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Waimar Tun, Cathleen Walsh, Jacqueline Siller, Betty Apt, Wendy Wolf, Jeffrey Klausner

Acceptance of Patient-Delivered Partner-Therapy for Incubating Syphilis Among Men Who Have Sex with Men (MSM), San Francisco, CA. Waimar Tun, Cathleen Walsh, Jacqueline Siller, Betty Apt, Wendy Wolf, Jeffrey Klausner. Cases of Early Syphilis San Francisco (1999 – 2002). Cases. Year.

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Waimar Tun, Cathleen Walsh, Jacqueline Siller, Betty Apt, Wendy Wolf, Jeffrey Klausner

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  1. Acceptance of Patient-Delivered Partner-Therapy for Incubating Syphilis Among Men Who Have Sex with Men (MSM), San Francisco, CA Waimar Tun, Cathleen Walsh, Jacqueline Siller, Betty Apt, Wendy Wolf, Jeffrey Klausner

  2. Cases of Early Syphilis San Francisco (1999 – 2002) Cases Year

  3. Traditional Partner Management • Patient counseling & education • Partner elicitation • Contact tracing • Partner notification • Evaluation & treatment of sex partners 77% (1043/1347) of identified sex partners either received treatment or had previous treatment (2000-2003).

  4. Partner Management:Jan 2001 – Dec 2002 No. of patients with early infectious syphilis 364 No. of sex partners reported 4,618 No. of sex partners with contact information 337 (7%)

  5. Patient-Delivered Partner Therapy(PDT) • Initiated July 2002 • Syphilis patients seen at SF City STD Clinic offered prophylactic therapy for incubating syphilis to distribute to: • Recent sex partners • High-risk social contacts • Goal: Prevent syphilis among high-risk MSM who might not be reached through traditional partner management strategies

  6. Syphilis PDT Pack • Fact sheets: Syphilis & Azithromycin prophylactic treatment • Directions for taking azithromycin • Information on where to seek medical care • Contact information • Condoms & lubrication 1 gm Azithromycin powder sachet

  7. Patients Accepting PDT Packs

  8. Evaluation Objective To identify barriers and facilitators of the acceptance of PDT packs by: • MSM syphilis patients • their sex partners • social contacts

  9. Methods • Focus groups (FG) • Patients w/ early syphilis • Sex partners • Social contacts of patients & sex partners • Disease & exposure status of participants kept confidential • PDT knowledge/experience not criteria for participation • 5-9 participants in each session

  10. Focus Group Interviews • Hypothetical questions regarding: • Reasons for accepting/refusing PDT if offered • Packaging and content of PDT packs • Abstracted themes and coded/sub-coded transcribed FG interviews

  11. Barriers: Perception of PDT • Only doctors should prescribe medicine • Liability for adverse drug reactions • Novelty of PDT • Should be tested & evaluated before taking the medicine “You should never get medicine unless it’s from a doctor. It’s prescribed by a doctor for specific people.” “If this was something…new I probably still would go to my healthcare professional…she would have all the information.”

  12. Barriers: Nature of Relationship with Partners • Anonymity of sex partners would make it difficult to distribute PDT packs • Concerns about negative repercussions from sex partners if they offer PDT packs “I’ve been with a guy for a few years and I’m still not sure what his name is... There’s also that little orgy thing where you’re invited and there’s 6 or 7 other guys. I don’t have any way to reach them.” “If you do know their names and they find out that you’ve given it [syphilis], most people get angry.”

  13. Barriers: Nature of Relationship with Partners “I think it’s probably easier to give it [the PDT pack] to people you know and trust. The less you know your partners, the less you trust them, the less likely you are to give it to the person…” • Would be less willing to give PDT packs to sex partners they don’t trust, know well, or care about

  14. Barriers: PDT Packaging & Contents • Would question legitimacy of PDT packs unless package looked official and was tamper-resistant • Would need critical information on syphilis & medication, and contact information

  15. Facilitators to Accepting PDT Packs • Social responsibility “I feel obliged to tell [my] partners…It’s a social obligation.” • Quick, convenient & free

  16. Program Recommendations • Community awareness campaign • Increase awareness of PDT packs • Importance of clinical evaluation & testing • Mode: Internet, gay newspapers, gay neighborhoods • Outreach at strategic venues • Patient counseling on PDT • Professional, official packaging • 1 gm azithromycin does not treat P&S syphilis • See a doctor if symptomatic

  17. SF Department of Public Health Lyn Fischer Charlotte Kent Robert Kohn Terrance Sha Giuliano Nieri Debra Williams-Taki Will Wong CDC/Division of STD Prevention Dayne Collins Kathleen Irwin Acknowledgements Better World Advertising Les Pappas

  18. Patients Accepting PDT Packs

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