1
|
Risk-Based Screening Tools to Optimise HIV Testing Services: a Systematic Review. Curr HIV/AIDS Rep 2022; 19:154-165. [PMID: 35147855 PMCID: PMC8832417 DOI: 10.1007/s11904-022-00601-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/31/2022]
Abstract
Purpose of review Effective ways to diagnose the remaining people living with HIV who do not know their status are a global priority. We reviewed the use of risk-based tools, a set of criteria to identify individuals who would not otherwise be tested (screen in) or excluded people from testing (screen out). Recent findings Recent studies suggest that there may be value in risk-based tools to improve testing efficiency (i.e. identifying those who need to be tested). However, there has not been any systematic reviews to synthesize these studies. Summary We identified 18,238 citations, and 71 were included. The risk-based tools identified were most commonly from high-income (51%) and low HIV (<5%) prevalence countries (73%). The majority were for “screening in” (70%), with the highest performance tools related to identifying MSM with acute HIV. Screening in tools may be helpful in settings where it is not feasible or recommended to offer testing routinely. Caution is needed for screening out tools, where there is a trade-off between reducing costs of testing with missing cases of people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1007/s11904-022-00601-5.
Collapse
|
2
|
Bonacci RA, Manahan LM, Miller JS, Moonan PK, Lipparelli MB, DiFedele LM, Davis LB, Lash RR, Oeltmann JE. COVID-19 Contact Tracing Outcomes in Washington State, August and October 2020. Front Public Health 2021; 9:782296. [PMID: 34900921 PMCID: PMC8661592 DOI: 10.3389/fpubh.2021.782296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Case investigation and contact tracing are important tools to limit the spread of SARS-CoV-2, particularly when implemented efficiently. Our objective was to evaluate participation in and timeliness of COVID-19 contact tracing and whether these measures changed over time. Methods: We retrospectively assessed COVID-19 case investigation and contact tracing surveillance data from the Washington State centralized program for August 1-31, 2020 and October 1-31, 2020. We combined SARS-CoV-2 testing reports with contact tracing data to compare completeness, reporting of contacts, and program timeliness. Results: For August and October respectively, 4,600 (of 12,521) and 2,166 (of 16,269) individuals with COVID-19 were referred to the state program for case investigation. Investigators called 100% of referred individuals; 65% (August) and 76% (October) were interviewed. Of individuals interviewed, 33% reported contacts in August and 45% in October, with only mild variation by age, sex, race/ethnicity, and urbanicity. In August, 992 individuals with COVID-19 reported a total of 2,584 contacts (mean, 2.6), and in October, 739 individuals reported 2,218 contacts (mean, 3.0). Among contacts, 86% and 78% participated in interviews for August and October. The median time elapsed from specimen collection to contact interview was 4 days in August and 3 days in October, and from symptom onset to contact interview was 7 days in August and 6 days in October. Conclusions: While contact tracing improved with time, the proportion of individuals disclosing contacts remained below 50% and differed minimally by demographic characteristics. The longest time interval occurred between symptom onset and test result notification. Improving elicitation of contacts and timeliness of contact tracing may further decrease SARS-CoV-2 transmission.
