All ETDs from UAB

Advisory Committee Chair

Sibylle Kristensen

Advisory Committee Members

Eric Chamot

Rodney C P Go

Gerald McGwin Jr

Sten H Vermund

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


This dissertation puts together three closely related articles on partner referral for sexually transmitted diseases (STD). The first paper sought to understand feasibility and acceptability of partner referral for STD in less developed countries using a systematic literature review. The results summarized from 39 articles indicate that partner referral outcome was more common for spousal partners than for causal partners. Client's reported barriers included stigma and fear of abuse while infrastructural barriers included limited resources are important. Client centered counseling was found to be effective in increasing partner referral in Africa. The second paper aimed to determine if intention of partner referral are associated with partner referral among STD patients in Dhaka, Bangladesh. Results from 451 STD patients indicate that 62% had positive intention of partner referral, whereas, 27% of the 321 patients who accepted referral cards actually referred their partners. In multivariate model, partner referral intention was positively associated with positive attitudes (prevalence ratio 2.5, 95% confidence interval 1.8 - 3.6) and social norm (PR 1.7, 95% CI 1.0-3.0). STD clients with positive partner referral intention were significantly more likely to refer their partners [PR=3.2; 95% CI=1.0-9.9]. The third paper was a quasi-randomized trial to assess the role of single session counseling among STD patients in Dhaka, Bangladesh on partner referral outcome. Of the 692 patients accepted partner referral cards, 33.4% referred their partner in the counseling group compared to 26.8% in the control group. Probability of partner referral was 1.2 times higher in the counseling group [PR: 1.2 (95% CI: 0.9 -1.6)] compared to the control group but the finding was not statistically significant. The study concludes that client-centered counseling to promote partner referral in Dhaka, Bangladesh should be further developed and studied to improve its effectiveness. Our findings may help policymakers to formulate strategies to overcome barriers in implementing partner referral programs in less developed countries. Intention of index STD patients was found to be associated with actual partner referral by mediating the effect of psychosocial and demographic factors. Counseling and other intervention programs can be guided by the theory driven intervention that deals psychosocial factors to improve partner referral in Bangladesh.

Included in

Public Health Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.