Using Assisted Partner Services for HIV Testing and the Treatment of Males and Their Female Sexual Partners: Protocol for an Implementation Science Study

Kariithi, Edward; Kemunto, Emily; Lagat, Harison; Otieno, George; Wamuti, Beatrice; Katz, David A.; Obong’o, Christopher; Macharia, Paul; Bosire, Rose; Masyuko, Sarah; Mugambi, Mary; Levin, Carol; Liu, Wenjia; Paladhi, Unmesha Roy; Weiner, Bryan J.; Farquhar, Carey

doi:10.2196/27262

Cited by 14 publications

(36 citation statements)

References 26 publications

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“…This study was nested within the APS scale-up study, a larger ongoing implementation science study (R01AI134130) [ 14 ] that aimed to scale-up APS in Kisumu and Homa Bay, two counties with the highest HIV prevalence (17.5%, 19.6%, separately) in Kenya [ 1 ]. In this study, HTS providers ask women who tested HIV positive to identify their male sexual partners, provide contact information of partners, and choose one of the three referral methods (contract referral, provider referral and dual referral) after providing adequate information on all the choices.…”

Section: Methodsmentioning

confidence: 99%

“…However, neither examined acceptability of APS to the service providers and challenges of delivering APS from the providers’ standpoint. As part of a larger ongoing implementation science study [ 14 ] which aimed to determine the effectiveness, feasibility, implementation fidelity, integration, and cost of APS when integrated in existing HIV service delivery in western Kenya, we qualitatively evaluated the acceptability of APS from the perspective of HIV testing services (HTS) providers. We explored their experience of providing APS, the barriers and the facilitators, and how contextual factors influenced their experience.…”

Section: Introductionmentioning

confidence: 99%

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“It is a process” – a qualitative evaluation of provider acceptability of HIV assisted partner services in western Kenya: experiences, challenges, and facilitators

Liu

Wamuti

Owuor³

et al. 2022

BMC Health Serv Res

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Background Assisted partner service (APS) is effective for increasing HIV testing services (HTS) uptake among sexual partners of people diagnosed with HIV with rare social harm. The acceptability of APS to HTS providers is important for the quality and effectiveness of APS delivery. Within a larger ongoing implementation science study of APS in western Kenya, we qualitatively evaluated the provider acceptability of APS. Methods From May–June 2020, we conducted virtual, semi-structured in-depth interviews with 14 HTS providers recruited from 8 of 31 study health facilities in Homa Bay and Kisumu counties. Participants were selected using criteria-based purposive sampling to maximize variation on patient volume (assessed by the number of index clients tested for HIV) and APS performance (assessed by sexual partners elicitation and enrollment). Interviews inquired providers’ experiences providing APS including challenges and facilitators and the impact of contextual factors. Data were analyzed using an inductive approach. Results Overall, HTS providers found APS acceptable. It was consistently reported that doing APS was a continuous process rather than a one-day job, which required building rapport and persistent efforts. Benefits of APS including efficiency in HIV case finding, expanded testing coverage in men, and increased HIV status awareness and linkage to care motivated the providers. Provider referral was perceived advantageous in terms of independent contact with partners on behalf of index clients and efficiency in partner tracing. Challenges of providing APS included protecting clients’ confidentiality, difficulty obtaining partners’ accurate contact information, logistic barriers of tracing, and clients’ refusal due to fear of being judged for multiple sexual partners, fear of breach of confidentiality, and HIV stigma. Building rapport with clients, communicating with patience and nonjudgmental attitude and assuring confidentiality were examples of facilitators. Working in rural areas and bigger facilities, training, supportive supervision, and community awareness of APS promoted APS delivery while low salaries, lack of equipment, and high workload undermined it. Conclusions HTS providers found APS acceptable. Delivering APS as a process was the key to success. Future scale-up of APS could consider encouraging provider referral instead of the other APS methods to improve efficiency and reduce potential harm to clients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“It is a process” – a qualitative evaluation of provider acceptability of HIV assisted partner services in western Kenya: experiences, challenges, and facilitators

Liu

Wamuti

Owuor³

et al. 2022

BMC Health Serv Res

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Section: Methodsmentioning

confidence: 99%

“…This microcosting analysis was conducted within in the aPS scale-up project (NIAID R01AI134130), a collaborative implementation science study between the Ministry of Health (MOH) National AIDS and STI Control Program (NASCOP), PATH-Kenya and University of Washington, conducted in 31 health facilities in Kisumu and Homa Bay counties in western Kenya [ 14 ]. Details of the aPS scale-up project and its implementation procedures have been published [ 14 ]. The overall goal of the project was to implement and evaluate the effectiveness of aPS when integrated within routine HTS, and assess implementation outcomes including acceptability, demand, integration, implementation fidelity, and costs.…”