Collapse
Affiliation(s)
- Robert A Bonacci
- Epidemic Intelligence Service, CDC, Atlanta, GA, United States.,COVID-19 Response Team, CDC, Atlanta, GA, United States
| | | | - James S Miller
- Epidemic Intelligence Service, CDC, Atlanta, GA, United States.,COVID-19 Response Team, CDC, Atlanta, GA, United States.,Washington State Department of Health, Tumwater, WA, United States
| | | | | | - Lisa M DiFedele
- Washington State Department of Health, Tumwater, WA, United States
| | - Lora B Davis
- Washington State Department of Health, Tumwater, WA, United States
| | - R Ryan Lash
- Epidemic Intelligence Service, CDC, Atlanta, GA, United States.,COVID-19 Response Team, CDC, Atlanta, GA, United States
| | | |
Collapse
|
3
|
Time to HIV testing of sexual contacts identified by HIV-positive index clients in Siaya County, Kenya. PLoS One 2020; 15:e0238794. [PMID: 32898159 PMCID: PMC7478530 DOI: 10.1371/journal.pone.0238794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022] Open
Abstract
There are no studies on time to test since notification among identified sexual contacts of HIV-positive index clients using program data in Siaya County and Kenya. We sought to understand time to HIV testing by contact characteristics after identification to inform targeted testing interventions. We retrospectively analyzed data from adult (aged ≥18 years) sexual contacts identified by HIV-positive index clients from 117 health facilities in Siaya County (June 2017–August 2018). We used Chi-square tests to assess for differences in characteristics of contacts by HIV testing. We performed Cox proportional hazards analysis and time to HIV testing of contacts analysis including time-varying covariates (cluster-adjusted by facility) to assess characteristics (age, sex, and relationship to index client) associated with time to HIV-testing since notification. Sexual contacts not tested were right censored at last follow-up date. We calculated hazard ratios with 95% confidence intervals to evaluate characteristics associated with time to testing. Of the 6,845 contacts included in this analysis, 3,858 (56.4%) were men. Most were aged 25–34 years (3,209 [46.9%]). Median time to contact testing was 14.5 days (interquartile range, 2.5–62). On multivariable analysis, contacts aged 18–24 years (aHR, 1.32 [95% CI: 1.01–1.73], p = 0.040) and 25–34 years (aHR, 1.18 [95% CI: 1.01–1.39], p = 0.038) had shorter time to HIV testing than those aged 35–44 years. Married polygamous (aHR, 1.12 [95% CI: 1.01–1.25], p = 0.039) and single contacts (aHR, 1.17 [95% CI: 1.08–1.27], p <0.001) had shorter time to HIV testing than married monogamous contacts. Non-spouse sexual contacts had shorter time to HIV testing than spouses, (aHR, 1.23 [95% CI: 1.15–1.32], p <0.001). We recommend enhanced differentiated partner services targeting older adults, married monogamous, and spouse sexual contacts to facilitate early diagnosis, same day treatment, and prevention in Western Kenya and sub-Saharan Africa at large.
Collapse
|
4
|
Monteiro MG, Farrant Braz A, Lima K, Ramos Lacerda H. Identification of serodiscordant couples, their clinical and laboratory characteristics, and vulnerabilities of HIV transmission risk in Northeastern Brazil in the era of pre-exposure prophylaxis (PrEP). REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i2.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: To evaluate the frequency of HIV serodiscordants couples and their seronegative partners who were candidates for pre-exposure prophylaxis (PrPE), and the knowledge about behavioural measures to reduce virus transmission. Methods: The research was performed in Northeastern Brazil, from February 2016 to March 2017. Ninety HIV-positive individuals (Index) and their HIV-serodiscordant partners (n = 17) were submitted for epidemiological, clinical, and laboratory questionnaires, and for rapid laboratory tests for syphilis, hepatitis B and C. Results: High frequencies of HIV-syphilis (34.4%) and HIV-HBV (3.3%) coinfection were detected in the HIV-positive individuals. Three new HIV cases were detected in partners. Most participants in both groups (85.6%, Index; 94.1%, Partners) had an excellent degree of knowledge regarding HIV transmission, although nine seronegative HIV partners with a high risk of HIV infection were identified (53%). HIV-positive individuals had a high frequency of HIV-syphilis co-infection and 10% of them did not use antiretroviral by personal option. Conclusions: Adoption of PrEP and other preventive measures to prevent HIV transmission in serodiscordants couples should be studied and evaluated.
