Table 2. Synthesis of review recommendations and associated STD prevention program roles.

	Common recommendations	Potential STD Prevention program roles
Patient referral orientation	Counseling enhancements to basic patient referral instruction ○ Can be from a mid-level provider or trained counselor ○ Should be based on a sound and comprehensive sexual history ○ Interactive counseling is superior to didactic instruction EPT, typically in the form of PDPT, should be a component of a STD prevention program.	Run an active DIS-based partner services program as a core function – HIV and syphilis: ○ Provide specialty assistance for important or hard to reach cases ○ Generate epidemiology for general STD prevention ○ Increase the value of HIV case-finding through linkage to care ○ STD clinics as models of excellence – provide wrap-around services for PN interventions primarily operated outside public clinics (e.g., PDPT) Provide rules, technical assistance, coordination/collaboration or (as permitted) advice on policy-making for: ○ EPT/PDPT ○ Follow-up with patients to assess PN ○ Interactive counseling for patient referral ○ Components of a sexual history or sexual health examination Provide and assure use of good-quality information on: ○ Referral cards ○ Counseling content (including with PDPT) Cost monitoring and resource allocation models ○ How much can be done through other clinical settings and for whom, and which infections? Research and Evaluation (e.g., Ql evaluations) ○ Focus on efficacious components of interventions for efficient intervention ○ Focus on combinations of PN interventions for effective intervention ○Focus on context of PN intervention for impact
Provider referral orientation	Because DIS are typically both more efficacious and costly than patients as agents of referral, they can serve a specialty role: ○ Partners who patients are unlikely to notify ○ Partners who are likely to be key to transmission ○Clusters (hidden infections and epidemiologically useful) ○ Network investigations can be useful in real time and increase the effectiveness of partner notification, especially over time. Provider referral for HIV identifies enough new positives to make it worthwhile as a public health activity. ○ Linkage to care is a substantial benefit
General	Partner notification finds a higher than average proportion of infected persons (GC, CT, HIV, syphilis) ○ But screening and testing have yielded more cases Increasing the proportion of partners treated through enhanced referral is cost-effective ○ More so than increasing screening Use communication technology ○ Often population-specific Community-level RCT needed for population-level infection management ○ Control groups are often “active,” so choose comparisons carefully