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Aheron S, Paredes-Vincent A, Patton ME, Gross J, Medley A, Mona G, Mtimkulu N, Nkuna K, Grund JM. Improving HIV Case Finding Through Index Testing: Findings from Health Facilities in 12 Districts of South Africa, October 2019-September 2021. AIDS Behav 2024; 28:1708-1718. [PMID: 38358586 PMCID: PMC11070287 DOI: 10.1007/s10461-024-04269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/16/2024]
Abstract
To assess the importance of index testing in HIV case finding, we analyzed quarterly data from October 2019 to September 2021 from 371 facilities in 12 districts in South Africa. Index testing accounted for 2.6% of all HIV tests (index and non-index) (n = 163,633), but 17.8% of all HIV-positive results, with an HIV-positivity 4-times higher than non-index testing modalities (4.1%). Despite twice as many adult females ≥ 15 years accepting index testing (n = 206,715) compared to adult males ≥ 15 years (n = 102,180), females identified fewer contacts (n = 91,123) than males (n = 113,939). Slightly more than half (51.2%) of all contacts elicited were tested (n = 163,633/319,680), while 19.7% (n = 62,978) of elicited contacts were previously diagnosed as HIV-positive and not eligible for further testing. These findings indicate index testing can be effective in increasing HIV diagnoses in South Africa. Further operational research is needed to address gaps identified in the index testing cascade, including elicitation and testing of contacts.
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Affiliation(s)
- Sarah Aheron
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa.
| | - Ariana Paredes-Vincent
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | - Monica E Patton
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | - Jessica Gross
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Amy Medley
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Gugu Mona
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | | | - Khensani Nkuna
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
| | - Jonathan M Grund
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
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2
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Nearchou F, Flinn C, Mc Laughlin D, Niland R. Sexual health behaviours and partner notification practices related to sexually transmitted infections in young adults in Ireland. Ir J Med Sci 2024:10.1007/s11845-024-03668-8. [PMID: 38517599 DOI: 10.1007/s11845-024-03668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) impose burdens on individuals and communities, while their prevalence in young people has risen continually in recent years. Partner notification is an effective public health strategy which can limit STI transmission. AIMS This study aimed to explore young adults' sexual health behaviours, attitudes toward STI testing, and feelings toward visiting a sexual health clinic. It also aimed to investigate preferences for partner notification and the role of self-efficacy in people's intentions to notify a partner for STIs including the human immunodeficiency virus (HIV). METHODS A quantitative, cross-sectional design was applied. Participants were 400 adults aged 18-34 years (M = 23 years; SD = 4.27), recruited from the Republic of Ireland. RESULTS Over half of the participants reported never being tested for STIs. These young people placed less importance on undergoing regular STI testing and testing after unprotected sex than their counterparts who had been tested for STIs. Self-efficacy was significantly associated with intentions to notify partner(s) for STIs including HIV. CONCLUSIONS As STIs are becoming increasingly prevalent in young adults, it is important to gain a deeper understanding of the interventions used to break the transmission chain and how different beliefs and attitudes may affect them. Self-efficacy was a key component in PN intentions, suggesting that the belief in someone's ability or skillset to perform a sexual health behaviour is positively related to their intention to perform the behaviour.
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Affiliation(s)
- Finiki Nearchou
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland.
| | - Clodagh Flinn
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
| | - Diarmuid Mc Laughlin
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
| | - Rachel Niland
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
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Oljira H, Rata A, Mulatu B, Abera T. Partner notification service utilization and associated factors among clients attending anti-retroviral therapy clinics of public health facilities in Gimbi Town, West Ethiopia, 2023: a facility-based mixed-method cross-sectional study. BMC Public Health 2024; 24:687. [PMID: 38438988 PMCID: PMC10913634 DOI: 10.1186/s12889-024-18196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/23/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Partner Notification Service is among the strategies used to conduct targeted Human Immunodeficiency Virus Testing Service by obtaining information about sexual contacts of index clients to refer for testing. But most people living with Human Immunodeficiency Virus are still unaware of their status, including Ethiopia. Limited studies are available on the magnitude of partner notification service utilization and associated factors in Ethiopia. OBJECTIVE The aim of this study was to assess the magnitude of partner notification service utilization and associated factors among people living with Human Immunodeficiency Virus attending anti-retroviral therapy clinics of public health facilities in Gimbi town, West Ethiopia. METHODS A facility-based mixed-method cross-sectional study design was used. Total of 455 study participants were selected by systematic random sampling for quantitative data and health workers were purposively selected for qualitative data until saturation of ideas was reached. The study was conducted from December 1, 2022 to January 30, 2023. Structured questionnaires and key informant interview guides were used for data collection. Quantitative data were analyzed using Statistical Package for Social Science version 25. Open code 4.02 software was used for qualitative data analysis. Frequencies and proportions were used to summarize descriptive statistics. Bivariable and multivariable logistic regression was used to identify associated factors then variables with a p value < 0.05 were declared to have an association with the dependent variable. RESULT Exactly 298 (65.5%) of the study participants were notified their HIV status to their sexual partners. Factors associated with Partner Notification Service Utilization were depression AOR: 0.12 (95% CI: 0.07, 0.20), urban settlers AOR: 2.21 (95% CI: 1.2, 3.83), fear of support loss AOR: 0.24 (95% CI: 0.14, 0.40) and intimate partner violence AOR: 0.55 (95% CI: 0.31, 0.97). From qualitative part of this study, factors associated to Partner Notification service utilization were fear of stigma, discrimination and fear of divorce. CONCLUSION Two-third of the study participants were utilized partner notification service, and efforts are important to prevent depression and intimate partner violence. Local government bodies and stakeholders should implement economic strengthening and strategies to address the rural community for HIV/AIDS prevention. Promotion of supportive and inclusive environment for PLHIV should also considered as way to increase PNS utilization.
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Affiliation(s)
- Habtamu Oljira
- Department of Biomedical Science, School of Medicine, Wallaga University, Nekemte, Oromia, Ethiopia.
| | - Abiriham Rata
- Nekemte Blood Bank, Oromia Health Beuareu, Nekemte, Oromia, Ethiopia
| | - Befirdu Mulatu
- Department of Public Health, Institute of Health Science, Wallaga University, Nekemte, Oromia, Ethiopia
| | - Tesfaye Abera
- Department of Nursing, School of Nursing and Midwifery, Wallaga University, Nekemte, Oromia, Ethiopia
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McGowan M, Bärnighausen K, Berner-Rodoreda A, McMahon SA, Mtaita C, Mauti J, Neuhann F. "The targets…are driving the agenda and that probably needs to change": stakeholder perspectives on HIV partner notification in sub-Saharan Africa. BMC Public Health 2024; 24:521. [PMID: 38373972 PMCID: PMC10877856 DOI: 10.1186/s12889-023-17422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/06/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Voluntary assisted partner notification (VAPN) in HIV contact tracing is a globally recommended strategy to identify persons who have been exposed to HIV and link them to HIV testing and follow-up. However, there is little understanding about how VAPN is experienced by stakeholders in sub-Saharan African (SSA) contexts. We conducted a multi-level and multi-national qualitative analysis evaluating stakeholder perspectives surrounding VAPN implementation to inform the development of future VAPN policies. METHOD We conducted in-depth interviews (IDIs) with VAPN stakeholders at global (n = 5), national (n = 6), and community level (n = 4) across a total of seven SSA countries. Eligible participants were ≥ 18 years old and had experience developing, implementing, or overseeing VAPN policies in SSA. We sought to understand stakeholder's perspectives on policy development, implementation, and perceived outcomes (barriers and facilitators). Interviews were audio recorded, transcribed, and analyzed thematically using a combination of inductive and deductive approaches. RESULTS Between December 2019 and October 2020 we conducted 15 IDIs. While participants agreed that VAPN resulted in a high yield of people newly diagnosed with HIV; they noted numerous barriers surrounding VAPN implementation across global, national, and community levels, the majority of which were identified at community level. Barriers at global and national level included high target setting, contradictory laws, and limited independent research disenfranchising the experiences of implementing partners. The barriers identified at community level included client-level challenges (e.g., access to healthcare facilities and fear of adverse events); healthcare worker challenges (e.g., high workloads); limited data infrastructure; and cultural/gender norms that hindered women from engaging in HIV testing and VAPN services. In response to these barriers, participants shared implementation facilitators to sustain ethical implementation of VAPN services (e.g., contact tracing methods) and increase its yield (e.g., HIV self-testing integrated with VAPN services). CONCLUSION Overall, stakeholders perceived VAPN implementation to encounter barriers across all implementation levels (global to community). Future VAPN policies should be designed around the barriers and facilitators identified by SSA stakeholders to maximize the implementation of (ethical) HIV VAPN services and increase its impact in sub-Saharan African settings.
