Partner Services as Targeted HIV Screening—Changing the Paradigm

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.

Partner Services in Sexually Transmitted Disease Prevention Programs

“…Partners of HIV index patients have increased rates of undiagnosed HIV (and often other STDs), and provider referral is a relatively effective means of assuring that those partners are found and evaluated, analogous to targeted screening. 37 Because the value of bringing an HIV-infected person to treatment is so high, provider referral is cost-effective even though it is a costly intervention. It can be made more cost-effective if other services are incorporated into care, as long as the costs and benefits are aligned from the perspective of policy (i.e., that the costs of provider referral for HIV are aligned with the total benefits of retention in care, social services, etc.…”

HIV Testing and Positivity Patterns of Partners of HIV-Diagnosed People in Partner Services Programs, United States, 2013-2014

“…One indication of success was the high proportion of partners tested for HIV (75.8%) compared with the rates reported by other partner services programs (range, 50%-63%). 11,13,14 However, there is room for improvement. Nearly 25% of partners were not tested, implying that they were potentially at risk for getting infected (if negative) or exposing their other partners to infection (if positive).…”

Assisted partner services for HIV case-finding

“…3 Partner services fit into a model of case-finding through screening because the approach is a type of targeted screening in networks of infected and exposed people. 4 Partner services have not been included in HIV prevention programmes in sub-Saharan Africa. Although partner or family testing of individuals diagnosed with HIV and disclosure of infection are within the standard of care, health facilities often take a passive approach and focus on the immediate family or household, and do not routinely follow up patients to ensure that all of their contacts have been tested.…”