Other Titles

Delivery of expedited partner therapy for STI treatment among women in Kenya​ [Title Slide]

Abstract

Background: Expedited partner treatment (EPT) for sexually transmitted infections (STIs) prevents re-infection and is recommended by the World Health Organization to reduce STI transmission.1,2 Yet, limited data exist on women’s experiences with EPT and their STI outcomes following EPT dispensation. We evaluated EPT outcomes and perspectives among women with recent STIs who were offered EPT in Kenya.

Methods: Women enrolled in a randomized trial at 5 antenatal clinics in Western Kenya (NCT04472884) were tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in pregnancy and/or postpartum as part of study procedures. 3-5 Women testing positive were offered directly observed therapy (DOT) and EPT to take to their sexual partners per national guidelines.6 We conducted qualitative interviews with a subset of women and analyzed transcripts using thematic analysis to understand women’s experiences with EPT guided by the Health Belief Model.7,8

Results: Among women with a positive CT and/or NG result (n=39), 37 (95%) accepted EPT. Median age of women was 26 years (IQR 21-29), 23% had ≤8 years of education, 15% were employed, and 72% were married. Reasons for not accepting EPT included concerns of partner violence, partner being away, and thinking that their partner may only take EPT after testing. Among those who accepted EPT, 59% (n=22) reported their partners accepted treatment, and 95% confirmed partners had completed the EPT regimen. No cases of social harm were reported. All women who tested positive returned for a test-of-cure (TOC) at least 30 days following treatment; 15% re-tested positive, including four CT-only, one NG-only, and one CT/NG co-infection. All women who re-tested positive had received DOT at initial diagnosis and accepted EPT but were uncertain whether their partner had taken or completed EPT at the time of TOC. In qualitative interviews, women reported feelings of emotional distress, perceived stigma, and fear of partner reactions following STI diagnoses. Motivations for accepting DOT and EPT included perceived benefits such as alleviating symptoms (e.g., abnormal discharge), avoiding re-infection, and protecting their babies from STIs. Some women had challenges dispensing EPT to partners and recommended provider-assisted disclosure of STI results.

Conclusion: Among women in Kenya with STI diagnoses during pregnancy or postpartum, EPT was highly acceptable and safely delivered in this setting.

Notes

References:

1. World Health Organization. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030. World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.2022.

2. World Health Organization. Guidelines for the management of symptomatic sexually transmitted infections. Geneva: World Health Organization; 2021.

3. Mogaka JN, Felix A, Julia D, et al. High acceptability of STI testing and EPT among pregnant Kenyan women initiating PrEP (Abstract #767). Conference on Retroviruses and Opportunistic Infections. Seattle, Washington2023.

4. Mogaka JN, Otieno FA, Akim E, et al. A Text Messaging-Based Support Intervention to Enhance Pre-exposure Prophylaxis for HIV Prevention Adherence During Pregnancy and Breastfeeding: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. Jan 30 2023;12:e41170.

5. Mogaka NJ, Felix A, Eunita A, et al. High STI Incidence among women initiating PrEP during pregnancy in Kenya AS-AIDS-2024-03956-. The 25th International AIDS Conference. Munich, Germany2024.

6. Ministry of Health Kenya, NASCOP. Kenya National Guidelines for Prevention, Management and Control of Sexually Transmitted Infections: Ministry of Health, National AIDS and STI Control Program;2018.

7. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the Health Belief Model. Health Educ Q. 1988;15(2):175-183.

8. Virginia B, Victoria C. Thematic Analysis: A Practical Guide 1st Edition: SAGE Publications Ltd; 2021.

Description

The World Health Organization recommends expedited partner therapy (EPT) for sexually transmitted infections (STIs) to reduce re-infections, especially among pregnant population; however, limited data exists on outcomes and women’s experience with EPT in Kenya. We evaluated EPT outcomes and perspectives among women with STI diagnosis. Motivations for accepting treatment and EPT uptake included alleviating symptoms and protecting babies. EPT was highly acceptable and safely delivered.

Author Details

Jerusha Nyabiage Mogaka, PhD; Tessa Concepcion, BS, MSGH; Felix Abuna, BSc; Eunita Akim, BSN; Melissa Mugambi, MD, PhD; Helen Aketch, BSc; Sarah Obatsa, BSc; John Kinuthia, MBChB, MMed, MPH; Kenneth Ngure, MPH, MSc, PhD; Kristin M. Beima-Sofie, MPH, PhD; Grace C. John-Stewart, MD, MPH, PhD; Jillian Pintye, BSN, MPH, PhD

Sigma Membership

Non-member

Type

Presentation

Format Type

Text-based Document

Study Design/Type

Randomized Controlled Trial

Research Approach

Quantitative Research

Keywords:

Implementation Science, Testing Strategies, Public Community Health

Conference Name

36th International Nursing Research Congress

Conference Host

Sigma Theta Tau International

Conference Location

Seattle, Washington, USA

Conference Year

2025

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

Review Type

Abstract Review Only: Reviewed by Event Host

Acquisition

Proxy-submission

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Delivery of Expedited Partner Therapy for Sexually Transmitted Infections Among Women in Kenya

Seattle, Washington, USA

Background: Expedited partner treatment (EPT) for sexually transmitted infections (STIs) prevents re-infection and is recommended by the World Health Organization to reduce STI transmission.1,2 Yet, limited data exist on women’s experiences with EPT and their STI outcomes following EPT dispensation. We evaluated EPT outcomes and perspectives among women with recent STIs who were offered EPT in Kenya.

Methods: Women enrolled in a randomized trial at 5 antenatal clinics in Western Kenya (NCT04472884) were tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in pregnancy and/or postpartum as part of study procedures. 3-5 Women testing positive were offered directly observed therapy (DOT) and EPT to take to their sexual partners per national guidelines.6 We conducted qualitative interviews with a subset of women and analyzed transcripts using thematic analysis to understand women’s experiences with EPT guided by the Health Belief Model.7,8

Results: Among women with a positive CT and/or NG result (n=39), 37 (95%) accepted EPT. Median age of women was 26 years (IQR 21-29), 23% had ≤8 years of education, 15% were employed, and 72% were married. Reasons for not accepting EPT included concerns of partner violence, partner being away, and thinking that their partner may only take EPT after testing. Among those who accepted EPT, 59% (n=22) reported their partners accepted treatment, and 95% confirmed partners had completed the EPT regimen. No cases of social harm were reported. All women who tested positive returned for a test-of-cure (TOC) at least 30 days following treatment; 15% re-tested positive, including four CT-only, one NG-only, and one CT/NG co-infection. All women who re-tested positive had received DOT at initial diagnosis and accepted EPT but were uncertain whether their partner had taken or completed EPT at the time of TOC. In qualitative interviews, women reported feelings of emotional distress, perceived stigma, and fear of partner reactions following STI diagnoses. Motivations for accepting DOT and EPT included perceived benefits such as alleviating symptoms (e.g., abnormal discharge), avoiding re-infection, and protecting their babies from STIs. Some women had challenges dispensing EPT to partners and recommended provider-assisted disclosure of STI results.

Conclusion: Among women in Kenya with STI diagnoses during pregnancy or postpartum, EPT was highly acceptable and safely delivered in this setting.