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Affiliation(s)
- Maureen McGowan
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Astrid Berner-Rodoreda
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caroline Mtaita
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Joy Mauti
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Florian Neuhann
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Lewy Mwanawasa Medical University, Lusaka, Zambia
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Sawras V, Deuffic-Burban S, Préau M, Spire B, Yazdanpanah Y, Champenois K. Assessing complex interventions: a systematic review of outcomes used in randomised controlled trials on STI partner notification in high-income countries. BMC Public Health 2023; 23:1838. [PMID: 37735382 PMCID: PMC10512513 DOI: 10.1186/s12889-023-16763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Partner notification interventions are complex and assessing their effectiveness is challenging. By reviewing the literature on the effectiveness of partner notification interventions, our aim was to evaluate the choice, collection, and interpretation of outcomes and their impact on study findings. METHODS We conducted a systematic review of individual-level randomised controlled trials evaluating the effectiveness of partner notification interventions for bacterial STIs, HIV or sexually transmitted HCV in high-income countries since 2000. Partner notification interventions included assisted patient referral interventions and expedited treatment. The content analysis was carried out through a narrative review. RESULTS In the 9 studies that met the inclusion criteria, 16 different outcomes were found. In most studies, one or two outcomes assessing partner notification practices were associated with an outcome reflecting STI circulation through index case reinfections. These outcomes assessed the main expected effects of partner notification interventions. However, partner notification is composed of a succession of actions between the intervention on the index case and the testing and/or treatment of the notified partners. Intermediate outcomes were missing so as to better understand levers and barriers throughout the process. Potential changes in participants' sexual behaviour after partner notification, e.g. condom use, were outcomes reported in only two studies assessing interventions including counselling. Most outcomes were collected through interviews, some weeks after the intervention, which might lead to desirability and attrition biases, respectively. Assessment of the effectiveness of partner notification interventions on partner testing/treatment was limited by the collection of data from index cases. Few data describing index cases and their partners were provided in the studies. Additional data on the number and type of exposed partners and the proportion of partners already aware of their infection before being notified would help to interpret the results. CONCLUSIONS These insights would help to understand why and under what conditions the intervention is considered effective and therefore can be replicated or adapted to other populations and contexts.
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Affiliation(s)
- Victoire Sawras
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, F-75018, France
| | - Sylvie Deuffic-Burban
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, F-75018, France
| | - Marie Préau
- Institut de Psychologie, Université Lumière Lyon 2, Inserm, U1296, Lyon, France
| | - Bruno Spire
- Aix Marseille Univ, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Yazdan Yazdanpanah
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, F-75018, France
- Service de maladies infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, F-75018, France
| | - Karen Champenois
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, F-75018, France.
- Inserm IAME - Faculté de Médecine Bichat, 16 rue Henri Huchard, Paris, 75018, France.
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Puttkammer N, Ihnatiuk A, Shapoval A, Kazanzhy A, Secor A, Shotorbani S, McDowell M, Golden M. Profile of partners who completed HIV testing and received a new HIV diagnosis in Ukraine's HIV index testing program: a retrospective cohort study to inform program improvement. BMC Infect Dis 2023; 23:291. [PMID: 37147618 PMCID: PMC10161989 DOI: 10.1186/s12879-023-08281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Approximately one-third of people living with HIV in Ukraine are unaware of their HIV status. Index testing (IT) is an evidence-based HIV testing strategy that supports voluntary notification of partners with HIV risk, so they can receive HIV testing, prevention, and treatment services. METHODS Ukraine scaled up IT services in 2019. This observational study of Ukraine's IT program covered 39 health facilities located in 11 regions with high HIV burden. The study used routine program data from January-December 2020 to describe the profile of named partners and explore index client (IC) and partner factors associated with two outcomes: 1) completing testing; and 2) HIV case finding. Analysis used descriptive statistics and multilevel linear mixed regression models. RESULTS The study included 8,448 named partners, of whom 6,959 had unknown HIV status. Among them,72.2% completed HIV testing and 19.4% of those tested were newly diagnosed with HIV. Two-thirds of all new cases were among partners of ICs who were recently diagnosed and enrolled in care (< 6 months), while one third were among partners of established ICs. In adjusted analysis, partners of ICs with unsuppressed HIV viral load (VL) were less likely to complete HIV testing (adjusted odds ratio [aOR] = 0.11, p < 0.001), but more likely to receive a new HIV diagnosis (aOR = 1.92, p < 0.001). Partners of ICs who cited injection drug use or having a known HIV + partner as their own reason for testing were more likely to receive a new HIV diagnosis (aOR = 1.32, p = 0.04 and aOR = 1.71, p < 0.001 respectively). Involving providers in the partner notification process was associated with completed testing (aOR = 1.76, p = 0.001) and HIV case finding (aOR = 1.64, p < 0.01), compared with notification by ICs. CONCLUSION HIV case detection was highest among partners of recently diagnosed ICs, but IT participation among established ICs still yielded an important share of all newly-identified HIV cases. Areas for improvement in Ukraine's IT program include completing testing for partners of ICs with unsuppressed HIV VL, with history of injection drug use or discordant partnerships. Using intensified follow-up for the sub-groups at risk of incomplete testing may be practical. Greater use of provider-assisted notification could also accelerate HIV case finding.
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Affiliation(s)
- Nancy Puttkammer
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA.
| | - Alyona Ihnatiuk
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Anna Shapoval
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Anna Kazanzhy
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Andrew Secor
- Department of Global Health, University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Solmaz Shotorbani
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Misti McDowell
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Matthew Golden
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
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7
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Levy JA, Earnshaw VA, Milanti A, Waluyo A, Culbert GJ. A qualitative study of healthcare providers' attitudes toward assisted partner notification for people with HIV in Indonesia. BMC Health Serv Res 2023; 23:71. [PMID: 36690986 PMCID: PMC9872286 DOI: 10.1186/s12913-022-08943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/06/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Assisted partner notification (APN) is recommended as a public health strategy to increase HIV testing in people exposed to HIV. Yet its adoption in many countries remains at an early stage. This qualitative study sought the opinions of HIV health service providers regarding the appropriateness and feasibility of implementing APN in Indonesia where such services are on the cusp of adoption. METHODS Four focus group discussions totaling 40 health service providers were held in Jakarta, Indonesia to consider APN as an innovative concept and to share their reactions regarding its potential implementation in Indonesia. Voice-recorded discussions were conducted in Bahasa, transcribed verbatim, and analyzed. RESULTS Participants recognized APN's potential in contacting and informing the partners of HIV-positive clients of possible viral exposure. They also perceived APN's value as a client-driven service permitting clients to select which of three partner notification methods would work best for them across differing partner relationships and settings. Nonetheless, participants also identified personal and health system challenges that could impede successful APN adoption including medical and human resource limitations, the need for specialized APN training, ethical and equity considerations, and lack of sufficient clarity concerning laws and government policies regulating 3rd party disclosures. They also pointed to the job-overload, stress, personal discomfort, and the ethical uncertainty that providers might experience in delivering APN. CONCLUSION Overall, providers of HIV services embraced the concept of APN but forecast practical difficulties in key service areas where investments in resources and system change appeared necessary to ensure effective and equitable implementation.
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Affiliation(s)
- Judith A. Levy
- grid.185648.60000 0001 2175 0319Health Policy & Administration, School of Public Health, University of Illinois Chicago, Chicago, IL USA
| | - Valerie A. Earnshaw
- grid.33489.350000 0001 0454 4791Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark, DE USA
| | - Ariesta Milanti
- grid.10784.3a0000 0004 1937 0482The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Agung Waluyo
- grid.9581.50000000120191471Faculty of Nursing, Universitas Indonesia, Kota Depok, Jawa Barat Indonesia
| | - Gabriel J. Culbert
- grid.185648.60000 0001 2175 0319Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
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Evans JR, Dawson HR, Chae H, Goldfarb D, Fisher RP, Dianiska RE, Daneshbodi A, Meissner CA. Enhancing the effectiveness of contact tracing interviews: A randomized controlled experiment of an enhanced cognitive interview protocol. Am J Infect Control 2022; 50:631-637. [PMID: 34971713 DOI: 10.1016/j.ajic.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the efficacy of a psychologically-based contact tracing interview protocol to a control protocol that emulated current practices under both interviewer-led and self-led modalities. METHODS This randomized controlled experiment utilized a 2 × 2 factorial design (Enhanced Cognitive protocol vs Control protocol; Interviewer-led call vs Self-led online survey). Data were collected online (n = 200; Mage = 44; 56.5% female; 79.5% White) during the COVID-19 pandemic (July 2, 2020 - September 15, 2020). RESULTS The Enhanced Cognitive protocol increased reported close contacts by 51% compared with the Control protocol (d = 0.44 [0.15, 0.71]). This effect was present for both interview modalities and for both identifiable and non-identifiable contacts. The Enhanced Cognitive protocol also increased both the quantity of person descriptors (d = 1.36 [0.87, 1.85]) and the utility of descriptions (r = 0.35 [0.13, 0.53]). CONCLUSIONS The application of cognitive principles in contact tracing interviews can significantly enhance the quantity and quality of information provided by respondents. Epidemiologists and public health investigators could benefit from utilizing cognitive principles and self-led modalities in contact tracing interviews.
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Affiliation(s)
| | - Haley R Dawson
- Florida International University, Department of Psychology, Miami, FL
| | - Hana Chae
- Florida International University, Department of Psychology, Miami, FL
| | - Deborah Goldfarb
- Florida International University, Department of Psychology, Miami, FL
| | - Ronald P Fisher
- Florida International University, Department of Psychology, Miami, FL
| | - Rachel E Dianiska
- University of California, Irvine, Department of Psychological Science, University of California, Irvine, CA
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Klabbers RE, Muwonge TR, Ayikobua E, Izizinga D, Bassett IV, Kambugu A, Tsai AC, Ravicz M, Klabbers G, O’Laughlin KN. Health Worker Perspectives on Barriers and Facilitators of Assisted Partner Notification for HIV for Refugees and Ugandan Nationals: A Mixed Methods Study in West Nile Uganda. AIDS Behav 2021; 25:3206-3222. [PMID: 33884511 PMCID: PMC8416880 DOI: 10.1007/s10461-021-03265-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 01/29/2023]
Abstract
Assisted partner notification (APN) is recommended by the World Health Organization to notify sexual partners of HIV exposure. Since 2018, APN has been offered in Uganda to Ugandan nationals and refugees. Distinct challenges faced by individuals in refugee settlements may influence APN utilization and effectiveness. To explore APN barriers and facilitators, we extracted index client and sexual partner data from APN registers at 11 health centers providing care to refugees and Ugandan nationals in West Nile Uganda and conducted qualitative interviews with health workers (N = 32). Since APN started, 882 index clients participated in APN identifying 1126 sexual partners. Following notification, 95% (1025/1126) of partners tested for HIV; 22% (230/1025) were diagnosed with HIV with 14% (139/1025) of tested partners newly diagnosed. Fear of stigma and disclosure-related violence limit APN utilization and effectiveness. Prospective research involving index clients and sexual partners is needed to facilitate safe APN optimization in refugee settlements.
