PARTNER REFERRAL AS A COMPONENT OF INTEGRATED SEXUALLY-TRANSMITTED DISEASE SERVICES IN 2 RWANDAN TOWNS

Objective: To document partner referral rates at health centres with i mproved STD services, and to determine factors contributing to success ful referral. Methods: Partner referral was initiated as part of the u pgrading of STD services in primary care health facilities in two semi -urban Rwanda towns. After syndromic management of the presenting comp laint, index patients received prevention education and condom demonst ration, and were urged to refer sexual partners to the health centre f or a free examination. Partner referral coupons linked by code number to the symptomatic index patient were given to facilitatate referral; no identifying information was collected on partners from the index pa tients. Results: Three quarters of the symptomatic patients seen at th e two primary health care facilities were women. Overall, the ratio of referred partners to index patients was 26%. Only 58% of index patien ts accepted partner referral coupons. The referral rate for those who did accept coupons was 45%. Partner referral worked best for regular p artners. Most index patients and partners were married and only four i ndex patients referred more than one partner. Women index patients, es pecially when pregnant, were more successful in referring partners tha n men. Index patients who referred partners tended to be older than th ose who did not. Awareness of STD symptoms in the partner, and diagnos is of cervicitis were associated with a higher rate of partner referra l. Conclusions: Efforts to improve rates of partner referral should be gin at the clinic level with improved counselling to convince more ind ex patients of the importance of partner referral. Partner symptom rec ognition may be useful for increasing rates of partner referral. Suppl ementary strategies are needed to reach non-regular partners. When syn dromic management is used, counselling should take into account the lo wer predictive values of identifying STD in women in order to avoid pa rtner accusation. Despite limitations, patient referral of sexual part ners can be an effective strategy for reaching a population at high ri sk for STD with minimal additional investment in health worker staff t ime.