O2.3 - “It’s not safe for me and what would it achieve?” Acceptability of patient referral partner notification for sexually transmitted infections to adolescents and young people in Zimbabwe
Background: Partner notification is considered integral to the management of sexually transmitted infections (STI). Patient-referral is a common partner notification strategy, particularly in resource-limited settings. It relies on index cases notifying and encouraging their partners to access treatment; however, it has shown limited efficacy. Little is understood about adolescent and young peoples’ experiences of partner notification, particularly, the risks and challenges encountered during patient-referral. A deeper understanding of the barriers and challenges of partner notification is critical to addressing the increasing rates of STIs among this population group.
Methods: This mixed methods study examined adolescent and young peoples’ experiences of engaging in the patient-referral partner notification process. All adolescent and young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered partner notification slips. Their partners could access free treatment at the service. Quantitative intervention data on partner notification slip uptake and partner treatment was collected and analysed. Youth researchers conducted in-depth interviews with 41 purposively selected adolescent and young people diagnosed with an STI to explore their experiences of partner notification. Qualitative data was analysed using thematic analysis.
Results: Among 1807 adolescent and young people (85% female) offered partner notification slips, 103 partners (5.7%) returned for treatment. Most participants described feeling ill-equipped to counsel and persuade their partners to seek treatment. Dilemmas described suggested partner notification posed considerable social risks to adolescent and young people, threatening their emotional and physical safety. Except for a minority in long-term, publicly acknowledged relationships, participants did not expect partner notification would achieve successful outcomes.
Conclusion: Partner notification exposes adolescent and young people to social, emotional, and physical harms. Low rates of partner return suggest partner notification is failing to reduce reinfection. Urgent interrogation of whether partner notification is a suitable or constructive strategy to continue to pursue with adolescent and young people is needed. Attention and investment should instead be directed toward developing parallel interventions that respond to adolescent and young peoples’ realities to prevent reinfection and interrupt onward transmission of STIs.
