Assisted partner notification services to augment HIV testing and linkage to care in Kenya: study protocol for a cluster randomized trial

Wamuti, Beatrice; Erdman, Laura K.; Cherutich, Peter; Golden, Matthew R.; Dunbar, Matthew D.; Bukusi, David; Richardson, Barbra A.; Ng’ang’a, Anne; Barnabas, Ruanne V.; Mutiti, Peter M.; Macharia, Paul; Jerop, Mable; Otieno, Felix; Poole, Danielle; Farquhar, Carey

doi:10.1186/s13012-015-0212-6

Cited by 33 publications

(41 citation statements)

References 18 publications

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“…In the light of recent WHO guidelines promoting index‐based approaches, this finding is timely and addresses important gaps in knowledge. Most research has focused on comparing active index‐based approaches to passive ones . To the best of our knowledge, this is the first rigorous assessment evaluating an enhanced passive referral approach in a low‐resource setting within the context of routine programme delivery.…”

Section: Discussionmentioning

confidence: 99%

Enhancing an HIV index case testing passive referral model through a behavioural skills‐building training for healthcare providers: a pre‐/post‐assessment in Mangochi District, Malawi

et al. 2019

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Introduction Although knowledge of HIV positivity is a necessary step towards engagement in HIV care, more than one quarter of HIV‐positive Malawians remain unaware of their HIV status. Testing the sexual partners, guardians and children of HIV‐positive persons (index case finding or ICF) is a promising way of identifying HIV‐positive persons unaware of their HIV status. ICF can be passive where the HIV‐positive individual (index) invites a partner (or contact) for HIV testing or active where a health provider assists the index with partner notification and offers HIV testing to the partner. Strategies to improve passive ICF have not been thoroughly studied. We describe the impact of a behavioural skills‐building training to enhance healthcare workers’ (HCWs) implementation of Malawi's passive ICF programme. Methods In June 2017, HCWs from 36 health facilities in Mangochi were oriented to Malawi's ICF programme and began implementation. In February and April 2018, a total of 573 HCWs from these facilities received further training from the Tingathe Programme. The training focused on eliciting more untested sexual contacts from indexes and better equipping indexes on issuing “family referral slips” to contacts. Monthly programmatic data were abstracted from clinical registers from October 2017 to July 2018. Monthly programmatic indicators were collected from the Index Case Testing Register and the HIV Counselling and Testing Register and were entered into a data set with one record per facility per month. T‐tests were used to compare the means of these indicators. Results During the ten‐month study period, there were 200 facility‐months observed before and 124 facility‐months observed after training. The mean number of indexes identified per facility‐month remained stable after training (pre = 18.9, post = 21.2, p = 0.74), but the mean number of sexual partners listed per facility‐month (pre = 6.3, post = 10.6, p < 0.001) increased. The mean number of contacts who received HIV testing (pre = 11.1, post = 24.8, p < 0.001) and the mean number of HIV‐positive contacts identified per facility‐month (pre = 1.3, post = 2.3, p < 0.001) also increased. Conclusions A brief behavioural skills‐building training impacted a range of meaningful outcomes, including identification of HIV‐positive individuals in a passive ICF programme. Such approaches could facilitate the identification of HIV‐positive persons unaware of their HIV status, a necessary step for engagement in HIV care.

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Section: Discussionmentioning

confidence: 99%

Enhancing an HIV index case testing passive referral model through a behavioural skills‐building training for healthcare providers: a pre‐/post‐assessment in Mangochi District, Malawi

et al. 2019

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“…For this subgroup analysis, we used data from a multicentre, cluster‐randomized controlled trial of aPS in Kenya. The trial methods have been described previously . In brief, the study included 18 HIV testing sites selected either from Nyanza or Nairobi/Central region and represented both rural and urban settings.…”

Section: Methodsmentioning

confidence: 99%

“…This control group provided the passive referral standard of care in Kenya. Further details are provided in the protocol and study paper . The study population included HIV infected index participants and their sexual partners.…”

Section: Methodsmentioning

confidence: 99%

Index participant characteristics and HIV assisted partner services efficacy in Kenya: results of a cluster randomized trial

et al. 2019

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Introduction We have previously demonstrated that assisted partner services (aPS) increases HIV testing and case finding among partners of persons living with HIV (PLHIV) in a cluster randomized trial in Kenya. However, the efficacy of aPS may vary across populations. In this analysis, we explore differences in aPS efficacy by characteristics of index participants. Methods Eighteen HIV testing sites were randomized to immediate versus 6‐week delayed aPS. Participants were PLHIV (or index participants) and their sexual partners. Partners of index participants were contacted for HIV testing and linked to care if HIV positive. Primary outcomes were the number of partners per index participant who: 1) tested for HIV, 2) tested HIV positive and 3) enrolled in HIV care. We used generalized estimating equations to assess differences in aPS efficacy by region, testing location, gender, age and knowledge of HIV status. Results From 2013 to 2015, the study enrolled 1119 index participants, 625 of whom were in the immediate group. These index participants named 1286 sexual partners. Immediate aPS was more efficacious than delayed aPS in promoting HIV testing among partners in high compared to low HIV prevalence regions (Nyanza incidence rate ratio (IRR) 7.2; 95% confidence interval (CI) 5.4, 9.6 vs. Nairobi/Central IRR 3.4 95% CI 2.3, 4.8). Higher rates of partner HIV testing were also observed for index participants in rural/peri‐urban compared to urban sites (IRR 6.6; 95% CI 4.5, 9.6 vs. IRR 3.5 95% CI 2.5, 5.0 respectively), for female versus male index participants (IRR 5.8 95% CI 4.2, 7.9 vs. IRR 3.7; 95% CI 2.4, 5.8 respectively) and for newly diagnosed versus known HIV‐positive index participants (IRR 6.0 95% CI 4.2, 8.7 vs. IRR 3.3; 95% CI 2.0, 7.7 respectively). Providing aPS to female versus male index participants also had a significantly higher HIV case finding rate (IRR 9.1; 95% CI 4.0, 20.9 vs. IRR 3.2 95% CI 1.7, 6.0 respectively.) Conclusions While it is known that aPS promotes increases in HIV testing and case finding, this is the first study to demonstrate significant differences in aPS efficacy across characteristics of the index participant. Understanding these differences and their drivers will be critical as aPS is brought to scale in order to ensure all PLHIV have access to these services.

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“…Assisted partner notification, including providerinitiated partner notification, is a proven, safe, and cost-effective intervention for identifying persons with undiagnosed infection [167][168][169][170][171][172], although programmes are rarely implemented in LMIC. AHI diagnosis may facilitate more effective partner services.…”

Section: Ideal Art Regimens For Ahimentioning

confidence: 99%

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

Rutstein

Ananworanich

Fidler

et al. 2017

Journal of the International AIDS Society

118

140

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Introduction: The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI.Methods: We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years.Results and Discussion: Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI – evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting.Conclusions: There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.

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Assisted partner notification services to augment HIV testing and linkage to care in Kenya: study protocol for a cluster randomized trial

Cited by 33 publications

References 18 publications

Enhancing an HIV index case testing passive referral model through a behavioural skills‐building training for healthcare providers: a pre‐/post‐assessment in Mangochi District, Malawi

Enhancing an HIV index case testing passive referral model through a behavioural skills‐building training for healthcare providers: a pre‐/post‐assessment in Mangochi District, Malawi

Index participant characteristics and HIV assisted partner services efficacy in Kenya: results of a cluster randomized trial

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

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