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Affiliation(s)
- Robin E. Klabbers
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Timothy R. Muwonge
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Ayikobua
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Diego Izizinga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ingrid V. Bassett
- Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Miranda Ravicz
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA USA
| | - Gonnie Klabbers
- Department of Health, Ethics and Society, Faculty of Health, Medicine, and Life
Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kelli N. O’Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, WA USA
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10
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Glaspy S, Cosmaro L, Botsi C, Stamou M, Giannopoulou M, Isari AM, Downey C, Hugh TM, Avramovic G, Lambert JS. Integrating partner notification and contact tracing services across Europe: findings from the Integrate project. BMC Infect Dis 2021; 21:796. [PMID: 34517838 PMCID: PMC8438812 DOI: 10.1186/s12879-021-06445-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partner notification/contact tracing (PN/CT) is a process whereby people diagnosed with an infectious disease notify their sexual and needle-sharing partners/close contacts and invite them for testing and treatment due to exposure to the disease. PN is a necessary testing and prevention tool supported by the European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO). Traditionally, PN efforts have been siloed within disease areas, with separate pathways and systems responsible for specific diseases. The INTEGRATE project sought to improve PN/CT outcomes by sharing knowledge across diseases and countries. METHODS INTEGRATE used two mapping exercises to assess the PN landscape in Europe and identify areas for integration and cross-learnings for Sexually Transmitted Infections (STIs) and Tuberculosis. Mapping exercises were surveys to 29 consortium partners and in-depth qualitative interviews at four selected pilot sites: Ireland, Greece, Romania and Italy. RESULTS Areas for the improvement of PN/CT emerged: lack of resources and insufficient staff training, different modes of disease transmission, country-specific laws and regulations, the advent of General Data Protection Regulation (GDPR), differences in healthcare system pathways, historical concerns, and cultural differences. Activities highlighted key areas PN/CT outcomes could be improved, including PN/CT specific trainings for staff, improving knowledge on laws, regulations, guidelines and pathways and creating a country/region specific Standard Operating Procedures (SOPs) for PN/CT, incorporating information on all four disease areas. Findings were analyzed and three key areas were identified and implemented for knowledge transfer namely the creation of an online repository of European country guidelines, the transfer of SOPs and PN training in pilot sites. CONCLUSION A major finding of the project was challenges associated with incorporating Tuberculosis (TB) contact tracing alongside other infectious diseases. Professionals in the field, emphasized that integrating TB contact tracing with the other disease areas would be challenging and arguably unjustified, due to the different ways of transmission of TB and because well-established historical pathways for TB in public health systems already exist. However, the success of TB services presents an ideal model to draw from when strengthening PN systems for other infectious diseases.
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Affiliation(s)
- Shannon Glaspy
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Lella Cosmaro
- Fondazione LILA Milano, Italian League for Fighting AIDS, Milan, Italy
| | - Chryssoula Botsi
- National Public Health Organization (NPHO)/EODY, Marousi, Greece.,Unit of Infectious Diseases Andreas Syggros Hospital, Athens, Greece
| | - Maria Stamou
- National Public Health Organization (NPHO)/EODY, Marousi, Greece
| | | | | | - Cheyenne Downey
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Tina Mc Hugh
- School of Medicine, University College Dublin, Dublin, Ireland.,Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gordana Avramovic
- School of Medicine, University College Dublin, Dublin, Ireland.,Fondazione LILA Milano, Italian League for Fighting AIDS, Milan, Italy
| | - John S Lambert
- School of Medicine, University College Dublin, Dublin, Ireland. .,Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland.
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11
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Abstract
HIV partner notification (PN) is a highly effective strategy to identify people living with undiagnosed HIV infection. This national audit of HIV PN is against the 2015 British Association of Sexual Health and HIV (BASHH)/British HIV Association (BHIVA)/Society of Sexual Health Advisers (SHAA)/National AIDS Trust (NAT) HIV PN standards, developed in response to the 2013 BASHH/BHIVA national HIV PN audit. We report significant improvements in the number of contacts tested per index case, likely due, in part, to clearer definitions as well as better ascertainment and reporting. There remains scope for improvement with informing and testing contactable contacts. Recommendations from this audit include further refinement of definitions and development of a national proforma for HIV PN.
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Affiliation(s)
- Lauren Bull
- Chelsea and Westminster NHS Foundation Trust
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12
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Godongwana M, Chewparsad J, Lebina L, Golub J, Martinson N, Jarrett BA. Ethical Implications of eHealth Tools for Delivering STI/HIV Laboratory Results and Partner Notifications. Curr HIV/AIDS Rep 2021; 18:237-246. [PMID: 33772406 PMCID: PMC8057984 DOI: 10.1007/s11904-021-00549-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
Purpose of Review eHealth tools are increasingly utilized for communication with patients. Although efficacious and cost-effective, these tools face several barriers that challenge their ethical use in sexual health. We reviewed literature from the past decade to pick illustrative studies of eHealth tools that deliver results of laboratory tests for sexually transmitted infections, including the human immunodeficiency virus, as well as partner notifications. We describe ethical implications for such technologies. Recent Findings Our review found that despite widespread research on the use of eHealth tools in delivering laboratory results and partner notifications, these studies rarely measured or reported on the ethical implications. Such implications can be organized according to the four major principles in bioethics: beneficence, patient autonomy, non-maleficence, and justice. The beneficence of eHealth typically measures efficacy in comparison to existing standards of care. Patient autonomy includes the ability to opt in or out of eHealth tools, right-based principles of consent, and sovereignty over healthcare data. To adhere to the principle of non-maleficence, relevant harms must be identified and measured—such as unintentional disclosure of illness, sexual orientation, or sexual activity. Justice must also be considered to accommodate all users equally, irrespective of their literacy level, with easy-to-use platforms that provide clear messages. Summary Based on case studies from this review, we developed a list of recommendations for the ethical development and evaluation of eHealth platforms to deliver STI/HIV results to patients and notifications to partners.
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Affiliation(s)
- Motlatso Godongwana
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa.
| | - Juanita Chewparsad
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Golub
- Center for TB Research, Johns Hopkins University, Baltimore, MD, USA
| | - Neil Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brooke A Jarrett
- Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Azizi A, Dewar J, Qu Z, Hyman JM. Using an agent-based sexual-network model to analyze the impact of mitigation efforts for controlling chlamydia. Epidemics 2021; 35:100456. [PMID: 33838588 DOI: 10.1016/j.epidem.2021.100456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022] Open
Abstract
Chlamydia trachomatis (Ct) is the most reported sexually transmitted infection in the United States, with a major cause of infertility, pelvic inflammatory disease, and ectopic pregnancy among women. Despite decades of screening women for Ct, rates increase among young African Americans (AA). We create and analyze a heterosexual agent-based network model to help understand the spread of Ct. We calibrate the model parameters to agree with survey data showing Ct prevalence of 12% of the women and 10% of the men in the 15-25 year-old AA in New Orleans, Louisiana. Our model accounts for both long-term and casual partnerships. The network captures the assortative mixing of individuals by preserving the joint-degree distributions observed in the data. We compare the effectiveness of intervention strategies based on randomly screening men, notifying partners of infected people, which includes partner treatment, partner screening, and rescreening for infection. We compare the difference between treating partners of an infected person both with and without testing them. We observe that although increased Ct screening, rescreening, and treating most of the partners of infected people will reduce the prevalence, these mitigations alone are not sufficient to control the epidemic. The current practice is to treat the partners of an infected individual without first testing them for infection. The model predicts that if a sufficient number of the partners of all infected people are tested and treated, then there is a threshold condition where the epidemic can be mitigated. This threshold results from the expanded treatment network created by treating an individual's infected partners' partners. Although these conclusions can help design future Ct mitigation studies, we caution the reader that these conclusions are for the mathematical model, not the real world, and are contingent on the validity of the model assumptions.
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Affiliation(s)
- Asma Azizi
- Simon A. Levin Mathematical Computational Modeling Science Center, Arizona State University, Tempe, AZ 85281, USA; Division of Applied Mathematics, Brown University, Providence, RI, 02906, USA.
| | - Jeremy Dewar
- Department of Mathematics, Tulane University, New Orleans, LA, 70118, USA
| | - Zhuolin Qu
- Department of Mathematics, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - James Mac Hyman
- Department of Mathematics, Tulane University, New Orleans, LA, 70118, USA
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14
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Vermandere H, Aguilera-Mijares S, Martínez-Vargas L, Colchero MA, Bautista-Arredondo S. Developing HIV assisted partner notification services tailored to Mexican key populations: a qualitative approach. BMC Public Health 2021; 21:555. [PMID: 33743651 PMCID: PMC7981994 DOI: 10.1186/s12889-021-10612-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Heleen Vermandere
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Santiago Aguilera-Mijares
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Liliane Martínez-Vargas
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - M Arantxa Colchero
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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15
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Pasquale DK, Doherty IA, Leone PA, Dennis AM, Samoff E, Jones CS, Barnhart J, Miller WC. Lost and found: applying network analysis to public health contact tracing for HIV. Appl Netw Sci 2021; 6:13. [PMID: 33681455 PMCID: PMC7889541 DOI: 10.1007/s41109-021-00355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Infectious disease surveillance is often case-based, focused on people diagnosed and their contacts in a predefined time window, and treated as independent across infections. Network analysis of partners and contacts joining multiple investigations and infections can reveal social or temporal trends, providing opportunities for epidemic control within broader networks. We constructed a sociosexual network of all HIV and early syphilis cases and contacts investigated among residents of 11 contiguous counties in North Carolina over a two-year period (2012-2013). We anchored the analysis on new HIV diagnoses ("indexes"), but also included nodes and edges from syphilis investigations that were within the same network component as any new HIV index. After adding syphilis investigations and deduplicating people included in multiple investigations (entity resolution), the final network comprised 1470 people: 569 HIV indexes, 700 contacts to HIV indexes who were not also new cases themselves, and 201 people who were either indexes or contacts in eligible syphilis investigations. Among HIV indexes, nearly half (48%; n = 273) had no located contacts during single-investigation contact tracing, though 25 (9%) of these were identified by other network members and thus not isolated in the final multiple investigation network. Constructing a sociosexual network from cases and contacts across multiple investigations mitigated some effects of unobserved partnerships underlying the HIV epidemic and demonstrated the HIV and syphilis overlap in these networks.
