Breakdown in the expedited partner therapy treatment cascade: the role of community pharmacists

Objectives: With the increasing incidence rates of sexually transmitted infections (STI), proper treatment of individuals and their sexual partner(s) is of critical public health importance. Expedited partner therapy (EPT), an STI treatment and prevention strategy, allows healthcare providers to offer prescriptions or medications to a patient for distribution to their sexual partner(s) without evaluating the partner. To understand the implementation and uptake of EPT, we evaluated pharmacists’ knowledge and practices related to EPT in 41 EPT-permissible states in the U.S. Methods: A randomized cohort of pharmacists were invited to complete a telephone interview from November 2017 through January 2018. Descriptive statistics were calculated for each variable of interest overall and stratified by EPT-adopter status. Fisher’s exact test was used to compare categorical measures such as EPT awareness and acceptance of EPT prescriptions by EPT-adopter status. One-way analyses of variance were used to compare continuous measures. Results: We contacted a national sample of 619 pharmacies; of those, 350 responded with 147 opting to complete the survey, resulting in a 42% (n=147/350) response rate. Participating outpatient pharmacies were characterized as independent (32.7%, n=48/147), chain or commercial (65.3%, n=96/147), or academic (2%, n=3/147). The majority of pharmacists, 76.3% (n=258/338), reported no prior knowledge of EPT. At the close of our interview, 97.3% (n=142/146) of pharmacists reported they would fill an EPT prescription if they received one in the future. These findings were stable across strata defined by high or low incidence rates of chlamydia and early, mid, or late EPT-adopter status. Conclusions: Increasing STI incidence rates may be associated with a lack of knowledge and awareness amongst pharmacists of EPT as an STI treatment strategy. Pharmacists in early-adopter states, in which EPT has been permissible ≥ five years are similarly unaware of EPT, suggesting that EPT and current outreach methods to inform healthcare providers does not increase its utilization. The majority of pharmacists would fill an EPT prescription in the future, suggesting that targeted pharmacist education may improve EPT utilization. Without engagement of pharmacists in the use of EPT, we may continue to observe a rise in STI incidence rates.