Expedited Partner Therapy

1
Expedited Partner Therapy
Illinois Hospital Association Webinar December 8,
2009

• Charlie Rabins, MPH
• Illinois Department of Public Health
• Sexually Transmitted Diseases Program

2
Overview and Purpose

• What is Expedited Partner Therapy (EPT)
• Why EPT is Needed in Illinois
• Highlights of Illinois EPT Legislation
• Senate Bill 0212/Public Act 096-0613
• Effective January 1, 2010
• How Hospitals can Help in STD Prevention
• Questions from Webinar Participants

3
What is Expedited Partner Therapy (EPT)

• To prescribe, dispense, furnish or otherwise
  provide prescription drugs to the sex partner or
  partners of persons diagnosed with STDs without
  physical examination of the partners

4
Purpose and Goals of EPT

• Purpose to treat partners of clients with
  chlamydia and/or gonorrhea who are unable or
  unlikely to seek medical care
• Goals
• Decrease new CT/GC infections in community
• Reduce CT/GC re-infection rates
• Decrease complications from untreated CT and GC

5
EPT Usage in U.S.

• EPT is a standard of care and supported by AMA
• In 2006, CDC issued an EPT guidance, concluding
  that EPT is a useful option to facilitate partner
  management - especially for the treatment of male
  partners of women with chlamydia and/or gonorrhea
• EPT has been proven to be safe and effective
• Adverse reactions to antibiotics are rare
• No reports in California since implementing EPT
  in 2001
• EPT is currently legal in 20 states

6
WHY IS EXPEDITED PARTNER THERAPY NEEDED IN
ILLINOIS
7
Illinois Chlamydia Cases By Sex1990 - 2008
Cases
8
GonorrheaIllinois 1986 - 2008
Cases
9
Reported Chlamydia Gonorrhea Cases by Age
GroupIllinois 2008
Chlamydia
Gonorrhea
10
Illinois Reported STD Case RatesDisparity
Between Racial/Ethnic Groups, 2008
Primary and Secondary
11
2008 Illinois Chlamydia Rates
Rate per 100,000 Population
12
2008 Illinois Gonorrhea Rates
gt300
gt 100 - 300
gt0 - 100
0
Rate per 100,000 Population
13
Re-infection Rates for Chlamydia

• Re-screening project in Illinois in 2006
  indicated 16 of female clients at selected
  provider types were re-infected within six months
  of prior treatment
• National studies - 15-25 CT re-infection
• Re-infection attributed primarily to untreated
  partners
• Illinois Department of Public Health (IDPH)
  recommends re-screening all females and males 3
  to 4 months after treatment for chlamydia and
  gonorrhea

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HIGHLIGHTS OF ILLINOIS EXPEDITED PARTNER THERAPY
LEGISLATION
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Highlights of Illinois EPT Law - 1

• Overwhelming Support in Legislature
• Amends
• Illinois STD Control Act (410 ILCS 325/3)
• Medical Practice Act (225 ILCS 60/64)
• Nurse Practice Act ((225 ILCS 65/70-170)
• Physician Assistant Practice Act (225 ILCS 95/25)
  
• Defines EPT
• Prescribe, dispense, furnish or otherwise provide
  prescription antibiotic drugs to sex partners
  (within the past 60 days) of persons clinically
  diagnosed with chlamydia or gonorrhea without
  physical examination of the partners, if in the
  judgment of the health care professional, the sex
  partner is unlikely or unable to present for
  comprehensive evaluation, testing and treatment

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Highlights of Illinois EPT Law - 2

• Stipulates Which Health Care Professionals (HCP)
  can Provide EPT
• Licensed physician (practice medicine in all its
  branches)
• Physician assistant delegated to provide STD
  therapy or EPT by supervising physician
• Advanced practice nurse with a written
  collaborative agreement with a collaborating
  physician that authorizes STD therapy or EPT
• Advanced practice nurse who practices in a
  hospital or ambulatory surgical treatment center
  and possesses appropriate clinical privileges in
  accordance with the Nurse Practice Act

