Summary of findings for the main comparison. Enhanced patient referral compared with simple patient referral for partner notification for STIs, including HIV.
| Enhanced patient referral compared with simple patient referral for partner notification for STIs, including HIV | ||||||
| Health problem: partner notification for STIs, including HIV Settings: people in rural and urban areas, given a diagnosis of STI (clinically or by a laboratory) in health services Intervention: enhanced patient referral Comparison: simple patient referral | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Simple patient referral | Enhanced patient referral | |||||
| Re‐infection in index patient ‐ home sampling vs. simple patient referral Follow‐up: 12 months | Study population | RR 2.14 (0.91 to 5.05) | 220 (1 study) | ⊕⊕⊝⊝ low1,2 | ||
| 64 per 1000 | 136 per 1000 (58 to 321) | |||||
| Moderate | ||||||
| 64 per 1000 | 137 per 1000 (58 to 323) | |||||
| Re‐infection in index patient ‐ information booklet vs. simple patient referral Follow‐up: 8 weeks | Study population | RR 0.55 (0.22 to 1.33) | 942 (2 studies) | ⊕⊕⊝⊝ low3,4 | ||
| 180 per 1000 | 99 per 1000 (40 to 239) | |||||
| Moderate | ||||||
| 156 per 1000 | 86 per 1000 (34 to 207) | |||||
| Re‐infection in index patient ‐ patient referral (DIS/health advisor) vs. patient referral (nurse) Follow‐up: 6 weeks | Study population | RR 0.35 (0.01 to 8.51) | 140 (1 study) | ⊕⊕⊝⊝ low5 | ||
| 14 per 1000 | 5 per 1000 (0 to 118) | |||||
| Moderate | ||||||
| 14 per 1000 | 5 per 1000 (0 to 119) | |||||
| Re‐infection in index patient ‐ disease‐specific website vs. simple referral Follow‐up: 1 weeks | Study population | RR 3.12 (0.17 to 58.73) | 105 (1 study) | ⊕⊕⊝⊝ low6 | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Moderate | ||||||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Re‐infection in index patient ‐ additional counselling vs. simple patient referral Follow‐up: 6 months | Study population | RR 0.49 (0.27 to 0.89) | 600 (1 study) | ⊕⊕⊕⊝ moderate7 | ||
| 101 per 1000 | 50 per 1000 (27 to 90) | |||||
| Moderate | ||||||
| 101 per 1000 | 49 per 1000 (27 to 90) | |||||
| The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DIS: disease intervention specialist; RR: risk ratio; STI: sexually transmitted infection. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Method of allocation concealment was not reported. 70% completed follow‐up, some were lost to follow‐up and some withdrew from the study, reasons for withdrawal were not reported. Study was not blinded. 2 Assuming alpha of 0.05 and beta of 0.2. For relative risk reduction of 20% with best estimate of control event rate of 0.2 approximately 3000 participants were required. The total sample size was 220 and did not meet the optimal information size. 3 High attrition rate and no information given on method of allocation concealment in one of the studies. Different methods were used for outcome assessment 4 I2 = 76% (P value = 0.06) and minimal overlap of CIs. 5 Sample size less than 400, there were very few events and CIs around both relative and absolute estimates include both appreciable benefit and appreciable harm. 6 Sample size was very small and optimal information size was not met. There were very few events and CIs overlapped, therefore, no effect both for absolute and relative estimates. 7 Risk for selective reporting and unclear method of allocation concealment.