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Affiliation(s)
- Dana K. Pasquale
- Department of Sociology, Duke University, 417 Chapel Drive, 276 Soc/Psych Building, Box 90088, Durham, NC 27708-0088 USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC USA
| | - Irene A. Doherty
- RTI International, Research Triangle Park, Durham, NC USA
- The Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, NC USA
| | - Peter A. Leone
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Ann M. Dennis
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Erika Samoff
- NC Department of Health and Human Services Communicable Disease Branch, Raleigh, NC USA
| | - Constance S. Jones
- NC Department of Health and Human Services Communicable Disease Branch, Raleigh, NC USA
| | - John Barnhart
- NC Department of Health and Human Services Communicable Disease Branch, Raleigh, NC USA
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH USA
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16
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Lasry A, Danho NK, Hulland EN, Diokouri AD, Kingbo MH, Doumatey NIL, Ekra AK, Ebah LG, Kouamé H, Hedje J, Jean-Baptiste AE. Outcome of HIV Testing Among Family Members of Index Cases Across 36 Facilities in Abidjan, Côte d'Ivoire. AIDS Behav 2021; 25:554-61. [PMID: 32875461 DOI: 10.1007/s10461-020-03002-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In Côte d'Ivoire, the Family Approach to Counseling and Testing (FACT) program began in 2015 and provides facility-based HIV testing to the sexual partners, children and other household family members of HIV-positive index cases. We evaluated whether the FACT program is an effective approach to HIV case finding. We reviewed 1762 index patient charts to evaluate outcomes of the FACT program, held across 36 facilities in Abidjan. Index cases enumerated a total of 644 partners, 2301 children and 508 other family members including parents and siblings. Among the partners tested for HIV, the positivity rate was 21%; for children the positivity rate was 5% and for all other family members the positivity rate was 11%. Offering HIV testing services to the family members of HIV positive index cases is an effective approach to case finding in Côte d'Ivoire. Particularly, offering HIV testing to the partners of positive women index cases can be key to identifying previously undiagnosed men and linking them to treatment.
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17
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Horwood J, Brangan E, Manley P, Horner P, Muir P, North P, Macleod J. Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation. BMC Fam Pract 2020; 21:265. [PMID: 33302884 PMCID: PMC7731735 DOI: 10.1186/s12875-020-01329-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Evidence suggests that a substantial proportion of these cases are not managed appropriately in line with national guidelines. With the increase in sexually transmitted infections and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority. We investigated feasibility and acceptability of extending the National Chlamydia Screening Programme's centralised, nurse-led, telephone management (NLTM) as an option for management of all cases of chlamydia and gonorrhoea diagnosed in Primary Care. METHODS Randomised feasibility trial in 11 practices in Bristol with nested qualitative study. In intervention practices patients and health care providers (HCPs) had the option of choosing NLTM or usual care for all patients tested for Chlamydia and Gonorrhoea. In control practices patients received usual care. RESULTS One thousand one hundred fifty-four Chlamydia/gonorrhoea tests took place during the 6-month study, with a chlamydia positivity rate of 2.6% and gonorrhoea positivity rate of 0.8%. The NLTM managed 335 patients. Interviews were conducted with sixteen HCPs (11 GPs, 5 nurses) and 12 patients (8 female). HCPs were positive about the NLTM, welcomed the partner notification service, though requested more timely feedback on the management of their patients. Explaining the NLTM to patients didn't negatively impact on consultations. Patients found the NLTM acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message regarding a negative result and valued talking to a sexual health specialist about positive results. CONCLUSION Extension of this established NLTM intervention to a greater proportion of patients was both feasible and acceptable to both patients and HCP, could provide a better service for patients, whilst decreasing primacy care workload. The study provides evidence to support the wider implementation of this NLTM approach to managing chlamydia and gonorrhoea diagnosed in primary care.
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Affiliation(s)
- Jeremy Horwood
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
- NIHR Health Protection Research Unit (HPRU) in in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Emer Brangan
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Petra Manley
- Field Service, National Infection Service, Public Health England, Bristol, UK
| | - Paddy Horner
- NIHR Health Protection Research Unit (HPRU) in in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- UNITY Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Peter Muir
- Public Health England South West Regional Laboratory, Bristol, UK
| | - Paul North
- Public Health England South West Regional Laboratory, Bristol, UK
| | - John Macleod
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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18
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Rosenbaum JE, Jennings J, Ellen JM, Borkovic LM, Scott JA, Wylie C, Rompalo A. Giving syphilis and gonorrhea to friends: using in-person friendship networks to find additional cases of gonorrhea and syphilis. BMC Public Health 2020; 20:1526. [PMID: 33081743 PMCID: PMC7575333 DOI: 10.1186/s12889-020-09589-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Syphilis and gonorrhea reached an all-time high in 2018. The resurgence of syphilis and gonorrhea requires innovative methods of sexual contact tracing that encourage disclosure of same-sex sexual contacts that might otherwise be suppressed. Over 75% of Grindr mobile phone application users report seeking “friendship,” so this study asked people diagnosed with syphilis and gonorrhea to identify their friends. Methods Patients at the two Baltimore sexually transmitted infection (STI) clinics and the Baltimore City Health Department were asked 12 questions to elicit members of their friendship networks before eliciting sexual networks. The study included 353 index cases and 172 friendship contacts, yielding a friendship network of 331 non-isolates (n = 331) and sexual-only network of 140 non-isolates. The data were plotted and analyzed using exponential family random graph analysis. Results Eliciting respondents’ in-person social contacts yielded 12 syphilis cases and 6 gonorrhea cases in addition to the 16 syphilis cases and 4 gonorrhea cases that would have been found with sexual contacts alone. Syphilis is clustered within sexual (odds ratio = 2.2, 95% confidence interval (1.36, 3.66)) and social contacts (OR = 1.31, 95% CI (1.02, 1.68)). Gonorrhea is clustered within reported social (OR = 1.56, 95% CI (1.22, 2.00)) but not sexual contacts (OR = 0.98, 95% CI (0.62, 1.53)). Conclusions Eliciting friendship networks of people diagnosed with syphilis and gonorrhea may find members of their sexual networks, drug use networks, or people of similar STI risk. Friendship networks include more diagnosed cases of syphilis and gonorrhea than sexual networks alone, especially among populations with many non-disclosing men who have sex with men (MSM) and women who have sex with women (WSW). Future research should evaluate whether this friendship network method of contact tracing can be implemented by adapting automated mobile phone COVID-19 contact tracing protocols, if these COVID-19 contact tracing methods are able to maintain anonymity and public trust.
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Affiliation(s)
- Janet E Rosenbaum
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, USA.
| | - Jacky Jennings
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jonathan M Ellen
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Laurel M Borkovic
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jo-Ann Scott
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Charleen Wylie
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Anne Rompalo
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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19
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Yan R, Deng B, Wen G, Huang L, Li L, Huang Z. Contact tracing of syphilis-seropositive pregnant women and syphilis-infection among their male partners in Bao'an district, Shenzhen, China. BMC Infect Dis 2020; 20:684. [PMID: 32948128 PMCID: PMC7501691 DOI: 10.1186/s12879-020-05403-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background Untreated male partners are a critical source of maternal re-infection. Contact tracing is a good way to identify infection among partners and reduce risk of mother-to-child transmission related to maternal re-infection. This study aimed to analyze the current situation and related factors of contact tracing of syphilis-seropositive pregnant women and syphilis-infection among their male partners. Method Data of syphilis-seropositive pregnant women and their male partners attending clinic for syphilis-screening were obtained from the Shenzhen Program for Prevention of Congenital Syphilis. Contact tracing rate of syphilis-seropositive pregnant women and syphilis prevalence among male partners were counted, and related factors were also analyzed using a random-effects logistic regression model. Result Of the 1299 syphilis-seropositive pregnant women, 74.1% (963/1299) had their male partners receiving syphilis-screening and 19.1% (184/963) of male partners were syphilis-infected. For pregnant women, being divorced (adjusted odds ratio [AOR] =0.39; 95%CI: 0.17–0.87), seeking for emergency services at their first antenatal clinics visits (AOR = 0.58; 95%CI: 0.44–0.77), reporting willingness to notify partner(AOR = 7.65; 95%CI: 4.69–12.49), multi-partners (AOR = 1.38; 95%CI:1.03–1.86) and having a history of drug abuse (AOR = 0.37; 95%CI: 0.14–1.00)were independently associated with successful contact tracing. For male partners, of minority ethnicity (AOR = 4.15; 95%CI: 1.66–10.34), age at first sex>20(AOR = 0.57; 95%CI: 0.37–0.87), reporting multi-partners (AOR = 1.60; 95%CI: 1.04–2.46), having a history of drug abuse (AOR = 4.07; 95%CI: 1.31–12.64) were independently associated with syphilis-infection. In addition, pregnant women with TRUST titer ≥1:8 (AOR = 2.81; 95%CI: 1.87–4.21), having a history of adverse pregnancy outcomes (AOR = 1.70; 95%CI: 1.14–2.53), reporting multi-partners (AOR = 0.43; 95%CI: 0.29–0.64) and reporting the current partner as the source of syphilis (AOR = 5.05; 95%CI: 2.82–9.03) were independently associated with partners’ syphilis-infection. Conclusion Contact tracing is feasible and effective in identifying syphilis-infected partners among syphilis-seropositive pregnant women. Contact tracing is associated with many factors such as women’s marital status, services at their first antenatal clinics visit and willingness of partner notification. Partners’ ethnicity, age at first sex, multi-partners and history of drug abuse as well as women’s levels of TRUST titer were associated with partners’ syphilis-infection.
