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Cope AB, Bernstein KT, Matthias J, Rahman M, Diesel JC, Pugsley RA, Schillinger JA, Chew Ng RA, Klingler EJ, Mobley VL, Samoff E, Peterman TA. Effectiveness of Syphilis Partner Notification After Adjusting for Treatment Dates, 7 Jurisdictions. Sex Transm Dis 2022; 49:160-165. [PMID: 34310526 PMCID: PMC9380961 DOI: 10.1097/olq.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Disease intervention specialists (DIS) prevent syphilis by ensuring treatment for patients' sex partners through partner notification (PN). Different interpretations of how to measure partners treated due to DIS efforts complicates PN evaluation. We measured PN impact by counting partners treated for syphilis after DIS interviewed the patient. METHODS We reviewed data from early syphilis cases reported during the 2015-2017 period in 7 jurisdictions. We compared infected partners brought to treatment using the following: (1) DIS-assigned disposition codes or (2) all infected partners treated 0 to 90 days after the patient's interview (adjusted treatment estimate). Stratified analyses assessed patient characteristics associated with the adjusted treatment estimate. RESULTS Disease intervention specialists interviewed 23,613 patients who reported 20,890 partners with locating information. Many of the 3569 (17.1%) partners classified by DIS as brought to treatment were treated before the patient was interviewed. There were 2359 (11.3%) partners treated 0 to 90 days after the patient's interview. Treatment estimates were more consistent between programs when measured using our adjusted estimates (range, 6.1%-14.8% per patient interviewed) compared with DIS-assigned disposition (range, 6.1%-28.3%). Treatment for ≥1 partner occurred after 9.0% of interviews and was more likely if the patient was a woman (17.9%), younger than 25 years (12.6%), interviewed ≤7 days from diagnosis (13.9%), HIV negative (12.6%), or had no reported history of syphilis (9.8%). CONCLUSIONS Counting infected partners treated 0 to 90 days after interview reduced variability in reporting and facilitates quality assurance. Identifying programs and DIS who are particularly good at finding and treating partners could improve program impact.
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Affiliation(s)
- Anna Barry Cope
- Centers for Disease Control and Prevention, Atlanta, GA
- North Carolina Department of Health and Human Services, Raleigh, NC
| | | | - James Matthias
- Centers for Disease Control and Prevention, Atlanta, GA
- Florida Department of Health, Tallahassee, FL
| | - Mohammad Rahman
- Centers for Disease Control and Prevention, Atlanta, GA
- Louisiana Department of Health, New Orleans, LA
| | - Jill C. Diesel
- Michigan Department of Health and Human Services, Detroit, MI
| | - River A. Pugsley
- Centers for Disease Control and Prevention, Atlanta, GA
- Virginia Department of Health, Richmond, VA
| | - Julia A. Schillinger
- Centers for Disease Control and Prevention, Atlanta, GA
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Rilene A. Chew Ng
- Centers for Disease Control and Prevention, Atlanta, GA
- San Francisco Department of Public Health, San Francisco, CA
| | - Ellen J. Klingler
- New York City Department of Health and Mental Hygiene, New York City, NY
| | | | - Erika Samoff
- North Carolina Department of Health and Human Services, Raleigh, NC
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Abstract
BACKGROUND There is a high level of coinfection with human immunodeficiency virus (HIV) among persons diagnosed with syphilis in the United States. Public health workers at state and local health departments help inform exposed partners to sexually transmitted disease (STD)/HIV infections to facilitate early testing and treatment (partner services). The federal initiative, Ending the HIV Epidemic (EHE), identifies 4 key strategies: diagnose, treat, prevent, and respond. This study describes the contributions of syphilis partner services to the EHE strategies in a county prioritized by the EHE plan. METHODS A retrospective record review of reported early syphilis cases (less than 1 year's duration) between 2016 and 2018 in the Indianapolis area was conducted to determine the extent of new HIV diagnoses, retention in HIV care, and other evidence-based HIV prevention interventions occurring after provision of syphilis partner services. RESULTS A total of 752 partners to early syphilis were attempted to be notified of exposure. There were 1,457 case patients and partners that received STD/HIV prevention counseling; 400 partners received STD treatment, 352 partners learned their HIV status, and 22 received new HIV diagnoses, with 68% retained in medical care and 60% virally suppressed. Two thirds of partner services were completed within 21 days. New HIV positivity among partners to HIV-negative syphilis case patients was 3.5% and 14% among HIV-positive syphilis case patients. CONCLUSIONS Partner services for syphilis was an effective method of addressing the EHE strategies, resulting in persons at risk tested, STD treatment provided, behavioral prevention counseling provided, and new HIV cases identified, leading to retention in medical care and viral suppression.
