Table 1. Summary data from reviews of partner services interventions 2005 - 2014.

Review and PN approach	Meta-data	Populations and Settings	Interventions and Principal Effects	Major Conclusions or Recommendations
Althaus et al. (2014) Health Technol Assess Patient & provider referral1	k = 21 studies N = 10 – 15,000 Study type: RCT Range = 1988 – 2011 Meta-analysis Grey literature = Yes Studies from: Africa Australia Europe N America	Populations Race/ethnicity: varied Gender: 33% female, 19% male, 48% both GLBTQ: 5% MSM (1 study) Settings and infections Settings: public health clinics (most), primary care, university clinic (1 study) STI diagnoses: CT, GC, NGU, TV, STI syndrome	EPT: 29% lower risk of reinfection in index across (mainly) GC and CT: RR = 0.71 (0.56-0.89). Inconsistent findings on number notified; moderate difference favoring EPT in numbers treated, but heterogeneous results (3 studies) Counseling: Lower reinfection rate vs. patient referral (no enhancements) (1 study). Some others were not distinguishable from basic patient referral. Intervention could be delivered by different health professionals (no differences among doctors, nurses, health advisors). EPT v. Counseling: Studies showed no consistent differences in reinfection or partners evaluated. Possible evidence EPT resulted in more partners treated (1 study).	Patient: ○ EPT results in a lower risk of reinfection in the index case when compared with simple patient referral, but not when compared with enhanced patient referral methods. Practice points/General: ○ Taking sexual histories is important. ○ PN is an efficient method for case- finding for chlamydia because partners of infected cases have rates 5-10 times higher than the general population.
Ferreira et al. (2013) Cochrane Review Patient & provider referral	k = 26 studies N = 17,578 Study type: RCT Range = 1977 – 2011 Meta-analysis Grey literature = Yes Studies from: Africa Australia Europe N America	Populations Race/ethnicity: varied Gender: 27% female, 23% Male, 50% both GLBTQ: 8% MSM Settings and infections Settings: STD clinics (most), primary care clinics, university clinic (1 study) STI diagnoses: CT, GC, NGU, syphilis, HIV, TV	Provider referral: Sparse evidence in recent trials, but some evidence suggests it is better than patient referral (not enhanced) (1 study). EPT: Index patients in the EPT group had a 29% lower risk of being re-infected compared with index patients in patient referral group (RR 0.71, 95% CI 0.56 to 0.89). Stratified data do not point to a clear advantage for any one infection. Inconsistent results for number of partners notified; more partners treated with EPT (varying estimates). EPT (vs. enhanced counseling): No difference in reinfection (RR 0.96, 95% CI 0.6 to 1.53)or number of partners elicited (MD 0.07, 95% CI −0.18-0.32) or evaluated (MD 0.01, 95% CI −0.02 to 0.03). Small increase in number of partners treated in the EPT group (MD 0.22, 95% CI 0.21 to 0.23)—1 study. Counseling: Mixed effects, with some RCTs showing efficacy and others none. Home sampling: Flat results for reinfection and treatment. Patient referral via internet: With EPT and internet notification together, more partners identified (MD 1.15, 95% CI 0.22 to 2.08) (1 study). No differences in the number of partners treated or notified.	Patient: ○ EPT is more successful than simple patient referral in preventing re-infection of the index patient and resulted in more partners treated when compared with simple patient referral and contract referral. These findings, however, cannot be demonstrated for any individual infection. ○ Those using EPT should include all components of the intervention. ○ Counseling for PN is worthwhile for syphilis and HIV. General: ○ No single optimal strategy for PN was obvious. The most effective components of interventions were not clear, and more research is needed in this area.
