Support among persons infected with HIV for routine health department contact for HIV partner notification

Human Immunodeficiency Virus Partner Notification Services Among a Representative Sample of Young Black Men Who Have Sex With Men Demonstrates Limited Service Offering and Potential Benefits of Clinic Involvement

BACKGROUND

Partner notification (PN) is commonly offered to persons recently diagnosed with human immunodeficiency virus (HIV) to improve linkage to care and prevent onward transmission. Yet, much remains unknown about the factors associated with successful PN participation in populations at highest risk.

METHODS

Data were collected during the first 2 waves (2013-2015) of "uConnect," a population-based cohort study of young black men who have sex with men in Chicago (N = 618). Participants completed a biobehavioral survey and were tested for HIV. Among HIV-infected participants (N = 187), weighted logistic regression models examined the relationship between participant characteristics and being offered PN and providing partner names.

RESULTS

30.3% (n = 187) of the sample was HIV-positive, of which 71.7% (n = 134) were offered PN, including: 8.2% (n = 11) by the city health department; 51.5% (n = 69) by health care providers; and 40.3% (n = 54) by both. Being offered PN was significantly associated with criminal justice involvement history (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.38-4.49), volatile nitrates usage (aOR, 2.88; 95% CI, 1.20-6.94), and recent conversations with HIV outreach workers (aOR, 2.68; 95% CI, 1.25-5.77). Providing partner names was significantly associated with intermittent (aOR, 7.26; 95% CI, 1.75-30.07) and heavy (aOR, 11.47; 95% CI, 2.57-51.22) marijuana use, and being offered PN by both the city health department and health care provider (aOR, 8.36; 95% CI, 2.73-25.62).

CONCLUSIONS

A substantial proportion of HIV-diagnosed individuals were never offered PN. Being offered PN by multiple sources is associated with participation, and improved collaboration within health systems may improve participation rates.

Integrating HIV Surveillance and Field Services: Data Quality and Care Continuum in King County, Washington, 2010-2015

OBJECTIVES

To assess how integration of HIV surveillance and field services might influence surveillance data and linkage to care metrics.

METHODS

We used HIV surveillance and field services data from King County, Washington, to assess potential impact of misclassification of prior diagnoses on numbers of new diagnoses. The relationship between partner services and linkage to care was evaluated with multivariable log-binomial regression models.

RESULTS

Of the 2842 people who entered the King County HIV Surveillance System in 2010 to 2015, 52% were newly diagnosed, 41% had a confirmed prior diagnosis in another state, and 7% had an unconfirmed prior diagnosis. Twelve percent of those classified as newly diagnosed for purposes of national HIV surveillance self-reported a prior HIV diagnosis that was unconfirmed. Partner services recipients were more likely than nonrecipients to link to care within 30 days (adjusted risk ratio [RR] = 1.10; 95% confidence interval [CI] = 1.03, 1.18) and 90 days (adjusted RR = 1.07; 95% CI = 1.01, 1.14) of diagnosis.

CONCLUSIONS

Integration of HIV surveillance, partner services, and care linkage efforts may improve the accuracy of HIV surveillance data and facilitate timely linkage to care.

Next-Generation Methods for HIV Partner Services: A Systematic Review

Partner notification is a widely accepted method whose intent is to limit onward HIV transmission. With increasing use of new technologies such as text messaging, e-mail, and social network sites, there is growing interest in using these techniques for "next-generation" HIV partner services (PS). We conducted a systematic review to assess the use and effectiveness of these technologies in HIV PS. Our literature search resulted in 1343 citations, with 7 meeting inclusion criteria. We found programs in 2 domains: (1) Public Health Department usage of new technologies to augment traditional partner notification (n = 3) and (2) patient or provider-led usage of partner notification Web sites (n = 4) The health department-based efforts showed an ability to find new cases in a previously unreachable population but in the limited comparisons to traditional PS had a lower rate of successful contact. Usage data from the partner notification Web sites revealed a high total number of e-notifications sent, with less than 10% of cards sent for HIV. Clear evidence on outcomes and directly traceable utilization for these Web services was lacking. When given a choice, most clients chose to send e-notifications via text versus e-mail. Although successful notification may be lower overall, use of next-generation services provides an avenue to contact those who would previously have been untraceable. Additional research is needed to determine to what extent technology-enhanced PS improves the identification of newly infected persons as well as the initiation of new prevention interventions for HIV-negative clients within high-risk networks.