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Mase WA, Hansen AR, Smallwood SW, Shah G, Peden AH, Mulherin T, Bender K. Disease Intervention Specialist Education for the Future: An Analysis of Public Health Curricula. Public Health Rep 2018; 133:738-748. [PMID: 30304646 DOI: 10.1177/0033354918792014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The objectives of this study were to (1) determine the degree of alignment between an existing public health curricula and disease intervention specialist (DIS) workforce training needs, (2) assess the appropriateness of public health education for DISs, and (3) identify existing curriculum gaps to inform future DIS training efforts. METHODS Using the iterative comparison analysis process of crosswalking, we compared DIS job tasks and knowledge competencies across a standard Council on Education for Public Health (CEPH)-accredited bachelor of science in public health (BSPH) and master of public health (MPH) program core curricula offered by the Georgia Southern University Jiann-Ping Hsu College of Public Health. Four researchers independently coded each DIS task and competency as addressed or not in the curriculum and then discussed all matches and non-matches between coders. Researchers consulted course instructors when necessary, and discussion between researchers continued until agreement was reached on coding. RESULTS The BSPH curriculum aligned with 75% of the DIS job tasks and 42% of the DIS knowledge competencies. The MPH core curriculum aligned with 55% of the job tasks and 40% of the DIS knowledge competencies. Seven job tasks and 9 knowledge competencies were considered unique to a DIS and would require on-the-job training. CONCLUSIONS Findings suggest that an accredited public health academic program, grounded in CEPH competencies, could address multiple components of DIS educational preparation. Similar analyses should be conducted at other CEPH-accredited schools and programs of public health to account for variations in curriculum.
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Affiliation(s)
- William A Mase
- 1 Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Andrew R Hansen
- 1 Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Stacy W Smallwood
- 1 Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Gulzar Shah
- 1 Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Angela H Peden
- 1 Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Ted Mulherin
- 1 Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Kaye Bender
- 2 Public Health Accreditation Board, Alexandria, VA, USA
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Scale-up and case-finding effectiveness of an HIV partner services program in Cameroon: an innovative HIV prevention intervention for developing countries. Sex Transm Dis 2014; 40:909-14. [PMID: 24220349 DOI: 10.1097/olq.0000000000000032] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Partner services (PSs) are a long-standing component of HIV control programs in the United States and some parts of Europe. Small randomized trials suggest that HIV PS can be effective in identifying persons with undiagnosed HIV infection. However, the scalability and effectiveness of HIV PS in low-income countries are unknown. METHODS We used data collected from 2009 to 2010 through a large HIV PS program in Cameroon to evaluate HIV PS in a developing country. HIV-positive index cases diagnosed in antenatal care, voluntary counseling and testing, and inpatient facilities were interviewed to collect information on their sexual partners. Partners were contacted via telephone or home visit to notify, test, and enroll those found to be HIV positive in medical care. RESULTS Health advisors interviewed 1462 persons with HIV infection during the evaluation period; these persons provided information about 1607 sexual partners. Health advisors notified 1347 (83.8%) of these partners, of whom 900 (66.8%) were HIV tested. Of partners tested, 451 (50.1%) were HIV positive, of whom 386 (85.6%) enrolled into HIV medical care. An average 3.2 index cases needed to be interviewed to identify 1 HIV case. CONCLUSIONS HIV PS can be successfully implemented in a developing country and is highly effective in identifying persons with HIV infection and linking them to care.
