1. Legal Status of Patient Delivered Partner Therapy (PDPT) in the U.S.: a National Survey of State Pharmacy Boards and Boards of Medical Examiners Uzoeshi Anukam MSII Center for AIDS & STD, University of WA Howard University College of Medicine

2. Background Patient delivered partner therapy (PDPT) is the practice of giving patients diagnosed with a curable STD medication to give to their sex partner(s) Approximately 50% of clinicians in the U.S. report having given a patient with gonorrhea or chlamydial infection medication for a partner PDPT has been shown to decrease reinfection rates in persons with gonorrhea in a RCT, and two RCTs have observed trends toward lower rates of recurrent or persistent CT in persons given PDPT The legal status of PDPT in the U.S. is ill-defined

3. Objective & Methods Objective: To define whether PDPT is legal in the U.S. Survey of directors of state boards of medicine and pharmacy in 50 states & the District of Columbia 5 questions: - Is PDPT legal? - Has the issue ever been addressed? - What organization is responsible for deciding if PDPT is legal? - Would a new law be required to make PDPT legal? - Would the board take disciplinary action against a provider who employed PDPT?

4. Response rate Medical Board Pharmacy Board Either medical or pharmacy board Any response 39 (76) 44 (86) 49 (96) Data 34 (67) 41 (80) 47 (92)

5. Is PDPT Legal? Legal Yes No Law is vague Don’t Know Ever addressed Yes No Don’t know Pharmacy Board N (%) 4 (10) 20 (49) 6 (15) 11 (27) 6 (15) 21 (51) 14 (34) Medical Board N (%) 5 (15) 14 (41) 5 (15) 10 (29) 7 (21) 16 (47) 11 (32)

6. Legal Illegal Unknown White = No response Disagreement med & pharm boards Legality of PDPT

7. Frequency of whether the issue of PDPT had ever been addressed by medical or pharmacy boards by perceived legal status Legal in state Yes No Law is vague Don’t Know Pharmacy Board (n=41) N (%) 2 (50) 4 (20) 0 Medical Board (n=34) N (%) 4 (80) 1 (7) 1 (20) 1 (10)

8. Agency responsible for deciding if PDPT is legal among areas in which practice was not considered legal Agency Medical board Pharm board Dept. Health Attorney general State legislature Don’t know Pharmacy Board (n=37)* N (%) 21 (57) 8 (22) 7 (19) 1 (3) 2 (5) 3 (8) Medical Board (n=29)* N (%) 15 (51) 9 (31) 3 (10) 0 6 (20) * 5 pharmacy boards and 7 medical boards indicated more than one agency would share responsibility

9. Would a new law be required? Percent

10. Would enforcement action be taken? Percent

11. Summary PDPT is clearly defined as being legal in 4 states (CA, WA, CO, TN). Two (CA, TN) have specific laws on PDPT, and 2 (CO, WA) have written ruling on the issue without specific laws. The legal status of PDPT in most other areas is ill-defined Many boards of pharmacy & medicine regard PDPT as illegal, though most have never addressed the issue. Some believe persons prescribing PDPT could be subject to legal action Most boards of pharmacy & medicine believe new laws would be required to clearly establish the practice as being lawful.

12. Conclusions Although PDPT is common throughout the U.S. and several studies suggest the practice can improve partner notification outcomes, the legal status of PDPT is ill-defined and the practice if often considered unlawful. If PDPT is to be promoted nationally, it will need to be explicitly defined as being legal. This will likely require new laws or written rulings from relevant professional, legal or public health agencies.

13. Center for AIDS & STD, UW Matthew R. Golden H. Hunter Handsfield WA State Pharmacy Board Donald Williams Contributors & Support Support UW NIH STD CRC AI31448 NIAID K23 AI01846-02.