Wetmore et al. (2010) Epidemiol Rev Patient referral	k = 7 studies N = not reported Study type: RCT Range = 1981 – 2009 Narrative Grey literature = No Studies from: Europe N America	Populations Race/ethnicity: varied Gender: 57% female, 14% male, 28% both GLBTQ: not reported Settings and infections Settings: STD clinics, FP clinics STI diagnoses: CT, GC, TV	EPT: Reductions in reinfection ranging from 25-62%, depending on population and infection. Counseling: 53% reduction in reinfection (1 study). Follow-up rates: Notes follow-up rates in PN studies ranged from 30-89%.	Patient: ○ Women with STIs may have more difficulty in convincing their male sex partners to take treatment than vice versa. ○ STI prevention efforts should integrate new technologies and focus on implementation research. General: ○ PN interventions, along with behavioral interventions, have shown “promising results with respect to reducing risk of STIs.” ○ Adherence to interventions is a consistent issue.
Alam et al. (2010) BMC Pub Health Patient referral	k = 39 studies N = 50 – 60,000 Study type: RCT, program evaluation, observational studies Range = 1996 – 2007 Narrative review Grey literature = No Studies from: Africa Asia S America Caribbean	Populations Race/ethnicity: varied Gender: 15% female, 8% male, 38% both, 33% unknown GLBTQ: not reported Settings and infections Settings: STD clinics, primary care clinics, FP clinics, hospitals STI diagnoses: CT, GC, syphilis, TV	EPT: Higher numbers of partners treated (1 study) Counseling: median of 54% of partners notified (range = 0-94%). Counseling generally results in more partners notified. Referral cards: 45% of those receiving referral cards had treated partners (1 study)	Patient: ○ Counseling raises awareness of PN and helps reduce STI-related stigma and fear. ○ Counseling should be promoted in public and private STD clinic settings. ○ Cell phones should be used to enhance PN (and the internet explored for use)
Hogben/Kissinger (2008) Sex Transm Dis Patient referral	k = 9 studies N = 1,140 Study type: RCT, program evaluation Range = 1997 – 2007 Aggregate data Grey literature = No Studies from: Europe N America	Populations Race/ethnicity: varied Gender: 100% male GLBTQ: minimal or none Settings and infections Settings: STD clinics (includes hospital GUM clinics), one CHC STI diagnoses: CT	Aggregated PN findings: 69% of partners notified through some patient-based approach (10 estimates); 46% treated. EPT: Data suggest increased levels of partner treatment (76% vs. 57%), compared to patient referral. Counseling: Increases in proportions of partners notified, but effects often confounded with other interventions (EPT). Referral cards: No reported increment in PN in a comparison with counseling (52% vs. 57%). Cards naming the infection may produce more partners for evaluation than generic card (84% vs. 33%) (1 study).	Patient: ○ Patient referral enhanced with either educational information or EPT is likely the most practical approach for management of sex partners of men infected with chlamydia in the US. General: ○ Efforts must be made to ensure that taking medication does not reduce overall care-seeking.
Hogben et al. (2007) Am J Prev Med Patient & provider referral	k = 9 studies n = 3,537 Study type: RCT, program evaluations Range = 1988 – 2003 Aggregated data Grey literature = No Studies from: N America (US only)	Populations Race/ethnicity: 58 – 87% Black, 18 – 70% White Gender: 67% both, others unclear GLBTQ: 56% MSM Settings and infections Settings: STD clinics and varied HIV testing sites STI diagnoses: HIV	Provider referral: DIS interview and either immediate follow-up or contract referral offered. 67% of partners located through PN; 63% tested, if notified; 20% new HIV+ among those tested (1 – 8% of all partners).	Provider: ○ Provider referral should be offered for all new HIV cases. ○ Benefits include earlier entry to care and reduced transmission.
Hogben (2007) Clin Infect Dis Patient & provider referral2	k = 39 studies (41 papers) N = 30 – 35,000 Study type: RCT, program evaluations, observational studies Range = 1999 – 2005 Narrative review Grey literature = No Studies from: Africa Asia Australia Europe N America	Populations Race/ethnicity: varied Gender: 5% female, 13% male, 33% both, 13% not applicable2 GLBTQ: 7% Settings and infections Settings: STD clinics, community clinics, hospitals, FP and primary care clinics (1 each), STI diagnoses: CT, GC, HIV, STI syndromes.	