Section: Methodsmentioning

confidence: 99%

“…The aPS scale-up project focused on evaluating aPS as a strategy for increasing HIV testing among men [ 14 ]. Though aPS is offered to both male and female clients receiving HTS in Kenya, this project deliberately targeted adolescent girls and women and their partners to address challenges in finding men who are difficult to mobilize through other interventions and may increase the burden of HIV through risky sexual behavior if not tested and treated Briefly, female clients testing HIV-positive at participating facilities (female index clients) received information on aPS and were screened for eligibility by healthcare workers.…”

Section: Methodsmentioning

confidence: 99%

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Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study

Wamuti

Kariithi²,

Lagat³

et al. 2022

BMC Health Serv Res

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Background HIV assisted partner services (aPS), or provider notification and testing for sexual and injecting partners of people diagnosed with HIV, is shown to be safe, effective, and cost-effective and was scaled up within the national HIV testing services (HTS) program in Kenya in 2016. We estimated the costs of integrating aPS into routine HTS within an ongoing aPS scale-up project in western Kenya. Methods We conducted microcosting using the payer perspective in 14 facilities offering aPS. Although aPS was offered to both males and females testing HIV-positive (index clients), we only collected data on female index clients and their male sex partners (MSP). We used activity-based costing to identify key aPS activities, inputs, resources, and estimated financial and economic costs of goods and services. We analyzed costs by start-up (August 2018), and recurrent costs one-year after aPS implementation (Kisumu: August 2019; Homa Bay: January 2020) and conducted time-and-motion observations of aPS activities. We estimated the incremental costs of aPS, average cost per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy, cost shares, and costs disaggregated by facility. Results Overall, the number of MSPs traced, tested, testing HIV-positive, and on antiretroviral therapy was 1027, 869, 370, and 272 respectively. Average unit costs per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy were $34.54, $42.50, $108.71 and $152.28, respectively, which varied by county and facility client volume. The weighted average incremental cost of integrating aPS was $7,485.97 per facility per year, with recurrent costs accounting for approximately 90% of costs. The largest cost drivers were personnel (49%) and transport (13%). Providers spent approximately 25% of the HTS visit obtaining MSP contact information (HIV-negative clients: 13 out of 54 min; HIV-positive clients: 20 out of 96 min), while the median time spent per MSP traced on phone and in-person was 6 min and 2.5 hours, respectively. Conclusion Average facility costs will increase when integrating aPS to HTS with incremental costs largely driven by personnel and transport. Strategies to efficiently utilize healthcare personnel will be critical for effective, affordable, and sustainable aPS.

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Providing HIV‐assisted partner services to partners of partners in western Kenya: an implementation science study

Sharma,

Mambo,

Kingston

et al. 2024

J Int AIDS Soc.

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IntroductionAssisted partner services (APS), or exposure notification and HIV testing for sexual partners of persons diagnosed HIV positive (index clients), is recommended by the World Health Organization. Most APS literature focuses on outcomes among index clients and their partners. There is little data on the benefits of providing APS to partners of partners diagnosed with HIV.MethodsWe utilized data from a large‐scale APS implementation project across 31 facilities in western Kenya from 2018 to 2022. Females testing HIV positive at facilities were offered APS; those who consented provided contact information for all male sexual partners in the last 3 years. Male partners were notified of their potential HIV exposure and offered HIV testing services (HTS). Males newly testing positive were also offered APS and asked to provide contact information for their female partners in the last 3 years. Female partners of male partners (FPPs) were provided exposure notification and HTS. All participants with HIV were followed up at 12 months post‐enrolment to assess linkage‐to antiretroviral treatment (ART) and viral suppression. We compared HIV positivity, demographics and linkage outcomes among female index clients and FPPs.ResultsOverall, 5708 FPPs were elicited from male partners, of whom 4951 received HTS through APS (87% coverage); 291 FPPs newly tested HIV positive (6% yield), an additional 1743 (35.2%) reported a prior HIV diagnosis, of whom 99% were on ART at baseline. At 12 months follow‐up, most FPPs were taking ART (92%) with very few adverse events: <1% reported intimate partner violence or reported relationship dissolution. FPPs were more likely than female index clients to report HIV risk behaviours including no condom use at last sex (45% vs. 30%) and multiple partners (38% vs. 19%).ConclusionsProviding HIV testing via APS to FPP is a safe and effective strategy to identify newly diagnosed females and achieve high linkage and retention to ART and can be an efficient means of identifying HIV cases in the era of declining HIV incidence. The high proportion of FPPs reporting HIV risk behaviours suggests APS may help interrupt community HIV transmission via increased knowledge of HIV status and linkage to treatment.

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Using Assisted Partner Services for HIV Testing and the Treatment of Males and Their Female Sexual Partners: Protocol for an Implementation Science Study

Cited by 14 publications

References 26 publications

“It is a process” – a qualitative evaluation of provider acceptability of HIV assisted partner services in western Kenya: experiences, challenges, and facilitators

“It is a process” – a qualitative evaluation of provider acceptability of HIV assisted partner services in western Kenya: experiences, challenges, and facilitators

Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study

Providing HIV‐assisted partner services to partners of partners in western Kenya: an implementation science study

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