HIV Partner Notification Is Effective and Feasible in Sub-Saharan Africa: Opportunities for HIV Treatment and Prevention

Abstract

Background Sexual partners of persons with newly diagnosed HIV infection require HIV counseling, testing and, if necessary, evaluation for therapy. However, many African countries do not have a standardized protocol for partner notification and the effectiveness of partner notification has not been evaluated in developing countries. Methods Individuals with newly diagnosed HIV infection presenting to STI clinics in Lilongwe, Malawi were randomized to one of three methods of partner notification: passive referral, contract referral, or provider referral. The passive referral group was responsible for notifying their partners themselves. The contract referral group was given seven days to notify their partners, after which a health care provider contacted partners who had not reported for counseling and testing. In the provider referral group, a health care provider notified partners directly. Results 240 index patients named 302 sexual partners and provided locator information for 252. Among locatable partners, 107 returned for HIV counseling and testing; 20/82 (24%; 95% CI 15 – 34%) partners returned in the passive referral arm, 45/88 (51%; 95% CI 41 – 62%) in the contract referral arm, and 42/82 (51%; 95% CI 40 – 62%) in the provider referral arm (p<0·001). Among returning partners (n=107), 67 (64%) of were HIV-infected with 54 (81%) newly diagnosed. Discussion This study provides the first evidence of the effectiveness of partner notification in sub-Saharan Africa. Active partner notification was feasible, acceptable, and effective among STI clinic patients. Partner notification will increase early referral to care and facilitate risk reduction among high-risk uninfected partners.

Partner notification for sexually transmitted infections and perception of notified partners

“…An important fact in this study was that all partner notifications were made by the index patients themselves, which may be associated with the type of relationship they have, as this is the most viable notification method for stable relationships (with affectional bond regardless of a marital relationship) when compared to casual sex (outside the context of a relationship) (13,18) . On the other hand, it may be a concern if the sexual behavior with high potential for STI transmission, in particular HIV, is focused on casual sex (4) . However, the lack of studies addressing this theme in Brazil does not allow to have a better understanding of how partners are being notified by health services.…”

“…However, despite the national recommendation methods, there is no study in the country showing how partners are notified and what strategies are currently used in health services. Improper notification is one of the main factors associated with the challenge of STI control (4)(5) , especially syphilis, whose non-treatment of partners of infected pregnant women is frequently mentioned as one of the causes of congenital syphilis in the country (6) . In the United States and in Europe, partner notification has become a strategy of HIV prevention, and it is related to the increased search for counseling and testing among sexual partners notified by index patients diagnosed with the virus (1)(2)4) .…”

“…Improper notification is one of the main factors associated with the challenge of STI control (4)(5) , especially syphilis, whose non-treatment of partners of infected pregnant women is frequently mentioned as one of the causes of congenital syphilis in the country (6) . In the United States and in Europe, partner notification has become a strategy of HIV prevention, and it is related to the increased search for counseling and testing among sexual partners notified by index patients diagnosed with the virus (1)(2)4) . Partner notification actions in case of index patients with syphilis, gonorrhea, chlamydia and HIV in most European countries are priorities and the main responsibility of specialty health providers from reference clinics (2) .…”

Perspective on Providing Partner Notification Services for HIV in Sub-Saharan Africa

“…Specifically, two recently reported trials, one each from Cameroon and Malawi, 2,3 suggestions for obtaining evidence on multiple fronts to solve this puzzle. Here is not the place to summarize this exceptional analysis of the realities on the ground, only to point out a relevant omission: nowhere in their report do the authors suggest using PN/contact tracing as a potentially useful investigatory tool to help close this "research gap" 7 and neither do the seasoned researchers.…”

“…Both historically and presently, most investigations into the HIV epidemics in sub-Saharan Africa have (surprisingly) focused almost exclusively on sexual intercourse variables and related risk markers. 9 Rarely are non-sexual modes of transmission considered or measured, a criticism that extends to the otherwise well-conducted PN trials in Cameroon and Malawi, 2,3 where named sexual partners who were identified as HIVinfected were presumed to have acquired HIV, by default, from sex. No attempt was apparently made to consider or investigate non-sexual exposures.…”