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Bernstein KT, Stephens SC, Moss N, Scheer S, Parisi MK, Philip SS. Partner services as targeted HIV screening--changing the paradigm. Public Health Rep 2014; 129 Suppl 1:50-5. [PMID: 24385649 DOI: 10.1177/00333549141291s108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Kyle T Bernstein
- San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, CA ; University of California at Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA
| | - Sally C Stephens
- San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, CA
| | - Nicholas Moss
- San Francisco Department of Public Health, HIV Prevention Section, San Francisco, CA
| | - Susan Scheer
- San Francisco Department of Public Health, HIV Epidemiology Section, San Francisco, CA
| | - Maree Kay Parisi
- San Francisco Department of Public Health, HIV Epidemiology Section, San Francisco, CA
| | - Susan S Philip
- San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, CA
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Emerson B, Plough K. Detection of acute HIV-1 infections utilizing NAAT technology in Dallas, Texas. J Clin Virol 2013; 58 Suppl 1:e48-53. [PMID: 23999031 DOI: 10.1016/j.jcv.2013.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The detection of an acute human immunodeficiency virus infection (AHI) is vital in the fight against the spread of HIV to uninfected partners. Detection early after transmission is critical because the virus is replicating at a high level and is undetectable by serological markers. Nucleic acid amplification testing can detect HIV-1 RNA 10-12 days after exposure. OBJECTIVE Provide Dallas County Public Health Department the ability to detect an AHI and maintain a three day turn-around-time for a reactive specimen. STUDY DESIGN The population includes patients requesting HIV testing at various clinics throughout the state of Texas. Analyze various pool sizes for the pooling of specimens with the Aptima HIV-1 RNA qualitative assay to detect an acute HIV infection. Modify the HIV testing algorithm to include the detection of an acute HIV infection without delaying reporting results to original submitters. Perform a study to compare the detection of HIV in various HIV assays (3rd generation EIA assay, 4th generation EIA assay, HIV-1 RNA NAAT). Perform public health follow-up on patients who are confirmed to have an acute HIV infection with a goal of preventing the spread to uninfected partners. RESULTS A pooling protocol was validated and performed concurrently with the EIA to maintain a reactive result released after three days of collection. Of the 148,888 (2009-2012) specimens screened for HIV, 161 AHIs were detected and the public health follow-up identified an additional 13 new HIV infections that had been a contact to one of the AHIs. CONCLUSION Without the advancement in technology, patients could have received a negative or indeterminate test prior to implementing the NAAT, resulting in a delay in diagnosis and potential spread to uninfected partners. Improving the detection of an AHI is crucial in preventing the spread of the virus.
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Affiliation(s)
- Brian Emerson
- 2377 N. Stemmons Fwy. Ste 100, Dallas, TX 75207, United States.
| | - Kelly Plough
- 2377 N. Stemmons Fwy. Ste 100, Dallas, TX 75207, United States.
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Katz DA, Hogben M, Dooley SW, Golden MR. Increasing public health partner services for human immunodeficiency virus: results of a second national survey. Sex Transm Dis 2011; 37:469-75. [PMID: 20661113 DOI: 10.1097/olq.0b013e3181e7104d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent US national efforts taken to prevent human immunodeficiency virus (HIV) infection have emphasized HIV case-finding, including partner services (PS). METHODS We collected data on HIV PS procedures and outcomes in 2006 from health departments in US metropolitan areas with the highest number of cases of acquired immunodeficiency syndrome, gonorrhea, chlamydial infection, and primary and secondary syphilis, and compared our results with the data collected through a similar study carried out in 2001. RESULTS Of the 71 eligible jurisdictions, 51 (72%) participated in this study. In 2006, health departments interviewed 11,270 (43%) of the 26,185 persons with newly reported HIV, which was an increase from the 32% reported in 2001 (P < 0.01). Among 10,498 potentially exposed partners, 2228 (21%) had been previously diagnosed with HIV, 803 (8%) were newly HIV-diagnosed, 3337 (32%) tested HIV-negative, and 4130 (39%) were not successfully notified, were notified but refused HIV testing and denied previous diagnosis, or did not have an outcome recorded. Combining data from all jurisdictions, public health staff needed to interview 13.6 persons with HIV to identify one new case of infection; this number was unchanged from 2001 (13.8; P = 0.75). CONCLUSION In the United States, the proportion of persons diagnosed with HIV receiving PS has increased since 2001, whereas HIV case-finding yields have remained stable. Despite this, most people newly diagnosed with HIV still do not receive PS.
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Affiliation(s)
- David A Katz
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA.
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