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Affiliation(s)
- Ruilin Yan
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Baoqing Deng
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Guichun Wen
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Licheng Huang
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Limei Li
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Zhiming Huang
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China.
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20
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Yan X, Li Y, Su H, Xing Y, Zhang B, Lu Z, Jia Z. Protect MSM from HIV and other sexually transmitted diseases by providing mobile health services of partner notification: protocol for a pragmatic stepped wedge cluster randomized controlled trial. BMC Public Health 2020; 20:1107. [PMID: 32664934 PMCID: PMC7362655 DOI: 10.1186/s12889-020-09162-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Recently, more and more men who have sex with men (MSM) look for casual partners through online dating platforms in China. However, most are unable to know their partners’ HIV and other sexually transmitted diseases (STD) statuses, leading to the rapid increase in HIV infection among Chinese MSM. Effective partner notification is urgently needed to increase the risk awareness of MSM and prevent HIV and other STDs transmission. However, the traditional intervention mainly targets to the HIV-positive MSM and the effect is not promising. Our study aims to provide Internet-based partner notification, along with a series of health services for HIV-negative MSM to protect them from HIV and other STDs. Methods A pragmatic stepped wedge cluster randomized controlled trial design is used to evaluate the effectiveness of a new intervention paradigm, which aims to reduce HIV and other STDs incidences among MSM in China. Through integrating a mobile health (mHealth) service application (app) to the current HIV and other STDs prevention and control methods, the new paradigm provides partner notification of HIV, syphilis, hepatitis B, and hepatitis C statuses. A total of 6172 MSM in 16 districts of Beijing, China will be recruited and randomized to sequentially receive partner notification intervention through the app at 6-month intervals. The primary outcomes are HIV incidence and the additional cost of the intervention. The secondary outcomes include incidences of syphilis, hepatitis B, and hepatitis C, disease transmission social networks, testing adherence, knowledge of HIV and STDs control, health self-responsibility awareness, changes of high risk behaviors and other related outcomes. The generalized linear mixed models (GLMM) will be used to analyze the differences of outcomes in the control period and in the intervention period. Discussion We expect that the HIV incidence will be significantly lower and the secondary outcomes will also be improved with providing health service of partner notification through mhealth intervention. The feasible and affordable public health intervention paradigm will have implications for HIV and STDs prevention and control among MSM and other key populations. Trial registration ClinicalTrials.gov, NCT04349748. Registered on 16 April 2020.
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Affiliation(s)
- Xiangyu Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Yongjie Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Hexuan Su
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yi Xing
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Bo Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Zuhong Lu
- State Key Laboratory for Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Zhongwei Jia
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. .,National Institute on Drug Dependence, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China. .,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China. .,Center for Technology and Policy Research on Infectious Disease Prevention and Control, Global Health Research Institute, Peking University, Beijing, China.
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21
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Madsen T, Jespersen S, Medina C, Té DDS, Wejse C, Laursen AL, Hønge BL. Acceptance and Feasibility of Partner Notification to HIV Infected Individuals in Guinea-Bissau. AIDS Behav 2020; 24:1476-1485. [PMID: 31705346 DOI: 10.1007/s10461-019-02717-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
As partner notification (PN) has shown effective in increasing the number of partners of HIV infected patients being tested we aimed to evaluate the feasibility of implementing PN in the West-African country Guinea-Bissau. Patients enrolled were offered the choice of three different PN methods. Acceptance, successful referrals and HIV status of partners were evaluated. Of 697 patients offered PN, 495 (71.0%) accepted and listed 547 partners. At end of follow-up 118 (21.5%) partners had been tested of which 44 (37.3%) were HIV infected. HIV infected partners had a higher median CD4 count at diagnosis compared with index patients; 401 cells/mm3 versus 240 cells/mm3, p < 0.001. The results indicate that implementation of PN is feasible, effective in identifying HIV infected partners and enables initiation of earlier treatment, yet there are major barriers to bringing partners in for testing which should be addressed in order to exploit the full potential of PN.
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Affiliation(s)
- Tina Madsen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
| | - Sanne Jespersen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Candida Medina
- National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
| | - David D S Té
- National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
| | - Christian Wejse
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- GloHAU, Center for Global Health, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Alex L Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Bo L Hønge
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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22
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Vilela Á, Bach P, Godoy P. [Compliance with the partner notification of HIV/STI patients in the counties of Lleida]. Rev Esp Salud Publica 2019; 93:e201912096. [PMID: 31782410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The partner notification is one of the main activities of epidemiological surveillance in Public Health. The primary objective was to estimate the compliance of the partner notification by health professionals who reported sexually transmitted diseases (HIV, Gonorrhoea, Syphilis and Chlamydia) during 2017 in Lleida's regions. METHODS We carried out a descriptive epidemiological study of prevalence about the compliance of partner notification. Data collection was done by epidemiological surveys of these notifiable diseases and additional information was recovered through medical record and interview with professionals. The factors associated with the lack of partner notification were studied through the odds ratio (OR) and its 95% confidence interval (CI). ORs were adjusted (ORa) with multivariate logistic regression models. RESULTS We studied 203 STD cases with an average age of 30.6 years (SD=11.1); 32.5% were women. There was 46.3% without partner notification. The main cause of this absence was the lack of patient cooperation (23.4%). The variables associated with the lack of partner notification were the male sex (aOR-3.5; CI95%=1.6-7.5), gonococcal infection (aOR-4.9; CI95%=1.2-19.8), chlamydia infection (aOR-3.9; CI95%=0.9-16.1) and homosexual/bisexual sexual orientation (aOR-2.2; CI95%=0.9-5.4). CONCLUSIONS Compliance of partner notification is low and it is related to male sex, sexual orientation (homosexual/bisexual/transsexual) and type of infection (Gonorrhoea and Chlamydia). Reducing the social stigma associated with sexual orientation and improving the information of health professionals could favour the contact studies.
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Affiliation(s)
- Álvaro Vilela
- Institut Català de la Salut. ABS Onze de Setembre. Lleida. España
- Institut de Recerca Biomèdica de Lleida (IRBLleida). Lleida. España
| | - Pilar Bach
- Agència de Salut Pública de Catalunya. Lleida. España
| | - Pere Godoy
- Institut de Recerca Biomèdica de Lleida (IRBLleida). Lleida. España
- Agència de Salut Pública de Catalunya. Lleida. España
- CIBER de Epidemiologia y Salud Pública (CIBERESP). Barcelona. España
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Katzman C, Mateu-Gelabert P, Kapadia SN, Eckhardt BJ. Contact tracing for hepatitis C: The case for novel screening strategies as we strive for viral elimination. Int J Drug Policy 2019; 72:33-39. [PMID: 31010750 PMCID: PMC6717536 DOI: 10.1016/j.drugpo.2019.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 01/07/2023]
Abstract
Contact tracing has been a key element of the public health response to infectious diseases for decades. These practices have been powerful in slowing the spread of tuberculosis, HIV, and other sexually transmitted infections. Despite success in other contexts, contact tracing for hepatitis C virus (HCV) has historically been considered infeasible because of a long asymptomatic period, which often makes it difficult to pinpoint the time of acquisition. Additionally, individuals may be reluctant to identify injecting partners because of stigma or fear of criminal repercussions. However, multiple factors - including the improved curability of HCV with advances in direct acting antiviral agents (DAAs), the implementation of age-based screening, and the current opioid epidemic -- have led to rapid changes in the landscape of HCV. HCV is increasingly concentrated among young people who inject drugs (PWID), many of whom are inadequately being reached by current screening practices. With the shift in the population most at risk for HCV and the fundamental changes in how we manage this disease, it's time to also rethink the public health response in identifying and informing those who may have been exposed. Contact tracing programs for HCV can augment existing screening strategies to provide curative treatment for patients and their partners, prevent reciprocal transmission of HCV between risk partners and within networks, and ultimately reach individuals who aren't yet engaged in healthcare and harm reduction. While there remain limitations to contact tracing for HCV, it has the potential to be a powerful tool in slowing the spread of the virus as we attempt to achieve viral elimination.
