Original Research Gynecology| Volume 218, ISSUE 5, P504.e1-504.e6, May 2018

Pharmacy-level barriers to implementing expedited partner therapy in Baltimore, Maryland

Published:February 03, 2018DOI:


      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.


      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.


      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).


      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.

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      1. Centers for Disease Control and Prevention. 2016 sexually transmitted disease surveillance report.
        (Available at:) (Accessed Sept. 27, 2017)
        • Fleming D.T.
        • Wasserheit J.N.
        From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection.
        Sex Transm Infect. 1999; 75: 3-17
      2. Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2016 national profile—Chlamydia.
        (Available at:) (Accessed Sept. 27, 2017)
        • Hillis S.D.
        • Owens L.M.
        • Marchbanks P.A.
        • Amsterdam L.E.
        • MacKenzie W.R.
        Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease.
        Am J Obstet Gynecol. 1997; 176: 103-107
        • Hosenfeld C.B.
        • Workowski K.A.
        • Berman S.
        • et al.
        Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature.
        Sex Transm Dis. 2009; 26: 478-489
        • Kissinger P.
        • Hogben M.
        Expedited partner treatment for sexually transmitted infections: an update.
        Curr Infect Dis Rep. 2011; 13: 188-195
        • Schillinger J.A.
        • Kissinger P.
        • Calvet H.
        • et al.
        Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial.
        Sex Transm Dis. 2003; 30: 49-56
        • Shiely F.
        • Hayes K.
        • Thomas K.K.
        • et al.
        Expedited partner therapy: a robust intervention.
        Sex Transm Dis. 2010; 37: 602-607
        • Oliver A.
        • Rogers M.
        • Schillinger J.A.
        The impact of prescriptions on sex partner treatment using expedited partner therapy for Chlamydia trachomatis infection, New York City, 2014–2015.
        Sex Transm Dis. 2016; 43: 673-678
        • Schillinger J.A.
        • Gorwitz R.
        • Rietmeijer C.
        • et al.
        The expedited partner therapy continuum: a conceptual framework to guide programmatic efforts to increase partner treatment.
        Sex Transm Dis. 2016; 43: S63-S75
      3. Centers for Disease Control and Prevention. Legal status of expedited partner therapy.
        (Available at:) (Accessed Dec. 5, 2017)
      4. EvergreenHealth. Maryland 2015 Pharmacy Directory. Available at: Accessed February 11, 2017.

      5. Maryland Board of Pharmacy.
        (Available at:) (Accessed May 15, 2017)
      6. Baltimore City Health Department (Maryland Department of Health web site).
        (Available at:) (Accessed June 9, 2017)
      7. Baltimore City Health Department. Baltimore City 2015 map of chlamydia rates by ZIP code.
        (Available at:) (Accessed February 11, 2017)
      8. US Department of Agriculture. USDA food access research atlas (United States Department of Agriculture web site).
        (Available at:) (Accessed June 10, 2017)
      9. US Census Bureau. 2011–2015 ACS 5-year summary file.
        (Available AT:) (Accessed June 10, 2017)
      10. State of Maryland. Maryland Code: Health-General §18-214.1.
        (Available at:) (Accessed June 10, 2017)
      11. Maryland Department of Health and Mental Hygiene. Expedited partner therapy regulations.
        (Available at:) (Accessed June 10, 2017)
        • Stopka T.J.
        • Donahue A.
        • Hutcheson M.
        • Green T.C.
        Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015.
        J Am Pharm Assoc. 2017; 57: S34
        • Qato D.M.
        • Daviglus M.L.
        • Wilder J.
        • Lee T.
        • Qato D.
        • Lambert B.
        ‘Pharmacy deserts’ are prevalent in Chicago’s predominantly minority communities, raising medication access concerns.
        Health Affairs. 2014; 33: 1958-1965
      12. Centers for Disease Control and Prevention. STDs in racial and ethnic minorities.
        (Available at:) (Accessed July 10, 2017)
        • Mmeje O.
        • Wallet S.
        • Kolenic G.
        • Bell J.
        Impact of expedited partner therapy (EPT) implementation on chlamydia incidence in the USA.
        Sex Transm Infect. 2017 May 17; (pii: sextrans-2016-052887. [Epub ahead of print])
        • Reid A.
        • Rogers M.E.
        • Arya V.
        • et al.
        Pharmacists’ knowledge and practices surrounding expedited partner therapy for chlamydia trachomatis, New York City, 2012 and 2014.
        Sex Transm Dis. 2016; 43: 679-684
      13. Drug Enforcement Administration. Valid prescription requirements. US Department of Justice.
        (Available at:) (Accessed Aug. 1, 2017)
      14. Department of Legislative Services. Assessing the impact of healthcare reform in Maryland.
        (Available at:) (Accessed Dec. 15, 2017)
      15. US Census Bureau. Health insurance coverage in the United States: 2016.
        (Available at:) (Accessed Dec. 15, 2017)
      16. Centers for Disease Control and Prevention. 2015 sexually transmitted diseases guidelines—special populations.
        (Available at:) (Accessed Dec. 15, 2017)
      17. US Census Bureau. Relationship files.
        (Available at:) (Accessed June 17, 2017)