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Highlights of Illinois EPT Law - 3

• Liability Protections for HCPs
• EPT provided to sex partners in good faith
  without fee or compensation where counseling and
  written materials are provided is not subject to
  civil or professional liability except for
  willful and wanton misconduct
• Choosing not to provide EPT has the same
  exemption from liability
• Liability Protections for Pharmacists/Pharmacists
• Not subject to civil or professional liability
  for choosing not to fill a prescription that
  would cause them to violate any provision of the
  Pharmacy Practice Act

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Highlights of Illinois EPT Law - 4

• Identifies Responsibilities of HCPs Providing EPT
• Counsel infected patients
• Provide written materials on EPT (developed by
  IDPH) to patients to give to their sex partners
  receiving EPT
• Requirements Related to Counseling and Written
  Materials
• Warnings related to pregnancy (antibiotics and
  need for HCP examination)
• Information about provided or prescribed
  antibiotics and dosage (allergy warnings and need
  for HCP examination)

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Highlights of Illinois EPT Law - 5

• Requirements Related to Counseling and Written
  Materials - Continued
• Information about treatment and prevention of
  STDs
• Requirement of abstinence until a period of time
  after treatment
• Importance of receiving examination and testing
  for HIV and other STDs and available resources
• Risk to self, others and public health if the STD
  is not completely/successfully treated
• Responsibility of the sex partner to inform their
  sex partners of the risk of STDs and prompt
  exam/treatment
• Other information as required by IDPH

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Highlights of Illinois EPT Law - 6

• Responsibility of Illinois Department of Public
  Health (IDPH) to develop and disseminate in
  electronic and written format
• Informational materials for sex partners
• Informational materials for STD repeaters
• Guidance for HCPs on EPT
• IDPH May Offer Educational Programs about EPT for
  HCPs and Pharmacists

21
EPT Barriers and Challenges

• Medication and prescription labeling
• Adverse reactions/allergy rare
• EPT may compromise quality of care
• Appropriate care seek comprehensive services
• Ideally partners receiving EPT will access care
• Benefits of EPT outweigh the risks
• Doing nothing may result in
• Re-infection and further community transmission
• Complications pelvic inflammatory disease,
  ectopic pregnancy, infertility, epididymitis
• Risks offset by patient education, written
  materials and encouraging a visit to HCP

22
EPT Implementation

• EPT law effective date January 1, 2010
• IDPH drafting
• Guidance for Illinois Health Care Professionals
• Patient and Partner Information sheets
• HCP Fact Sheet
• STD Repeater Information Sheet
• Materials will be available
• IDPH Internet
• IDPH STD Program
• Health Care Organizations and Associations

23
Importance of Hospitals in STD Prevention and
Treatment in Illinois
Number and Percent of Reported Cases of STDs in
Illinois from Hospitals in 2008
24
Preventing STDsHow Hospitals Can Help

• Conduct sexual history whenever feasible
• Screen all sexually active females under 26 years
  of age for chlamydia and gonorrhea at least
  annually
• Screen females 26 years of age and older for
  chlamydia and gonorrhea based on risk factors
• symptoms and sex partner history
• Conduct diagnostic testing and presumptive
  treatment when STDs are suspected
• Counsel infected persons, provide EPT and
  recommend sex partner notification and referral

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EPT On-Line Resources

• IDPH Website (EPT HCP Guidance , Patient and
  Partner Written Materials will be Available by
  1/1/2010)
• www.idph.state.il.us
• Illinois EPT Law (SB 0212, PA 69-613)
• http//www.ilga.gov/legislation/publicacts/96/PDF/
  096-0613.pdf
• CDC
• EPT website http//www.cdc.gov/std/ept/
• CDC white paper http//www.cdc.gov/std/treatment/
  EPTFinalReport2006.pdf

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Questions

• Charlie Rabins
• Chief, STD Section
• Illinois Department of Public Health
• charlie.rabins_at_illinois.gov
• 217-782-2747