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24
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Wynn A, Moucheraud C, Moshashane N, Offorjebe OA, Ramogola-Masire D, Klausner JD, Morroni C. Using partner notification to address curable sexually transmitted infections in a high HIV prevalence context: a qualitative study about partner notification in Botswana. BMC Public Health 2019; 19:606. [PMID: 31138228 PMCID: PMC6538557 DOI: 10.1186/s12889-019-6813-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partner notification is an essential component of sexually transmitted infection (STI) management. The process involves identifying exposed sex partner(s), notifying these partner(s) about their exposure to a curable STI, and offering counselling and treatment for the STI as a part of syndromic management or after results from an STI test. When implemented effectively, partner notification services can prevent the index patient from being reinfected with a curable STI from an untreated partner, reduce the community burden of curable STIs, and prevent adverse health outcomes in both the index patient and his or her sex partner(s). However, partner notification and treatment rates are often low. This study seeks to explore experiences and preferences related to partner notification and treatment for curable STIs among pregnant women receiving care in an antenatal clinic with integrated HIV and curable STI testing. Results are intended to inform efforts to improve partner notification and treatment rates in Southern Africa. METHODS We conducted qualitative interviews among women diagnosed with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and/or Trichomonas vaginalis (TV) infection while seeking antenatal care in Gaborone, Botswana. Semi-structured interviews were used to obtain women's knowledge about STIs and their experiences and preferences regarding partner notification. RESULTS Fifteen women agreed to participate in the study. The majority of women had never heard of CT, NG, or TV infections prior to testing. Thirteen out of 15 participants had notified partners about the STI diagnosis. The majority of notified partners received some treatment; however, partner treatment was often delayed. Most women expressed a preference for accompanying partners to the clinic for treatment. Experiences and preferences did not differ by HIV infection status. CONCLUSIONS The integration of STI, HIV, and antenatal care services may have contributed to most women's willingness to notify partners. However, logistical barriers to partner treatment remained. More research is needed to identify effective and appropriate strategies for scaling-up partner notification services in order to improve rates of partners successfully contacted and treated, reduce rates of STI reinfection during pregnancy, and ultimately reduce adverse maternal and infant outcomes attributable to antenatal STIs.
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Affiliation(s)
- Adriane Wynn
- GloCal, University of California Global Health Institute, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Corrina Moucheraud
- Fielding School of Public Health, Department of Health Policy and Management, University of California Los Angeles, 31-269 CHS, Box 951772, Los Angeles, CA 90095 USA
| | - Neo Moshashane
- Botswana-UPenn Partnership, UB Main Campus, Gaborone, Botswana
| | - Ogechukwu Agatha Offorjebe
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA
- Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA 90059 USA
| | | | - Jeffrey D. Klausner
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA
| | - Chelsea Morroni
- Botswana-UPenn Partnership, UB Main Campus, Gaborone, Botswana
- Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Medicine, University of Botswana, Gaborone, Botswana
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
- Women’s Health Research Unit, University of Cape Town, Cape Town, South Africa
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25
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Perez-Brumer AG, Passaro RC, Oldenburg CE, Garcia J, Sanchez J, Salvatierra HJ, Lama JR, Clark JL. Homophobia and heteronormativity as dimensions of stigma that influence sexual risk behaviors among men who have sex with men (MSM) and women (MSMW) in Lima, Peru: a mixed-methods analysis. BMC Public Health 2019; 19:617. [PMID: 31113398 PMCID: PMC6528354 DOI: 10.1186/s12889-019-6956-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Stigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. Recognizing the heterogeneous behaviors/identities within the category "MSM," we used mixed-methods to assess sexual risk behaviors among men who have sex with men only (MSMO) and behaviorally bisexual MSM (MSMW) with HIV and/or other STIs. METHODS MSMO/MSMW recently diagnosed (< 30 days) with HIV, syphilis, urethritis, or proctitis completed a cross-sectional survey assessing sexual risk behaviors, anticipated disclosure, and sexual partnership characteristics (n = 332). Multivariable generalized estimating equation models assessed characteristics associated with female compared to male partners in the last three partnerships. Follow-up qualitative interviews (n = 30) probed partner-specific experiences (e.g., acts and disclosure). RESULTS Among all participants, 13.9% (n = 46) described at least one of their last three sex partners as female (MSMW). MSMW (mean age of 31.8) reported a mean of 3.5 partners (SD = 4.5) in the past 3 months and MSMO (mean age 30.6) reported a mean of 4.6 partners (SD = 9.7) in the past 3 months. MSMW were more likely to report unprotected insertive anal sex (77.9%) than MSMO (43.1%; p < 0.01). Cisgender female partners were associated with condomless insertive sex in the last 3 months (aPR: 3.97, 95%CI: 1.98-8.00) and classification as a "primary" partnership (2.10, 1.34-3.31), and with lower prevalence of recent HIV diagnosis (0.26, 0.11-0.61). Planned notification of HIV/STI diagnoses was less common for female than for male partners (0.52, 0.31-0.85). Narratives illustrate internal (e.g., women as 'true' partners) and community-level processes (e.g., discrimination due to exposure of same-sex behavior) that position homosexual behavior and bisexual identity as divergent processes of deviance and generate vulnerability within sexual networks. CONCLUSIONS MSMW recently diagnosed with HIV/STI in Peru report varying partnership characteristics, with different partner-specific risk contexts and prevention needs. Descriptions highlight how behaviorally bisexual partnerships cut across traditional risk group boundaries and suggest that HIV/STI prevention strategies must address diverse, partnership-specific risks.
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Affiliation(s)
- Amaya G Perez-Brumer
- Columbia Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th St., New York, NY, 10032, USA.
| | - Ryan C Passaro
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan Garcia
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jorge Sanchez
- Centro de Investigaciones Tecnologicas y Biomedicas Universidad Nacional de San Marcos, Lima, Peru
| | | | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Nakku-Joloba E, Kiguli J, Kayemba CN, Twimukye A, Mbazira JK, Parkes-Ratanshi R, Birungi M, Kyenkya J, Byamugisha J, Gaydos C, Manabe YC. Perspectives on male partner notification and treatment for syphilis among antenatal women and their partners in Kampala and Wakiso districts, Uganda. BMC Infect Dis 2019; 19:124. [PMID: 30727950 PMCID: PMC6366113 DOI: 10.1186/s12879-019-3695-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background Syphilis screening can be successfully integrated into antenatal clinics, and potentially avert significant morbidity and mortality to unborn infants. A minority of male partners report for testing and treatment, increasing the likelihood of reinfection. We conducted a qualitative study to understand factors influencing male partners to seek treatment after syphilis notification by their pregnant partners. Methods A purposeful sample of 54 adults who participated in the STOP (Syphilis Treatment of Partners) study was stratified by gender (24 women, 30 male partners) and enrolled for in-depth interviews which were audio recorded, transcribed, and analyzed using the thematic approach. Results The participants’ median age (IQR) was 32 years (25–44), 87% were married, and 57.4% (31/74) had attained secondary education. Fourteen of 22 (63%) female participants reported that they sometimes experienced domestic violence. Male participant’s knowledge of syphilis and their perception of their valued role as responsible fathers of an unborn baby facilitated return. Female’s fear of partner‘s violence and poor communication between partners, were barriers against delivery of the notification forms to partners and subsequent treatment of partners. For men, fear of injection pain, perceptions of syphilis as a genetic disease and as a woman’s problem, busy work schedules, poor access to good STD services, shared facilities with women in clinics, as well as HIV-related stigma were important barrier factors. Conclusions The return to the clinic for treatment of male partners after partner notification by infected pregnant women, was low due to limited knowledge about syphilis, fear of painful injection, fears of domestic violence, lack of communication skills (individual characteristics) and syphilis disease characteristics such as signs and symptoms. This, combined with health services characteristics such as structural barriers that hinder male partner treatment, low access, low capacity, work/time challenges, inadequate laboratory services and low clinic personnel capacity; threatens efforts to eliminate mother-to-child infection of syphilis. Improved public messaging about syphilis, better services, legal and policy frameworks supporting STD notification and treatment in resource-constrained settings are needed for effective STD control. Trial registration Clinicaltrials.govNCT02262390., Date Registered October 8 2014.
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Affiliation(s)
- Edith Nakku-Joloba
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. .,STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.
| | - Juliet Kiguli
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Adeline Twimukye
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joshua Kimeze Mbazira
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Monica Birungi
- STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.,Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joshua Kyenkya
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Josaphat Byamugisha
- Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Charlotte Gaydos
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Yukari C Manabe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
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Quinn C, Nakyanjo N, Ddaaki W, Burke VM, Hutchinson N, Kagaayi J, Wawer MJ, Nalugoda F, Kennedy CE. HIV Partner Notification Values and Preferences Among Sex Workers, Fishermen, and Mainland Community Members in Rakai, Uganda: A Qualitative Study. AIDS Behav 2018; 22:3407-3416. [PMID: 29372453 DOI: 10.1007/s10461-018-2035-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
HIV partner notification involves contacting sexual partners of people who test HIV positive and referring them to HIV testing, treatment, and prevention services. To understand values and preferences of key and general populations in Rakai, Uganda, we conducted 6 focus group discussions and 63 in-depth interviews in high prevalence fishing communities and low prevalence mainland communities. Participants included fishermen and sex workers in fishing communities, male and female mainland community members, and healthcare providers. Questions explored three approaches: passive referral, provider referral, and contract referral. Qualitative data were coded and analyzed using a team-based matrix approach. Participants agreed that passive referral was most suitable for primary partners. Provider referral was acceptable in fishing communities for notifying multiple, casual partners. Healthcare providers voiced concerns about limited time, resources, and training for provider-assisted approaches. Options for partner notification may help people overcome barriers to HIV serostatus disclosure and help reach key populations.