The effects of early multiple-time PN counseling on newly HIV-diagnosed men who have sex with men in Taiwan

Partner notification (PN) is an important method for controlling the AIDS epidemic worldwide. Here, we looked into the differences between two PN counseling modes for HIV (+) men who have sex with men in Taiwan. Using random assignment, we placed 42 of the 84 subjects into the experimental group where they received two sessions of PN counseling, while the control group (42) received only one session. All 84 subjects were single males with an average age of 28.06. The mean number of successful notified partner was 5.38 (SD = 3.44) in the experimental which was statistically significantly higher than 2.81 (SD = 1.62) in the control group (β = 0.650, p = 0.000). The notification success rate was 77.13 % in the experimental and 74.21 % in the control group (IRR 1.039, 95 % CI 0.83-1.30). In the experimental and control group, the average number of the partners accepted an HIV test was 1.86 (SD = 1.58) and 0.79 (SD = 0.66) (β = 0.601, p = 0.000), and 39.74 and 27.27 % of the tested partners were HIV positive (IRR 1.457, 95 % CI 0.69-3.06). The study results may be used to improve the policies and practices for PN and contact follow-up.

Opportunities for improving partner notification for HIV: results from a community-based participatory research study

To identify actionable opportunities for improving Partner Notification (PN) for HIV among men who have sex with men (MSM), we characterized the perspectives and experiences of PN among Medical Case Managers (case managers), Disease Intervention Specialists (DIS), and MSM. In partnership with an AIDS service organization and the Connecticut State Health Department, we conducted a focus group of case managers (n = 14) and in-depth interviews with DIS (n = 7) and MSM (n = 24). We found differences between MSM's and providers' (case managers and DIS) perspectives regarding (1) determinants of sexual risk behaviors; (2) considerations impacting HIV disclosure; and (3) barriers to trusting relationships between MSM and providers. Factors impacting MSM perspectives on PN were incompletely appreciated by both case managers and DIS. PN may be improved through improving provider understanding of the complexities for MSM regarding sexual risk behaviors and disclosure and transcending barriers to trusting relationships between MSM and providers.

Partner services as targeted HIV screening--changing the paradigm

OBJECTIVES

The San Francisco Department of Public Health (SFDPH) has the goal of offering HIV partner services (PS) to all individuals newly diagnosed with HIV in San Francisco. However, measuring the potential impact of these services is challenging. Building on an existing syphilis partner notification program, we developed a framework for expanding and monitoring HIV PS in San Francisco.

METHODS

We identified process and outcome measures to evaluate HIV PS in San Francisco, including the number of index patients interviewed, the proportion of named partners who had previously diagnosed HIV infection, the proportion of HIV-uninfected partners who tested through HIV PS, and the positivity rate among the partners tested. Results were recorded in a locally developed electronic surveillance and case-management system at SFDPH.

RESULTS

We examined HIV PS data from 2005-2011. In 2011, 426 new HIV diagnoses were reported, and 178 were assigned for HIV PS; of these, 124 (69.7%) patients were successfully interviewed, naming a total of 109 sex partners. Of the named partners, 34 (31.2%) had been previously diagnosed with HIV. Among the remaining named partners not known to be HIV infected, 31 (32.3%) were tested, for a positivity of 22.6% (n=7). The proportion of HIV that was newly diagnosed by a provider who participated in the citywide HIV PS program increased from 15.4% in 2005 to 69.5% in 2011.

CONCLUSIONS

As HIV PS expand, locally relevant outcome measures are increasingly important. Using these criteria, HIV PS as a targeted screening activity resulted in the identification of newly diagnosed HIV cases.

With whom did you have sex? Evaluation of a partner notification training for STI professionals using motivational interviewing

OBJECTIVE

To enhance partner notification (PN) practices in Dutch STI clinics, a PN training using motivational interviewing as core strategy was offered to STI professionals and evaluated.

METHODS

The effectiveness of PN training on professionals' attitude, self-efficacy, skills and behavior toward PN, was examined using within-subject and between-subject comparison. Before the training and at three months follow-up, a questionnaire was completed by the intervention group (n=54) and a non-random control group (n=37).

