Background
Addressing record high rates of Chlamydia trachomatis incidence in the United States requires the utilization of effective strategies,
such as expedited partner therapy, to reduce reinfection and further transmission.
Expedited partner therapy, which can be given as a prescription or medication, is
a strategy to treat the sexual partners of index patients diagnosed with a sexually
transmitted infection without prior medical evaluation of the partners.
Objective
There are multiple steps in the prescription–expedited partner therapy cascade, and
we sought to identify pharmacy-level barriers to implementing prescription–expedited
partner therapy for Chlamydia trachomatis treatment.
Study Design
We used spatial analysis and ArcGIS, a geographic information system, to map and assess
geospatial access to pharmacies within Baltimore, MD, neighborhoods with the highest
rates of Chlamydia trachomatis (1180.25–4255.31 per 100,000 persons). Expedited partner therapy knowledge and practices
were collected via a telephone survey of pharmacists employed at retail pharmacies
located in these same neighborhoods. Cost of antibiotic medication in US dollars was collected.
Results
Census tracts with the highest Chlamydia trachomatis incidence rates had lower median pharmacy density than other census tracts (26.9
per 100,000 vs 31.4 per 100,000, P < .001). We identified 25 pharmacy deserts. Areas defined as pharmacy deserts had
larger proportions of black and Hispanic or Latino populations compared with non-Hispanic
whites (93.1% vs 6.3%, P < .001) and trended toward higher median Chlamydia trachomatis incidence rates (1170.0 per 100,000 vs 1094.5 per 100,000, P = .110) than non–pharmacy desert areas. Of the 52 pharmacies identified, 96% (50
of 52) responded to our survey. Less than a fifth of pharmacists (18%, 9 of 50) were
aware of expedited partner therapy for Chlamydia trachomatis. Most pharmacists (59%, 27 of 46) confirmed they would fill an expedited partner
therapy prescription. The cost of a single dose of azithromycin (1 g) ranged from
5.00 to 39.99 US dollars (median, 30 US dollars).
Conclusion
Limited geographic access to pharmacies, lack of pharmacist awareness of expedited
partner therapy, and wide variation in expedited partner therapy medication cost are
potential barriers to implementing prescription–expedited partner therapy. Although
most Baltimore pharmacists were unaware of expedited partner therapy, they were generally
receptive to learning about and filling expedited partner therapy prescriptions. This
finding suggests the need for wide dissemination of educational material targeted
to pharmacists. In areas with limited geographic access to pharmacies, expedited partner
therapy strategies that do not depend on partners physically accessing a pharmacy
merit consideration.
Key words
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Article info
Publication history
Published online: February 03, 2018
Accepted:
January 23,
2018
Received in revised form:
December 18,
2017
Received:
October 16,
2017
Footnotes
The authors report no conflict of interest.
Cite this article as: Qin JZ, Diniz CP, Coleman JS. Pharmacy-level barriers to implementing expedited partner therapy in Baltimore, Maryland. Am J Obstet Gynecol 2018;218:504.e1-6.
Identification
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