Opt-Out Referral of Men Who Have Sex With Men Newly Diagnosed With HIV to Partner Notification Officers: Results and Yield of Sexual Partners Being Contacted

Peer-mediated HIV assisted partner services to identify and link to care HIV-positive and HCV-positive people who inject drugs: a cohort study protocol

INTRODUCTION

Targeted, tailored interventions to test high-risk individuals for HIV and hepatitis C virus (HCV) are vital to achieving HIV control and HCV microelimination in Africa. Compared with the general population, people who inject drugs (PWID) are at increased risk of HIV and HCV and are less likely to be tested or successfully treated. Assisted partner services (APS) increases HIV testing among partners of people living with HIV and improves case finding and linkage to care. We describe a study in Kenya examining whether APS can be adapted to find, test and link to HIV care the partners of HIV-positive PWID using a network of community-embedded peer educators (PEs). Our study also identifies HCV-positive partners and uses phylogenetic analysis to determine risk factors for onward transmission of both viruses.

METHODS

This prospective cohort study leverages a network of PEs to identify 1000 HIV-positive PWID for enrolment as index participants. Each index completes a questionnaire and provides names and contact information of all sexual and injecting partners during the previous 3 years. PEs then use a stepwise locator protocol to engage partners in the community and bring them to study sites for enrolment, questionnaire completion and rapid HIV and HCV testing. Outcomes include number and type of partners per index who are mentioned, enrolled, tested, diagnosed with HIV and HCV and linked to care.

ETHICS AND DISSEMINATION

Potential index participants are screened for intimate partner violence (IPV) and those at high risk are not eligible to enrol. Those at medium risk are monitored for IPV following enrolment. A community advisory board engages in feedback and discussion between the community and the research team. A safety monitoring board discusses study progress and reviews data, including IPV monitoring data. Dissemination plans include presentations at quarterly Ministry of Health meetings, local and international conferences and publications.

TRIAL REGISTRATION NUMBER

NCT03447210, Pre-results stage.

Developing HIV assisted partner notification services tailored to Mexican key populations: a qualitative approach

Background

Assisted partner notification services (APNS) may increase HIV testing, early diagnosis, and treatment, but they are not formally implemented in Mexico, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transwomen (TW). This study aimed to explore the awareness of and need for HIV partner notification, as well as to outline potential strategies for APNS based on identified barriers and facilitators.

Methods

We conducted semi-structured interviews to explore partner notification with MSM, TW, and counselors. Afterwards, brainstorm sessions were carried out to produce strategies for implementing APNS.

Results

Most participants reported experiences with informal partner notification and serostatus disclosure, but not with APNS. Only one counselor indicated assisting notification systematically. The main barriers for notifying or disclosing mentioned by both MSM and TW included fear of (violent) reactions, discrimination and lacking contact information of casual partners. Participants thought it was easier to inform a formal partner, conditional of being well informed about HIV. Given current stigma and lack of awareness, it was suggested that APNS should be preceded by HIV awareness efforts, and be provided by counselors or peers to mitigate potential rejection or violent reactions.

Conclusions

While APNS are not formally implemented in Mexico, all participants supported the service, indicating that APNS could potentially enhance early HIV diagnosis in Mexico. Strategies to implement such services need to be flexible addressing the individual needs of participants, guaranteeing the safety of more vulnerable participants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10612-3.

Using electronic communication technologies for improving syphilis partner notification in Chile: healthcare providers' perspectives - a qualitative case study

Background Partner notification (PN) in Australia has been studied and improved in recent decades. International researchers have highlighted the use of electronic communication technologies to assist PN (Internet partner notification or IPN). Using the Australian experience as an example, the aim of this study is to explore clinicians' perspectives on the use of specialised websites, such as Let them know, to facilitate PN in the Chilean context.

METHODS

Semi-structured interviews were conducted with healthcare providers (HCPs) in 14 primary health care centres and six sexual health units located at two regional Health Services, as well as with key informants from different backgrounds. Interviews were transcribed verbatim and QSR International's NVivo 11 PRO Software was used for cross-case thematic analysis, which followed an inductive approach. Selected quotes were translated from Spanish to English. Codes and themes were reviewed by the research team.

RESULTS

Most participants were unaware of IPN and demonstrated interest. Many agreed this could be a feasible strategy considering the high use of mobile technologies and the Internet in Chile. Participants' primary concerns around this approach were confidentiality, privacy and efficacy, given the local cultural context. The use of a counsellor to offer professional support and guidance was identified as essential to strengthen PN in Chile.

CONCLUSION

The use of IPN could be an alternative PN strategy for Chile. However, the involvement of local staff and further research to explore patients' perceptions and preferences will be essential in tailoring interventions.

Community-led HIV testing services including HIV self-testing and assisted partner notification services in Vietnam: lessons from a pilot study in a concentrated epidemic setting

INTRODUCTION

The HIV epidemic in Vietnam is concentrated in key populations and their partners - people who inject drugs, men who have sex with men, sex workers and partners of people living with HIV. These groups have poor access to and uptake of conventional HIV testing services (HTS). To address this gap, lay provider- and self-testing and assisted partner notification (aPN) were introduced and delivered by the community. We explored the feasibility and effectiveness of implementing aPN as part of community testing services for key populations.

METHODS

Lay provider testing and self-testing was started in January 2017, and targeted key populations and their partners. Since July 2017, aPN was introduced. HTS was offered at drop-in houses or coffee shops in Thai Nguyen and Can Tho provinces. All self-testing was assisted and observed by peer educators. Both in-person and social network methods were used to mobilize key populations to test for HIV and offer HTS to partners of people living with HIV. Client-level data, including demographic information and self-reported risk behaviour, were collected on site by peer educators.