RESULTS

In the within-subject comparison, positive changes were observed in self-efficacy, skills, and PN behaviors (all p<.05), but not in attitudes toward PN. When we examined differences in change-scores between the intervention and control group, self-efficacy was no longer significant.

CONCLUSION

The PN training significantly improved PN skills and -behavior, but had no effect on professionals' attitudes or self-efficacy toward PN. The selection of a convenience control sample seems to offer a more rigorous test of hypotheses than pre-post evaluation only.

PRACTICE IMPLICATIONS

The beneficial effect of PN training of STI professionals seems to support a wider roll-out of the training to all STI clinics in the Netherlands, although effects on the number of partners notified and transmissions prevented need to be examined in future research.

Partner Referral by HIV-Infected Persons to Partner Counseling and Referral Services (PCRS) - Results from a Demonstration Project

Objective:

The objectives of this article are to determine factors associated with refusal and agreement to provide partner information, and evaluate the effectiveness of referral approaches in offering PCRS.

Methods:

Index clients from 5 sites that used 3 different PCRS approaches were interviewed to obtain demographic and risk characteristics and choice of partner referral method for PCRS. Logistic regression was used to assess factors associated with providing partner information.

Results:

The percentage of index clients who refused to provide partner information varied by site (7% to 88%). Controlling for PCRS approach, index clients who were older than 25 years, male, or reported having male-male sex in the past 12 months were more likely (p <0.01) to refuse to provide partner information. Overall, 72% of named partners referred by index clients were located and offered PCRS. The proportion of partners who were located and offered PCRS differed by referral approach used, ranging from 38% using contract referral (index clients agree to notify their partners within a certain timeframe, else a disease intervention specialist or health care provider will notify them) to 98% using dual referral (index clients notify their partners with a disease intervention specialist or provider present).

Conclusion:

Success in obtaining partner information varied by the PCRS approach used and effectiveness in locating and notifying partners varied by the referral approach selected. These results provide valuable insights for enhancing partner services.

Improving partner services by embedding disease intervention specialists in HIV-clinics

BACKGROUND/OBJECTIVES

Notifying partners of HIV-infected persons and referring them for testing and treatment is an effective method of disease control and identification of undiagnosed STD and/or HIV. To improve partner elicitation interviews, disease intervention specialists (DIS) were placed in 3 HIV clinics during 2008 and 2009.

METHODS

We reviewed the Arizona state STD surveillance database for 2007 to identify the providers (outside of the public STD clinics) reporting the highest number of syphilis cases. DIS were placed in the clinics for half a day per week (2 clinics) or on an on-call basis (1 clinic) to deliver penicillin and interview patients. We calculated changes in the number of patients interviewed, days elapsed from specimen collection to treatment (time to treatment), days elapsed from specimen collection to initial DIS contact (time to interview), and number of reported and locatable partners from these 3 clinics before and after the clinic placement of DIS.

RESULTS

Before the placement of clinic-based DIS, 219 syphilis cases were diagnosed at the 3 clinics (January 2006 through January 2008). After DIS placement, 115 syphilis cases were diagnosed (February 2008 through September 2009) for a total of 334 cases in this analysis. A greater percent of patients completed a partner elicitation interview during the period of DIS placement (94% after vs. 81% before, P = 0.001). There were increases in the average number of locatable partners (1.1 after vs. 0.6 before, P = 0.004) and an increase in the average number of partners exposed and brought to treatment (CDC Disposition A) or infected and brought to treatment (CDC Disposition C) (0.6 after vs. 0.3 before, P = 0.02), and the time to interview decreased (18 days before vs. 9 days after, P = 0.02).

CONCLUSIONS/IMPLICATIONS

Placing DIS within community HIV clinics improved partner services. STD and/or HIV programs should consider this method to improve partner notification.

Partner Notification for Gonococcal and Chlamydial Infections in Men Who Have Sex With Men: Success Is Underestimated by Traditional Disposition Codes

BACKGROUND

Recent reports evaluating partner notification (PN) efforts among men who have sex with men (MSM) have observed relatively poor outcomes. However, the validity of traditional PN disposition codes is not known, possibly leading to overly pessimistic assessments of PN outcomes.

OBJECTIVES

To evaluate PN practices among MSM with gonococcal or chlamydial infection, assess the utility of offering MSM PN assistance and compare patient self-reported PN outcomes with those recorded using Disease Intervention Specialist (DIS) disposition codes.

