 40% of infections in men are asymptomatic; as a result they may go undetected. Provider referral partner notification is routinely used as a technique in the control of chlamydia requiring the naming of recent sex partners by index cases in order for them to be notified by the public health service for testing and treatment. In order for provider referral to work, sex partners must be named; however, predictors of compliance with partner naming requests have not been formally determined, nor has the general acceptability of provider referral to adolescents Objective. To identify the determinants of female index case compliance to provider referral requests for partner names and locating information; to reveal adolescent perceptions of provider referral Methods. A cross-sectional study was conducted examining the socio-demographic and sexual history of 222 women ages 14--24 and their 241 partners. Bivariate analysis was performed to identify predictors associated with provider referral compliance. In-depth interviews and focus group discussions were conducted with chlamydia positive adolescent women, at-risk men ages 18--24 and disease intervention specialists (DIS) Results. Almost all index cases (93%) named at least one partner; 58% of these partners were located for treatment. Two partners were named by 16% of index cases. Partners were an average of 2.7 years older than index cases. Bivariate analysis failed to demonstrate an association between hypothesized predictors and provider referral compliance. Qualitative research revealed that while both men and women were concerned with potential violence and loss of relationship in response to notifying a partner of chlamydia infection, a sense of responsibility encouraged provider referral compliance. Interviews with DIS confirmed these findings Conclusion. The majority of named partners were located and treated and qualitative data suggest that the potential of violence and loss of relationship as well as a sense of responsibility influence the decision to name partners