Neighborhood Social Vulnerability and Access to Expedited Partner Therapy Prescriptions: A Secret Shopper Audit Survey

BackgroundSexually transmitted infections (STIs) disproportionately impact populations with higher social vulnerability. Expedited Partner Therapy (EPT), which allows the treatment of partners without requiring a medical visit, reduces STI reinfection rates and expands treatment access for underserved groups. However, EPT remains underutilized, particularly in the electronic prescription era, which introduces logistical complexities. Previous studies highlight low pharmacist awareness of EPT, but few have assessed its real world availability in pharmacies or how accessibility varies by socioeconomic subcomponent of the Social Vulnerability Index (SVI). ObjectiveThis study aimed to evaluate pharmacist awareness and willingness to dispense electronic, nameless EPT prescriptions in New York City (NYC) pharmacies and examine how these outcomes vary by the socioeconomic factors of the pharmacys location. Study DesignA cross-sectional study of 347 randomly sampled NYC pharmacies was conducted using a telephone-based secret shopper approach. Research associates posed as patients seeking to fill hypothetical EPT prescriptions to assess pharmacist awareness, willingness to dispense, and insurance acceptability. Multivariable logistic regression models evaluated the association between EPT awareness and willingness with SVI, adjusting for pharmacy type, neighborhood location, and local chlamydia rates. ResultsAmong surveyed pharmacies, 40% (134/335) of pharmacists were aware of EPT, and only 30% (100/333) were willing to fill nameless prescriptions. Non-chain pharmacies were significantly less likely to be aware of EPT compared to national chains (34% vs. 54%, p=0.02). The most common dispensing approach was filling prescriptions under the index patients name (34%, 114/335), with most pharmacies (86%, 179/208) accepting insurance. Only 30% (100/333) of pharmacists were willing to dispense nameless EPT prescriptions. Most pharmacists methods of dispensing EPT prescriptions did not follow NY state EPT guidelines (54%, n=113). The most frequent reasons for refusal included unfamiliarity with EPT (62%, 66/107) and the incorrect belief that patient names were legally required (28%, 30/107). Adjusted regression showed increased odds of awareness of EPT in areas with the highest socioeconomic SVI quartile compared to the lowest quartile (odds ratio 3.7; 95% CI 1.4-10.8), though willingness to fill prescriptions did not differ by SVI (p=0.35). ConclusionDespite higher pharmacist awareness of EPT in more socioeconomically vulnerable areas, willingness to dispense nameless prescriptions remains low across NYC pharmacies. Independent pharmacies demonstrated particularly low awareness and engagement with EPT. These findings underscore the need for targeted pharmacist education, system-level interventions to streamline EPT dispensing, and enhanced training to ensure guideline adherence, particularly in high-need areas. Addressing these barriers could reduce STI disparities and improve public health outcomes.