STUDY DESIGN

We reviewed the records of all MSM with gonococcal or chlamydial infection interviewed by Public Health-Seattle and King County for purposes of PN in 2004. Men were asked to indicate whether each of their sex partners were already notified or treated at time of interview and were offered PN assistance.

RESULTS

DIS interviewed 409 of 628 (65%) MSM reported with gonococcal or chlamydial infection. Three hundred thirteen of the 409 (76%) interviewed men provided information about their number of sex partners in the 60 days before diagnosis and specific information about 1 or more of their potentially exposed partners. These index cases reported a total of 1037 sex partners, but provided information about only 634 (61%). Two hundred thirteen of the 313 (68%) index cases reported notifying at least 1 partner. Index cases reported that 295 of all 1037 (28%) reported partners had been notified, and that 170 (16%) were treated; DIS disposition codes documented the treatment of 111 (11%) partners. Only 18 (6%) index cases requested DIS assistance contacting a partner; DIS notified and assured the treatment of 24 of the 35 (69%) partners reported by these 18 men.

CONCLUSIONS

Although MSM with gonorrhea or chlamydia seldom accept assistance notifying partners, they report higher levels of partner treatment than suggested by DIS disposition codes, with 68% indicating that they had notified at least 1 sex partner and 46% reporting that at least 1 of their partners received treated.

A novel emergency department based prevention intervention program for people living with HIV: evaluation of early experiences

BACKGROUND

HIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention. Emergency Departments (EDs) frequently care for PLWH, but do not typically endorse a prevention mission. We conducted a pilot exploratory evaluation of the first reported ED program to address the prevention needs of PLWH.

METHODS

This retrospective observational cohort evaluation reviewed program records to describe the first six months of participants and programmatic operation. Trained counselors provided a risk assessment and counseling intervention combined with three linkage interventions: i) linkage to health care, ii) linkage to case management, and iii) linkage to partner counseling and referral.

RESULTS

Of 81 self-identified PLWH who were approached, 55 initially agreed to participate. Of those completing risk assessment, 17/53 (32%, 95 CI 20% to 46%) reported unprotected anal/vaginal intercourse or needle sharing in the past six months with a partner presumed to be HIV negative. Counseling was provided to 52/53 (98%). For those requesting services, 11/15 (73%) were linked to healthcare, 4/23 (17%) were coordinated with case management, and 1/4 (25%) completed partner counseling and referral.

CONCLUSION

Given base resources of trained counselors, it was feasible to implement a program to address the prevention needs for persons living with HIV in an urban ED. ED patients with HIV often have unmet needs which might be addressed by improved linkage with existing community resources. Healthcare and prevention barriers for PLWH may be attenuated if EDs were to incorporate CDC recommended prevention measures for healthcare providers.

The effectiveness of HIV partner counseling and referral services in increasing identification of HIV-positive individuals a systematic review

Partner counseling and referral services (PCRS) are part of the spectrum of care for HIV-positive people and their sexual or needle-sharing partners. Referral includes notifying partners of exposure, after which they are (ideally) tested and receive prevention or risk reduction counseling or enter into care (if they test positive). Using The Guide to Community Preventive Services's methods for systematic reviews, the effectiveness of PCRS was evaluated, including partner notification, in identifying a population at high risk of HIV infection and in increasing testing in those populations. In this review, PCRS efforts using provider referral were found to be effective in reaching a population with a high prevalence of HIV. Nine studies qualified for the review. In these studies, a range of one to eight partners was identified per index case (a person newly diagnosed with HIV who has partners who should be notified); a mean of 67% of identified partners were found and notified of their potential exposure to HIV, and a mean of 63% of those notified were tested (previously known "positives" were not tested). Of those tested, a mean of 20% were HIV positive. Therefore, even given that not all partners could be found and notified and that some who could be found did not accept testing, 1% to 8% of people named as potentially exposed and not previously known to be HIV positive were identified as HIV positive through partner notification (although these people were not necessarily infected by the index case). Evidence was insufficient to determine whether PCRS, including partner notification, was also effective in changing behavior or reducing transmission because available studies did not generally report on these outcomes. Little empirical evidence was available to assess potential harm of the interventions, but current studies have not shown substantial harms. Based on Community Guide rules of evidence, sufficient evidence shows that PCRS with partner notification by a public health professional ("provider referral") effectively increases identification of a high-prevalence target population for HIV testing.