EPT (including field-delivered therapy): Reductions in index patient reinfection, OR/RR estimates ranging from 0.38 to 0.80. One study used DIS assistance as requested. Partner treatment rates increased by 10 – 40% (2 studies). Internet-based PN (provider referral): small N studies of people with large numbers of partners resulted in 26 – 44% of partners contacted; more than 5.9 partners per index patient average. Referral cards: Mixed results compared to basic patient referral and counseling (48 – 73%, 2 studies); lower reinfection rates (1 study). Network PN (provider referral): Interviewing social contacts yielded a 30% increase in syphilis infections found; interviewing uninfected social contacts yielded a 5.3% syphilis prevalence among partners (1 study).	Patient: ○ A patient who can notify his partner but is unlikely to bring the partner to the clinic may need EPT if provider referral is unavailable. Provider: ○ The role of the Internet emphasizes the need for broad collaboration among jurisdictions conducting PN. ○ Network analyses could produce a more efficient series of investigations over time. General: ○ Protocols and procedures increase effectiveness and efficiency in programs.
Trelle et al. (2007) BMJ Patient referral	k = 14 studies N = 12,389 Study type: RCT Range = 1988 – 2006 Meta-analysis Grey literature = Yes Studies from: Africa Europe N America	Populations Race/ethnicity: varied Gender: 29% female, 21% males, 43% both, 7% unknown (1 study) GLBTQ: Minimal or none Settings and infections Settings: STD clinics (primarily, others unknown) STI diagnoses: CT, GC, TV, non-specific urethritis, STI syndrome.	EPT: Rate of persistent or recurrent infections in patients managed with patient delivered partner therapy was lower than in controls, RR = 0.73 (0.57-0.93). Effect only shown for GC/CT (not TV). EPT also resulted in higher treatment rates, RR = 1.44, (1.12-1.86); effect sizes varied for reinfection and treatment. Counseling: When EPT was compared to enhanced counseling, there were no differences in reinfection rates, although EPT resulted in more partners treated, RR= 1.25 (1.15-1.37). Didactic approaches were not effective alone, but approaches that were more interactive resulted in more partners notified. Home sampling: The number of partners tested and infections identified increased if home sampling was available (p < .001); approximately 8 kits needed per test returned. Adverse events: None found when measured (2 studies).	Patient: ○ Consider using PDPT ○ Consider using home sampling for partners ○Consider providing additional information for partners should be considered. General: ○ Sharing responsibility between the provider and the index patient improves partner management outcomes.
Brewer (2005) Sex Transm Dis Provider referral	k = 91 studies N = unknown Study type: RCT, program evaluation Range = 1975 – 2004 Aggregated and narrative Grey literature = Yes Studies from: N America	Populations Race/ethnicity: varied Gender: unclear, >50% M GLBTQ: At least 7 reports include MSM patients, but populations primarily heterosexual. Settings and infections Settings: STD clinics STI diagnoses: CT, GC, HIV, syphilis	Provider referral: It takes about 4-5 interviews of patients in clinics to find a case of syphilis, GC or CT through DIS- based PN. It takes about 9 interviews of patients in clinics to find a case of HIV through DIS-based PN. Provider referral consistently resulted in a higher percentage of partners notified than did patient referral. Screening/testing: Confidential testing results in 2-3 times more partners notified through PN. The yield from screening (per dollar spent) is typically greater than for PN.	Provider: ○ Provider referral is more efficacious than patient-based methods ○ Intensified program PN efforts lead to decreasing incidence. General: ○ Manage resource allocation by case- finding yield and contributions to epidemiologic understanding (because PN competes for resources with other interventions and assessment)

Note. Overall N for some reviews could not be determined because some studies appeared in multiple comparisons, some studies were of institutional practice, or because individual studies were not listed with sample sizes. In these cases, we have provided a range.

PN = partner notification, CT = chlamydial infection, GC = gonorrhea, TV = trichomoniasis, grey literature = unpublished in peer-reviewed settings.

¹Data are drawn from Chapters 2 and 5 on clinical and cost effectiveness of partner notification.

²This review included surveys of institutions and practices as well as patient or provider behaviors.