Preferences for Expedited Partner Therapy Among Adolescents in an Urban Pediatric Emergency Department A Mixed-Methods Study Zohar Shamash, MD,* Marina Catallozzi, MD, MSCE,† Peter S. Dayan, MD, MSc,* and Lauren S. Chernick, MD, MSc* Objectives: Expedited partner therapy (EPT) refers to treating sexual partners of patients with sexually transmitted infections by providing pre- scriptions or medications to give to their partners. Expedited partner ther- apy is not routinely prescribed in the emergency department (ED). Our objective was to explore adolescent preferences for EPT use in the ED. Methods: We conducted a mixed-methods study using surveys and semistructured interviews in one urban ED. Sexually active patients aged 15 to 19 years completed an anonymous survey eliciting (1) sexual history and risky sexual behaviors, (2) preferences for partner notification when hypothetically testing positive for an STI, and (3) preferences for EPT. A subsample of survey respondents participated in the interviews, which were conducted until no new perspectives emerged. Investigators analyzed interviews using thematic analysis. Results: A total of 247 participants completed surveys; the majority were female (183/247, 74%), Hispanic (209/243, 86%), and did not use a con- dom at last intercourse (129/243, 53%). Two thirds of participants (152/ 236, 64%) did not prefer EPT for partner notification. Preference for EPT was not associated with sex, age, ethnicity, condom use, a steady sex- ual partner, or STI history. Qualitative data from both surveys and inter- views revealed the following reasons for not preferring EPT: concern for partner safety, importance of determining partner STI status, perceived benefit of clinical interaction, and partner accountability. Reasons for pre- ferring EPT included increased treatment accessibility and convenience. Conclusions: The majority of adolescent patients in a pediatric ED did not prefer EPT. Emergency department practitioners should address com- mon concerns regarding EPT to increase EPT adherence if prescribed. Key Words: expedited partner therapy, sexually transmitted infection, adolescent sexual health (Pediatr Emer Care 2019;00: 00–00) R ates of chlamydia and gonorrhea are rising in the United States, with almost 2 million cases diagnosed annually. 1 Nearly half of all newly diagnosed sexually transmitted infections (STIs) occur in young adults and adolescents. 2 Sexually transmitted infections af- fect 1 in 4 adolescent females and reinfection rates are high. 3–5 Many adolescents are at high risk for contracting STIs because they have unprotected intercourse, are biologically more susceptible to infection, engage in relationships of limited duration, and face multiple obstacles to accessing health care. 6 Partner notification is the practice of identifying sexual part- ners, informing partners of STI exposure, ensuring partners re- ceive STI evaluation and treatment, and providing education about STI prevention. 7 Methods of partner notification include patient/partner referral (patient informs their partner about their infection and is advised to seek testing and treatment), provider refer- ral (provider tells the partner), contract referral (health service staff tell partners who do not seek timely medical care), and expedited partner therapy (EPT). Expedited partner therapy is the practice of providing treatment to patients' sexual partners without a medical evaluation or clinical assessment. Typically, a provider distributes medication or a prescription to the infected patient to be given to their exposed sexual partner (patient-delivered partner therapy) along with written preven- tion information. Large clinical trials have shown that use of EPT re- sults in slightly improved or equivalent rates of reinfection in both adults and adolescents. 8–10 Expedited partner therapy is legal in over 40 states and is a recommended practice for chlamydia and gonorrhea by the American College of Obstetrics and Gynecology, Centers for Disease Control and Prevention, and the Society for Adolescent Health and Medicine. 7,11,12 Despite the use of EPT in the outpatient setting, little data are available on the use of EPT in the emergency department (ED). 13,14 Emergency departments provide medical care for more than 18 million adolescents annually, the majority being poor, minority, and with many unmet health care needs. 15,16 Studies show that STI rates among adolescent ED patients can range from 4% to 26%, depending on symptomatology. 17–19 As a result, researchers are studying new ways to improve diagnostic testing and timely treatment of STIs in the ED setting. 17 As STI detection rates improve in the ED and providers increasingly need to treat patients testing positive for chlamydia and gonorrhea, it re- mains unclear if and how EPT can fit into the ED workflow. One important factor regarding the feasibility of EPT imple- mentation in the ED is adolescent perceptions of EPT. Although literature from the outpatient setting suggests that adolescents have mixed attitudes toward EPT, adolescents in the ED may differ. 20–23 Therefore, our objective was to use a mixed-methods approach to explore adolescent preferences for EPT use in the ED. METHODS We performed a mixed methods cross-sectional study using a written questionnaire and semistructured individual interviews in a pediatric ED in New York City. This ED cares for more than 50,000 patients annually and serves a population of predomi- nantly Hispanic, low socioeconomic status, and publicly insured patients. The local institutional review board approved the study, From the *Division of Pediatric Emergency Medicine, Department of Pediat- rics, Columbia University Medical Center; and †Division of Child and Adolescent Health, Departments of Pediatrics and Population and Family Health, Mailman School of Public Health, New York, NY. Presented at the 2015 Society of Adolescent Health and Medicine Annual Conference, Los Angeles, CA, March 11, 2015; and 2015 Pediatric Academic Society Annual meeting, San Diego, CA, April 27, 2015. Disclosure: The authors declare no conflict of interest. L.S.C. was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number KL2TR001874. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Reprints: Lauren S. Chernick, MD, MSc, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New Year, NY 10032 (e‐mail: lc2243@columbia.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.pec-online.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161 ORIGINAL ARTICLE Pediatric Emergency Care • Volume 00, Number 00, Month 2019 www.pec-online.com 1 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.