Collapse
|
5
|
Partner Notification for Youth Living With HIV in 14 Cities in the United States. J Acquir Immune Defic Syndr 2017; 77:46-52. [PMID: 29023252 DOI: 10.1097/qai.0000000000001565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying factors associated with partner notification among youth living with HIV is critical for effective HIV prevention and treatment strategies. METHODS A total of 924 male and female behaviorally infected youth aged 13-24 across 14 U.S. cities completed an audio computer-assisted self-interview including questions about demographics and experiences with patient- and provider-referral partner notification. RESULTS The majority of participants self-identified as male (82.5%), Black/non-Hispanic (70.1%), and Hispanic/Latino (18.2%). Most males (93.4%) reported engaging in male-to-male sexual contact. Over three-quarters (77.6%) reported that all or some of their partners were contacted, while 22.4% indicated that none were contacted regarding potential HIV exposure. Most (52.4%) reported that only one person talked to them about notifying partners including the HIV tester (36.5%) followed by their health care provider/doctor (27.6%). Less than a fifth (18.3%) were themselves notified of their own exposure to HIV. Using multivariable logistic regression, 3 factors were associated with successful partner notification: (1) when more than one person talked to participants about partner notification (AOR = 1.87, 1.33-2.62); (2) if they themselves had been notified of their own HIV exposure (AOR = 1.83, 1.13-2.95); and (3) if their education included some college or technical school versus less than high school (AOR = 1.72, 1.04-2.85). CONCLUSIONS Partner notification among youth living with HIV is unsuccessful at least 22.4% of the time, although minimal criteria for partner services are being met almost universally. Partner notification might benefit from enhanced guidelines that call for both HIV testers and HIV care providers to discuss this important strategy with HIV-positive youth.
Collapse
|
6
|
Dalal S, Johnson C, Fonner V, Kennedy CE, Siegfried N, Figueroa C, Baggaley R. Improving HIV test uptake and case finding with assisted partner notification services. AIDS 2017; 31:1867-1876. [PMID: 28590326 PMCID: PMC5538304 DOI: 10.1097/qad.0000000000001555] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the enormous expansion of HIV testing services (HTS), an estimated 40% of people with HIV infection remain undiagnosed. To enhance the efficiency of HTS, new approaches are needed. The WHO conducted a systematic review on the effectiveness of assisted partner notification in improving HIV test uptake and diagnosis, and the occurrence of adverse events, to inform the development of normative guidelines. METHODS We systematically searched five electronic databases through June 2016. We also contacted experts in the field and study authors for additional information where needed. Eligible studies compared assisted HIV partner notification services to passive or no notification. Where multiple studies reported comparable outcomes, meta-analysis was conducted using a random-effects model to produce relative risks (RRs) or risk ratios and 95% confidence intervals (CIs). RESULTS Of 1742 citations identified, four randomized controlled trials and six observational studies totalling 5150 index patients from eight countries were included. Meta-analysis of three individually randomized trials showed that assisted partner notification services resulted in a 1.5-fold increase in HTS uptake among partners compared with passive referral (RR = 1.46; 95% CI: 1.22-1.75; I = 0%). The proportion of HIV-positive partners was 1.5 times higher with assisted partner notification than with passive referral (RR = 1.47; 95% CI: 1.12-1.92; I = 0%). Few instances of violence or harm occurred. CONCLUSION Assisted partner notification improved partner testing and diagnosis of HIV-positive partners, with few reports of harm. WHO strongly recommends voluntary assisted HIV partner notification services to be offered as part of a comprehensive package of testing and care.