Sexually acquired infections: do lay experiences of partner notification challenge practice?

AIM

This paper is a report of a study to explore experiences of partner notification for syphilis from the perspectives of gay, bisexual and other men who have sex with men.

BACKGROUND

Partner notification is the 'cornerstone' of the prevention and control of sexually acquired infections. As a health strategy, it has been in use for over six decades and is employed across all continents. Its success relies almost entirely on the voluntary response of index patients in disclosing details of their sexual partners and sexual practices and the voluntary response of sexual partners who have been traced. However, internationally, few studies have explicitly explored lay experiences of partner notification.

METHOD

A purposive sample of 40 gay, bisexual and other men who have sex with men was recruited from two genitourinary clinics in the Greater Dublin area of Ireland and a variety of gay social venues. Semi-structured interviews were carried out between December 2002 and February 2004.

FINDINGS

Men's perspectives on partner notification featured three interweaving stages: on tracing sexual partners, on informing partners and on attending clinics. Participants were in favour of partner notification, but did not find it easy to comply with the demands it made on their relationships. Compliance was difficult not only because of the problem of physically tracing casual and anonymous partners, but also because of the challenge of actually notifying partners. The main incentive for contacts to attend clinics was concern for their own health and that of others. Barriers to attending were fear of being exposed to the stigma of being gay and/or having a sexually acquired infection.

CONCLUSION

There is a need to develop evidence-based methods, which are grounded in the lay experience, to support index patients in 'breaking bad news' and for continued efforts to de-stigmatize sexually acquired infections and homosexuality in the view of the general public.

A systematic review of HIV partner counseling and referral services: client and provider attitudes, preferences, practices, and experiences

OBJECTIVES

The objectives of this study were to understand client and provider attitudes, experiences, and practices regarding HIV partner notification in the United States and to help identify future research and program needs.

GOALS

The goals of this study were to synthesize the literature reporting client and provider attitudes, experiences, and practices and to identify potential negative effects of HIV partner notification.

STUDY DESIGN

This study consisted of a systematic qualitative review.

RESULTS

Clients were willing to self-notify partners and participate in provider notification, and few reported negative effects. The majority of health care providers were in favor of HIV partner notification; however, they did not consistently refer index clients to HIV partner notification programs.

CONCLUSION

Considering that clients have positive attitudes toward self- and provider referral, local HIV prevention programs need to ensure that all HIV-positive clients are offered partner notification services. Additional research is needed to assess the potential risks of notifying partners and to identify effective techniques to improve client and provider participation.

HIV-infected individuals as partners in prevention: a redefinition of the partner notification process

Over the past ten years, the advances that have turned HIV into a chronic illness have also highlighted the importance of integrating prevention and care in the fight against the epidemic. This integration involves not only the creation of new programs, but also a reexamination of the process through which services and supports are provided. In this article, HIV partner notification is used as a case example; the discussion includes: the shifting time frame within which partner notification occurs; the expanding role of HIV-positive individuals in effecting both disease management and prevention goals; the connection between partner-notification and behaviorally-based risk reduction; and the ethical implications of advances on the partner notification process. The authors argue that partner notification services must be located in the context of overall treatment for infected individuals, and demonstrate how a redefinition of the partner notification process can serve as a spring-board for ongoing prevention counseling and support.

Physicians' opinions about partner notification methods: case reporting, patient referral, and provider referral

BACKGROUND

The United States has relied upon partner notification strategies to help break the chain of infection and re-infection for sexually transmitted diseases (STD). Physicians are a vital link in the system of STD control, but little is known of physician opinions about partner notification strategies.

METHODS

We collected opinions about partner notification from a national probability sample of physicians in specialties diagnosing STDs. Physicians responded to 17 questions about three relevant forms of STD partner notification: patient based referral, provider based referral, and case reporting.

RESULTS

Exploratory factor analyses showed that responses for each form of partner notification could be grouped into four categories: perceived practice norms, infection control, patient relationships, and time/money. Multivariate analyses of the factors showed that physicians endorsed patient based referral most favourably and provider based referral least favourably.

CONCLUSION

Physicians' opinions about partner notification strategies appear to reflect objective reality in some areas, but not in others. Strategies that improve the fit between physicians' opinions and effective notification are needed: some are discussed here.