RESULTS

Between January 2017 and May 2018, 3978 persons from key populations were tested through community-led HTS; 66.7% were first-time testers. Of the 3978 clients, 3086 received HTS from a lay provider and 892 self-tested in the presence of a lay provider. Overall, 245 (6.2% of tested clients) had reactive results, 231 (94.3%) were confirmed to be HIV positive; 215/231 (93.1%) initiated antiretroviral therapy (ART). Of 231 adult HIV-positive clients, 186 (80.5%) were provided voluntary aPN, and 105 of their partners were contacted and received HTS. The ratio of partners who tested for HIV per index client was 0.56. Forty-four (41.9%) partners of index clients receiving HTS were diagnosed with HIV, 97.7% initiated ART during the study period. No social harm was identified or reported.

CONCLUSIONS

Including aPN as part of community-led HTS for key populations and their partners is feasible and effective, particularly for reaching first-time testers and undiagnosed HIV clients. Scale-up of aPN within community-led HTS for key populations is essential for achieving the United Nations 90-90-90 targets in Vietnam.

Brief Report: HIV Assisted Partner Services Among Those With and Without a History of Intimate Partner Violence in Kenya

BACKGROUND

HIV assisted partner services (APS) are a notification and testing strategy for sex partners of HIV-infected index patients. This cluster-randomized controlled trial secondary data analysis investigated whether history of intimate partner violence (IPV) modified APS effectiveness and risk of relationship dissolution.

SETTING

Eighteen HIV testing and counseling sites in Kenya randomized to provide immediate APS (intervention) or APS delayed for 6 weeks (control).

METHODS

History of IPV was ascertained at study enrollment and defined as reporting ever experiencing physical or sexual IPV. Those reporting IPV in the month before enrollment were excluded. We tested whether history of IPV modified intervention effectiveness and risk of relationship dissolution using population-averaged Poisson and log-binomial generalized estimating equation models. Exploratory analyses investigated associations between history of IPV and events that occurred after HIV diagnosis using log-binomial generalized estimating equation models.

RESULTS

The study enrolled 1119 index participants and 1286 partners. Among index participants, 81 (7%) had history of IPV. History of IPV did not modify APS effectiveness in testing, newly diagnosing, or linking partners to care. History of IPV did not modify the association between receiving immediate APS and relationship dissolution during the study.

CONCLUSIONS

Among participants who had not experienced IPV in the last month but had experienced IPV in their lifetimes, our results suggest that APS is an effective and safe partner notification strategy in Kenya. As APS is scaled up in different contexts, these data support including those reporting past IPV and closely monitoring adverse events.

Partner Notification Outcomes for Men Who Have Sex With Men Diagnosed With Syphilis Referred to Partner Notification Officers, Melbourne, Australia

BACKGROUND

We examined the extent of partner notification for men who have sex with men (MSM) who were diagnosed with syphilis, and offered referral to a partner notification officer (PNO), to assist them with informing recent sexual partners.

METHODS

Between October 2013 and March 2015, MSM diagnosed with syphilis at the Melbourne Sexual Health Centre were routinely offered a referral to a PNO. The outcomes of this intervention were evaluated including the proportion of men who accepted PNO services and the number of sexual partners informed by the PNO.

RESULTS

There were 380 MSM diagnosed with syphilis. Those with primary or secondary syphilis reported a total of 813 partners over 3 months and those with early latent syphilis reported a total of 1400 partners over 12 months. Sixty nine percent of index men (n = 262) had documented discussion of partner notification, 34% (n = 128) accepted PNO referral, and 28% (n = 105) were contacted by the PNO, 58 of whom reported they had already notified partners themselves. Only 14 index men (4%) provided the PNO with contact details for 28 partners, 25 of whom were notified by the PNO. Among those interviewed, the most common barrier to partner notification was the presence of anonymous partners and absence of contact details for partners.

CONCLUSIONS

Despite offering an effective PNO service in our centre, ultimately only 4% of MSM with syphilis had at least 1 partner notified by the PNO with patients declining the PNO service and anonymous partners posing the major barriers. Alternative patient initiated methods for improving partner notification for syphilis among MSM using newer communication technologies are required.

A Qualitative Study of Means to Improve Partner Notification After an HIV Diagnosis Among Men Who Have Sex with Men in Australia

Improved partner notification (PN) after HIV diagnosis could help control HIV among men who have sex with men (MSM). However, there is little evidence exploring what this experience is like for Australian MSM and how achievable it is in the era of the Internet and smartphones. Fifteen of 39 invited MSM recently diagnosed with HIV undertook a semistructured interview about PN. Interviews were thematically analyzed using a combined deductive/inductive approach. Three main themes arose: fear of PN and HIV disclosure, partners' unexpected reactions, and the need for more patient support. MSM found PN difficult and uncomfortable and described fear about potential repercussions of PN; however, they felt it was the right thing to do. Regular partners were more likely to be notified, and in person, because of the availability of contact information but more notably because of a sense of moral responsibility. Men commonly had few contact details for casual partners and preferred PN strategies that allowed them to remain anonymous, largely reflecting the reasons for and ways in which they met casual partners: online or through apps and predominantly for once-off, anonymous sex. Most described unexpected positive responses from partners who were contacted personally by the men. Our study also showed that participants required professional support to carry out PN, especially with casual partners, as well as support around understanding the implications of and treatments relating to being HIV positive. PN could be improved by offering more options that allow the index patient to remain anonymous, particularly when notifying casual partners.