Collapse
Affiliation(s)
- Shona Dalal
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Virginia Fonner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Carmen Figueroa
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| |
Collapse
|
7
|
Song W, Mulatu MS, Rorie M, Zhang H, Gilford JW. HIV Testing and Positivity Patterns of Partners of HIV-Diagnosed People in Partner Services Programs, United States, 2013-2014. Public Health Rep 2017; 132:455-462. [PMID: 28614670 PMCID: PMC5507429 DOI: 10.1177/0033354917710943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Human immunodeficiency virus (HIV) partner services are an integral part of comprehensive HIV prevention programs. We examined the patterns of HIV testing and positivity among partners of HIV-diagnosed people who participated in partner services programs in CDC-funded state and local health departments. METHODS We analyzed data on 21 484 partners submitted in 2013-2014 by 55 health departments. We conducted descriptive and multivariate analyses to examine patterns of HIV testing and positivity by demographic characteristics and geographic region. RESULTS Of 21 484 partners, 16 275 (75.8%) were tested for HIV; 4503 of 12 886 (34.9%) partners with test results were identified as newly HIV-positive. Compared with partners aged 13-24, partners aged 35-44 were less likely to be tested for HIV (adjusted odds ratio [aOR] = 0.86; 95% confidence interval [CI], 0.78-0.95) and more likely to be HIV-positive (aOR = 1.35; 95% CI, 1.20-1.52). Partners who were male (aOR = 0.89; 95% CI, 0.81-0.97) and non-Hispanic black (aOR = 0.68; 95% CI, 0.63-0.74) were less likely to be tested but more likely to be HIV-positive (male aOR = 1.81; 95% CI, 1.64-2.01; non-Hispanic black aOR = 1.52; 95% CI, 1.38-1.66) than partners who were female and non-Hispanic white, respectively. Partners in the South were more likely than partners in the Midwest to be tested for HIV (aOR = 1.56; 95% CI, 1.35-1.80) and to be HIV-positive (aOR = 2.18; 95% CI, 1.81-2.65). CONCLUSIONS Partner services programs implemented by CDC-funded health departments are successful in providing HIV testing services and identifying previously undiagnosed HIV infections among partners of HIV-diagnosed people. Demographic and regional differences suggest the need to tailor these programs to address unique needs of the target populations.
Collapse
Affiliation(s)
- Wei Song
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mesfin S. Mulatu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michele Rorie
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Zhang
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John W. Gilford
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
8
|
Hogben M, Behel S. Assisted partner services for HIV case-finding. Lancet HIV 2016; 4:e55-e56. [PMID: 27913226 DOI: 10.1016/s2352-3018(16)30211-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Matthew Hogben
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | - Stephanie Behel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| |
Collapse
|
9
|
Abstract
BACKGROUND Partner services have been a mainstay of public health sexually transmitted disease (STD) prevention programs for decades. The principal goals are to interrupt transmission and reduce STD morbidity and sequelae. In this article, we review current literature with the goal of informing STD prevention programs. METHODS We searched the literature for systematic reviews. We found 9 reviews published between 2005 and 2014 (covering 108 studies). The reviews varied by study inclusion criteria (e.g., study methods, geographic location, and infections). We abstracted major conclusions and recommendations from the reviews. RESULTS Conclusions and recommendations were divided into patient referral interventions and provider referral interventions. For patient referral, there was evidence supporting the use of expedited partner therapy and interactive counseling, but not purely didactic instruction. Provider referral through Disease Intervention Specialists was efficacious and particularly well supported for HIV. For other studies, modeling data and testing outcomes showed that partner notification in general reached high-prevalence populations. Reviews also suggested more focus on using technology and population-level implementation strategies. However, partner services may not be the most efficient means to reach infected persons. CONCLUSIONS Partner services programs constitute a large proportion of program STD prevention activities. Value is maximized by balancing a portfolio of patient and provider referral interventions and by blending partner notification interventions with other STD prevention interventions in overall partner services program structure. Sexually transmitted disease prevention needs program-level research and development to generate this portfolio.
Collapse
|
10
|
Fenton KA, Aquino GA, Dean HD. Program collaboration and service integration in the prevention and control of HIV infection, viral hepatitis, STDs, and tuberculosis in the U.S.: lessons learned from the field. Public Health Rep 2014; 129 Suppl 1:1-4. [PMID: 24385642 DOI: 10.1177/00333549141291s101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kevin A Fenton
- Gustavo Aquino is the Associate Director for Program Integration, Hazel Dean is the Deputy Director, and Kevin Fenton is the former Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia
| | - Gustavo A Aquino
- Gustavo Aquino is the Associate Director for Program Integration, Hazel Dean is the Deputy Director, and Kevin Fenton is the former Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia
| | - Hazel D Dean
- Gustavo Aquino is the Associate Director for Program Integration, Hazel Dean is the Deputy Director, and Kevin Fenton is the former Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia
| |
Collapse
|