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接受患者转介伙伴通知以治疗性传播感染的意愿:来自津巴布韦的混合方法研究。

Acceptability of patient-referral partner notification for sexually transmitted infections to young people, a mixed methods study from Zimbabwe.

机构信息

Associate Lecturer, School of Public Health, University of Sydney, Sydney, Australia.

Assistant Professor, THRU Zim, Harare, Zimbabwe; Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK.

出版信息

Sex Reprod Health Matters. 2023 Dec;31(1):2220188. doi: 10.1080/26410397.2023.2220188.

Abstract

Partner notification (PN) is considered integral to the management of sexually transmitted infections (STI). Patient-referral is a common PN strategy and relies on index cases notifying and encouraging their partners to access treatment; however, it has shown limited efficacy. We conducted a mixed methods study to understand young people's experiences of PN, particularly the risks and challenges encountered during patient-referral. All young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered PN slips, which enabled their partners to access free treatment at the service. PN slip uptake and partner treatment were recorded. Among 1807 young people (85.0% female) offered PN slips, 745 (41.2%) took up ≥1 PN slip and 103 partners (5.7%) returned for treatment. Most participants described feeling ill-equipped to counsel and persuade their partners to seek treatment. Between June and August 2021, youth researchers conducted in-depth interviews with 41 purposively selected young people diagnosed with an STI to explore their experiences of PN. PN posed considerable social risks, threatening their emotional and physical safety. Except for a minority in long-term, publicly acknowledged relationships, participants did not expect PN would achieve successful outcomes. Public health discourse, which constructs PN as "the right thing to do", influenced participants to adopt narratives that concealed the difficulties of PN and their unmet needs. Urgent interrogation is needed of whether PN is a suitable or constructive strategy to continue pursuing with young people. To improve the outcomes of preventing reinfection and onward transmission of STIs, we must consider developing alternative strategies that better align with young people's lived experiences. Partner notification is a public health strategy used to trace the sexual partners of people who have received a sexually transmitted infection (STI) diagnosis. It aims to interrupt the chains of STI transmission and prevent reinfection by treating both the person diagnosed and their sexual partners. The least effective but most common partner notification strategy used in many resource-limited settings is called "patient referral". This involves a sexual healthcare provider encouraging the person diagnosed to give a "partner notification slip" to their potentially exposed sexual partner/s and persuading them to access treatment. This research sought to better understand young people's experiences of partner notification, particularly the risks and challenges they faced during patient-referral.All young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered PN slips, which enabled their partners to access free treatment at the service. Young people trained as researchers interviewed 41 young people who had received a STI diagnosis to explore their experiences of partner notification.Only a small number (5.7%) of the partners of those who took a slip attended the service for treatment. Most participants felt they did not have the preparation, skills, or resources to persuade their partners to seek treatment. Many described negative experiences during and after partner notification, including relationship breakdown, reputation damage, and physical violence.These findings suggest that we should reconsider if partner notification is suitable or effective for use with young people. We should explore alternative approaches that do not present risks to young people's social, emotional, and physical safety and well-being.

摘要

性传播感染(STI)管理中,性伴通知被认为是不可或缺的。患者转诊是一种常见的性伴通知策略,依赖于索引病例通知并鼓励其性伴接受治疗;然而,它的效果有限。我们进行了一项混合方法研究,以了解年轻人的性伴通知体验,特别是在患者转诊期间遇到的风险和挑战。

所有在津巴布韦社区性健康服务机构就诊并被诊断患有 STI 的 16-24 岁年轻人都接受了咨询,并提供了性伴通知条,使他们的性伴能够在该服务机构获得免费治疗。记录了性伴通知条的使用情况和性伴的治疗情况。在 1807 名(85.0%为女性)被提供性伴通知条的年轻人中,有 745 名(41.2%)使用了至少 1 张通知条,有 103 名(5.7%)性伴返回接受治疗。大多数参与者表示,他们在为性伴提供咨询和劝说他们接受治疗方面感到准备不足。

2021 年 6 月至 8 月期间,青年研究人员对 41 名被诊断患有 STI 的年轻人进行了深入访谈,以探讨他们的性伴通知体验。性伴通知带来了相当大的社会风险,威胁到他们的情感和身体安全。除了少数处于长期、公开承认的关系中的年轻人外,参与者们并不期望性伴通知会取得成功。公共卫生话语将性伴通知构建为“正确的做法”,这促使参与者采用掩盖性伴通知困难和未满足需求的叙述。

迫切需要质疑性伴通知是否适合或构建性策略,继续在年轻人中推行。为了改善预防性传播感染再次感染和传播的效果,我们必须考虑开发其他更好地符合年轻人生活体验的策略。性伴通知是一种公共卫生策略,用于追踪已接受性传播感染(STI)诊断的人的性伴。其目的是通过治疗被诊断者及其性伴,中断 STI 的传播链,防止再次感染。在许多资源有限的环境中,最无效但最常见的性伴通知策略称为“患者转诊”。这涉及到性健康提供者鼓励被诊断者向他们可能暴露的性伴/性伴提供“性伴通知条”,并说服他们接受治疗。

这项研究旨在更好地了解年轻人的性伴通知体验,特别是他们在患者转诊期间面临的风险和挑战。所有在津巴布韦社区性健康服务机构就诊并被诊断患有 STI 的 16-24 岁年轻人都接受了咨询,并提供了性伴通知条,使他们的性伴能够在该服务机构获得免费治疗。接受培训的青年研究人员对 41 名被诊断患有 STI 的年轻人进行了访谈,以探讨他们的性伴通知体验。只有少数(5.7%)接受通知条的性伴接受了治疗。大多数参与者表示,他们没有准备、技能或资源来劝说他们的性伴接受治疗。许多人描述了在性伴通知期间和之后的负面经历,包括关系破裂、声誉受损和身体暴力。

这些发现表明,我们应该重新考虑性伴通知是否适合或有效用于年轻人。我们应该探索不会对年轻人的社会、情感和身体安全和福祉带来风险的替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe5a/10424614/a0f188a9d103/ZRHM_A_2220188_F0001_OB.jpg

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