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Affiliation(s)
- Caitlin Quinn
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | | | | | - Virginia M Burke
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Naadiya Hutchinson
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | | | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Caitlin E Kennedy
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
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28
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Wood JM, Harries J, Kalichman M, Kalichman S, Nkoko K, Mathews C. Exploring motivation to notify and barriers to partner notification of sexually transmitted infections in South Africa: a qualitative study. BMC Public Health 2018; 18:980. [PMID: 30081960 PMCID: PMC6080399 DOI: 10.1186/s12889-018-5909-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022] Open
Abstract
Background This article will review qualitative data from intervention-based counselling sessions to explore barriers to partner notification (PN) for South African men and women who have contracted sexually transmitted infections (STIs). This qualitative study took place in a township where there is high STI and HIV prevalence. In addition to reviewing barriers to PN, the study will also identify participants’ perceptions about effective PN strategies that are presented during the intervention. Ultimately, the study will assess the intervention’s impact on participants’ motivation and skills to notify their partners about their STI status. Methods Relying on recorded counselling sessions from an intervention run by a parent study, this sub- study reviewed 30 transcripts from counselling sessions with 15 men and 15 women. The intervention was a 60 min interactive session where STI and HIV education, risk mitigation, and effective PN strategies were discussed. Participants were between 19 and 41 years old (mean age = 28.4) and lived within the catchment area of a South African township. Recordings were chosen based on verbal responsiveness of the participant and were manually coded for analysis. In addition, two programme counsellors were interviewed about their perceptions of the intervention and their experiences with participants to enhance rigour and reduce potential bias. Results By the conclusion of the intervention session, both male and female participants were motivated to notify their partners face-to-face about their positive STI status. Despite this, misperceptions about the etiology and transmission of STIs, as well as inadequate support from the clinical level and power imbalances amongst men and women emerged as major barriers for the prevention of future STIs. Conclusions While the intervention appears to be successful in facilitating partners’ intentions to notify, the data shows significant social and structural barriers that will create difficulties for the prevention of future STIs. Participants’ persistent concerns about acquiring HIV or their current positive status affect decision-making and therefore, could be a window of opportunity for health-care providers or lay counsellors to discuss STIs in high prevalence areas.
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Affiliation(s)
- Julia M Wood
- School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, Western Cape, 7925, South Africa.
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Moira Kalichman
- Department of Psychological Sciences, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA
| | - Seth Kalichman
- Department of Psychological Sciences, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA
| | - Koena Nkoko
- City of Cape Town, City Health Department Cnr NY 1 Lansdowne Road Fezeka Administration Complex Guguletu, Cape Town, Western Cape, South Africa
| | - Catherine Mathews
- South African Medical Research Council, Tygerberg, P.O Box 19070, Cape Town, Western Cape, 7505, South Africa
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29
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Semple SJ, Pines HA, Strathdee SA, Vera AH, Rangel G, Magis-Rodriguez C, Patterson TL. Uptake of a Partner Notification Model for HIV Among Men Who Have Sex With Men and Transgender Women in Tijuana, Mexico. AIDS Behav 2018; 22:2042-2055. [PMID: 29159592 DOI: 10.1007/s10461-017-1984-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Undiagnosed HIV infection is common among men who have sex with men (MSM) and transgender women (TW) in Latin America. We examined uptake of a partner notification (PN) model among MSM and TW in Tijuana, Mexico. Forty-six HIV-positive MSM/TW enrolled as index patients, and reported 132 MSM/TW sexual partners for PN. Of notified partners (90/132), 39% declined eligibility screening or participation, 39% tested for HIV, and of those 28% were newly-diagnosed HIV-positive. Partners who were seen by the index patient more than once in the past 4 months and those who primarily had sex with the index patient in one of their homes were more likely to be notified via PN (76% vs. 50%; p = 0.01 and 86% vs. 64%, p = 0.02, respectively). Lower than expected PN uptake was associated with problems identifying index patients, obtaining reliable partner contact information, and engaging notified partners.
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Nanhoe AC, Visser M, Omlo JJ, Watzeels AJCM, van den Broek IV, Götz HM. A pill for the partner via the chlamydia patient? Results from a mixed method study among sexual health care providers in the Netherlands. BMC Infect Dis 2018; 18:243. [PMID: 29843643 PMCID: PMC5975518 DOI: 10.1186/s12879-018-3139-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/10/2018] [Indexed: 11/17/2022] Open
Abstract
Background Chlamydia prevalence in the Netherlands remains high despite targeted efforts. Effective Partner Notification (PN) and Partner Treatment (PT) can interrupt transmission and prevent re-infections. Patient Initiated Partner Treatment (PIPT) may strengthen chlamydia control. This study explores the current practice of PN and PT, and benefits of, and barriers and facilitators for PIPT among professionals in sexual health care in the Netherlands. Methods A qualitative study was performed among GPs, GP-assistants (GPAs), physicians and nurses working at Sexual Health Clinics (SHC) and key-informants on ethnical diversity using topic lists in focus groups (N = 40) and semi-structured questionnaires in individual interviews (N = 9). Topics included current practices regarding PN and PT, attitude regarding PIPT, and perceived barriers and facilitators for PIPT. Interviews were taped, transcribed verbatim, and coded using ATLAS.ti. A quantitative online questionnaire on the same topics was sent to all physicians and nurses employed at Dutch SHC (complete response rate 26% (84/321)). Results The qualitative study showed that all professionals support the need for more attention to PN, and that they saw advantages in PIPT. Mentioned barriers included unwilling PN-behaviour, Dutch legislation, several medical considerations and inadequate skills of GPs. Also, concerns about limited knowledge of cultural sensitivity around PN and PT were raised. Mentioned facilitators of PIPT were reliable home based test-kits, phone-contact between professionals and notified partners, more consultation time for GPs or GPAs and additional training. The online questionnaire showed that SHC employees agreed that partners should be treated as soon as possible, but also that they were reluctant towards PIPT without counselling and testing. Conclusions Professionals saw advantages in PIPT, but they also identified barriers hampering the potential introduction of PIPT. Improving PN and counselling skills with specific focus on cultural sensitivity is needed. PIPT could be considered for specific partners. PIPT in combination with home based testing and using e-healthcare should be further explored and developed.
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Affiliation(s)
- Anita C Nanhoe
- Center for Research and Business Intelligence, Rotterdam, The Netherlands
| | - Maartje Visser
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jurriaan J Omlo
- Center for Research and Business Intelligence, Rotterdam, The Netherlands
| | | | - Ingrid V van den Broek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hannelore M Götz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. .,Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Matoga M, Mmodzi P, Massa C, Bula A, Hosseinipour M, Chasela C. Health System Factors Influencing Partner Notification for STIs and HIV in Lilongwe Malawi. A Pre-intervention Phase Assessment for a Quality Improvement Project. ACTA ACUST UNITED AC 2018; 3. [PMID: 29707699 PMCID: PMC5918274 DOI: 10.4172/2576-1420.1000125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Despite its wide use, passive partner notification (PN) has a low yield of sexual partners influenced by patient-related and health system (HS) factors. Methods We conducted a qualitative study and clinic observations during a pre-intervention phase of a quality improvement (QI) project to identify HS factors that influenced passive PN at Bwaila STI unit (BSU) in Lilongwe Malawi from January to February 2016. We conducted 15 in-depth interviews with health workers and clinic observations for six clinic flow and PN processes at the clinic. Results The majority of health workers felt that the lack of incentives for sexual partners or couples who presented to the clinic was the most important negative HS factor that influenced passive PN. We observed an average clinic start time of 09:02 hours. The average duration of the group health talk was 56 minutes and there was no difference in the time spent at the clinic between index cases and partners (1 hour 41 minutes versus 1 hour 36 minutes respectively). Discussion Lack of incentives for sexual partners or couples was the most important HS factors that impacted the yield of sexual partners. Interventions focusing on designing simple non-monetary incentives and QI of passive PN should be encouraged.
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Affiliation(s)
- Mitch Matoga
- University of North Carolina Project, Lilongwe, Malawi.,University of the Witwatersrand, Johannesburg, South Africa
| | | | - Cecelia Massa
- University of North Carolina Project, Lilongwe, Malawi
| | - Agatha Bula
- University of North Carolina Project, Lilongwe, Malawi
| | - Mina Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles Chasela
- University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, EQUIP, Centurion, South Africa
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John SA, Walsh JL, Cho YI, Weinhardt LS. Perceived Risk of Intimate Partner Violence Among STI Clinic Patients: Implications for Partner Notification and Patient-Delivered Partner Therapy. Arch Sex Behav 2018; 47:481-492. [PMID: 29090392 PMCID: PMC5775910 DOI: 10.1007/s10508-017-1051-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 06/16/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
Patient-delivered partner therapy (PDPT) is the practice of providing patients diagnosed with a bacterial sexually transmitted infection (STI) medication to give directly to their partner for treatment without requiring the partner to participate in diagnostic testing and counseling. Despite a growing body of evidence in support of PDPT, literature is limited to date on the influence of perceived risk of intimate partner violence (IPV) on PDPT use. We analyzed mixed-method data from 196 quantitative surveys (61% male, M age = 31.2, 92% Black or African-American) and 25 qualitative interviews to better understand the barriers and facilitators associated with PDPT delivery for patients attending a Midwestern, publicly funded STI clinic in the U.S. Nearly a third of surveyed patients (29; 34% of women, 26% of men) expressed worry about IPV when delivering PDPT. Patients had concerns about infidelity worry, embarrassment, and anxiety (referred to as IWEA hereafter) associated with partner notification and PDPT delivery. We found IWEA was highly correlated with IPV concerns in a fully adjusted logistic regression model. Women had 2.43 (95% CI = 1.09-5.42) times greater odds of worrying about IPV than men; other significant factors associated with IPV worry included higher condom use, no prior STI diagnosis, and being uninsured (as compared to having Medicare/Medicaid insurance). Encouraging communication between healthcare providers and their patients about the potential for IPV could facilitate patient triaging that results in the consideration of alternative partner referral mechanisms for patients or partners at risk of harm and better outcomes for patients and their partners.
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Affiliation(s)
- Steven A John
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, 142 W. 36th Street, 9th Floor, New York, NY, 10018, USA.
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Young Ik Cho
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Lance S Weinhardt
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Magaziner S, Montgomery MC, Bertrand T, Daltry D, Jenkins H, Kendall B, Molotnikov L, Pierce L, Smith E, Sosa L, van den Berg JJ, Marak T, Operario D, Chan PA. Public health opportunities and challenges in the provision of partner notification services: the New England experience. BMC Health Serv Res 2018; 18:75. [PMID: 29386023 PMCID: PMC5793459 DOI: 10.1186/s12913-018-2890-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partner notification services (PNS) are recommended by the Centers for Disease Control and Prevention as a public health intervention for addressing the spread of HIV and other sexually transmitted diseases (STDs). Barriers and facilitators to the partner notification process from a public health perspective have not been well described. METHODS In 2015, a coalition of New England public health STD directors and investigators formed to address the increasing STD prevalence across the region (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and to promote communication between state STD programs. To evaluate barriers and facilitators of PNS programs, a survey was administered to representatives from each state to describe PNS processes and approaches. RESULTS Of the six PNS programs, Connecticut, Maine, Massachusetts, Vermont, and New Hampshire had combined HIV and STD PNS programs; Rhode Island's programs were integrated but employed separate disease intervention specialists (DIS). All states performed PNS for HIV and syphilis. Maine, New Hampshire and Vermont performed services for all gonorrhea cases. Rhode Island, Connecticut, and Massachusetts performed limited partner notification for gonorrhea due to lack of resources. None of the six states routinely provided services for chlamydia, though Maine and Vermont did so for high-priority populations such as HIV co-infected or pregnant individuals. Across all programs, clients received risk reduction counseling and general STD education as a component of PNS, in addition to referrals for HIV/STD care at locations ranging from Planned Parenthood to community- or hospital-based clinics. Notable barriers to successful partner notification across all states included anonymous partners and index cases who did not feel comfortable sharing partners' names with DIS. Other common barriers included insufficient staff, inability of DIS to identify and contact partners, and index cases declining to speak with DIS staff. CONCLUSIONS In New England, state health departments use different strategies to implement PNS programs and referral to STD care. Despite this, similar challenges exist across settings, including difficulty with anonymous partners and limited state resources.
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Affiliation(s)
- Sarah Magaziner
- Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903 USA
| | - Madeline C. Montgomery
- Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906 USA
| | - Thomas Bertrand
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908 USA
| | - Daniel Daltry
- Vermont Department of Health, 108 Cherry Street, Burlington, VT 05402 USA
| | - Heidi Jenkins
- Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134 USA
| | - Brenda Kendall
- Maine Center for Disease Control and Prevention, State House Station 11, Augusta, ME 04333 USA
| | - Lauren Molotnikov
- Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108 USA
| | - Lindsay Pierce
- New Hampshire Department of Health and Human Services, 29 Hazen Drive, Concord, NH 03301 USA
| | - Emer Smith
- Maine Center for Disease Control and Prevention, State House Station 11, Augusta, ME 04333 USA
| | - Lynn Sosa
- Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134 USA
| | - Jacob J. van den Berg
- Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903 USA
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903 USA
| | - Theodore Marak
- Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906 USA
| | - Don Operario
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903 USA
| | - Philip A. Chan
- Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903 USA
- Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906 USA
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908 USA
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903 USA
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Plotkin M, Kahabuka C, Christensen A, Ochola D, Betron M, Njozi M, Maokola W, Kisendy R, Mlanga E, Curran K, Drake M, Kessy E, Wong V. Outcomes and Experiences of Men and Women with Partner Notification for HIV Testing in Tanzania: Results from a Mixed Method Study. AIDS Behav 2018; 22:102-116. [PMID: 29090397 PMCID: PMC5758678 DOI: 10.1007/s10461-017-1936-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A growing evidence base supports expansion of partner notification in HIV testing services (HTS) in sub-Saharan Africa. In 2015, a cross-sectional study was conducted in Njombe region, Tanzania, to evaluate partner notification within facility-based HTS. Men and women newly diagnosed with HIV were enrolled as index clients and asked to list current or past sexual partners for referral to HTS. Successful partner referral was 2.5 times more likely among married compared to unmarried index clients and 2.2 times more likely among male compared to female index clients. In qualitative analysis, male as well as female index clients mentioned difficulties notifying past or casual partners, and noted disease symptoms as a motivating factor for HIV testing. Female index clients mentioned gender-specific challenges to successful referral. Women may need additional support to overcome challenges in the partner notification process. In addition to reducing barriers to partner notification specific to women, a programmatic emphasis on social strengths of males in successfully referring partners should be considered.
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Affiliation(s)
| | | | | | | | | | | | - Werner Maokola
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Renatus Kisendy
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | - Kelly Curran
- Jhpiego Baltimore, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Drake
- Jhpiego Tanzania, Dar es Salaam, Tanzania
| | - Eusebi Kessy
- Ministry of Health, Community Development, Gender, Elderly and Children, Njombe, Tanzania
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van den Broek IVF, Donker GA, Hek K, van Bergen JEAM, van Benthem BHB, Götz HM. Partner notification and partner treatment for chlamydia: attitude and practice of general practitioners in the Netherlands; a landscape analysis. BMC Fam Pract 2017; 18:103. [PMID: 29262799 PMCID: PMC5738758 DOI: 10.1186/s12875-017-0676-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chlamydia prevalence remains high despite scaling-up control efforts. Transmission is not effectively interrupted without partner notification (PN) and (timely) partner treatment (PT). In the Netherlands, the follow-up of partners is not standardized and may depend on GPs' time and priorities. We investigated current practice and attitude of GPs towards PN and PT to determine the potential for Patient-Initiated Partner Treatment, which is legally not supported yet. METHODS Multiple data-sources were combined for a landscape analysis. Quantitative data on (potential) PT were obtained from prescriptions in the national pharmacy register (2004-2014) and electronic patient data from NIVEL-Primary Care Database (PCD) and from STI consultations in a subgroup of sentinel practices therein. Furthermore, we collected information on current practice via two short questionnaires at a national GP conference and obtained insight into GPs' attitudes towards PN/PT in a vignette study among GPs partaking in NIVEL-PCD. RESULTS Prescription data showed Azithromycin double dosages in 1-2% of cases in the pharmacy register (37.000 per year); probable chlamydia-specific repeated prescriptions or double dosages of other antibiotics in NIVEL-PCD (115/1078) could not be interpreted as PT for chlamydia with certainty. STI consultation data revealed direct PT in 6/100 cases, via partner prescription or double doses. In the questionnaires the large majority of GPs (>95% of 1411) reported to discuss PN of current and ex-partner(s) with chlamydia patients. Direct PT was indicated as most common method by 4% of 271 GPs overall and by 12% for partners registered in the same practice. Usually, GPs leave further steps to the patients (83%), advising patients to tell partners to get tested (56%) or treated (28%). In the vignette study, 16-20% of 268 GPs indicated willingness to provide direct PT, depending on patient/partner profile, more (24-45%) if patients would have the chance to notify their partner first. CONCLUSION GPs in the Netherlands already treat some partners of chlamydia cases directly, especially partners registered in the same practice. Follow-up of partner notification and treatment in general practice needs more attention. GPs may be open to implement PIPT more often, provided there are clear guidelines to arrange this legally and practically.
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Affiliation(s)
- Ingrid V. F. van den Broek
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, RIVM, Bilthoven, The Netherlands
| | - Gé A. Donker
- NIVEL Primary Care Database, Sentinel Practices, Utrecht, The Netherlands
| | - Karin Hek
- NIVEL Primary Care database, Utrecht, The Netherlands
| | - Jan E. A. M. van Bergen
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, RIVM, Bilthoven, The Netherlands
- Department of General Practice, Academic Medical Center, Amsterdam; STI AIDS Netherlands, Amsterdam, The Netherlands
| | - Birgit H. B. van Benthem
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, RIVM, Bilthoven, The Netherlands
| | - Hannelore M. Götz
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, RIVM, Bilthoven, The Netherlands
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
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Udeagu CN, Shah S, Toussaint MM, Pickett L. Sociodemographic Differences in Clients Preferring Video-Call Over In-person Interview: A Pilot Study of HIV Tele-partner Services. AIDS Behav 2017; 21:3078-86. [PMID: 27752874 DOI: 10.1007/s10461-016-1586-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The New York City Department of Health Disease Intervention Specialists (DIS) routinely contact newly HIV-diagnosed persons via telephone calls and in-person meetings to conduct partner services (PS) interviews in order to elicit the names and contact information of the HIV-exposed partners for notification and HIV-testing, and to assist clients with linkage to care. From October 2013 to December 2015, we offered PS interviews conducted via video-call alongside voice-call and in-person modes in a selected geographic area of NYC. PS interviews were conducted according to the clients' preferred mode (in-person, voice- or video-call) and location (health care facility, clients' residences, or other NYC locations). At the conclusion of the PS interviews, DIS elicited responses from persons interviewed via video-call on their perception, satisfaction and personal experiences using video-call for public health and personal purposes. Acceptance and satisfaction with PS interviews via video-call were high among clients aged <30 years, men who have sex with men, or with education above high school; while PS yields were similar across modes. These results provide evidence of the potential effectiveness of video-call interviews for specific populations.
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Kahabuka C, Plotkin M, Christensen A, Brown C, Njozi M, Kisendi R, Maokola W, Mlanga E, Lemwayi R, Curran K, Wong V. Addressing the First 90: A Highly Effective Partner Notification Approach Reaches Previously Undiagnosed Sexual Partners in Tanzania. AIDS Behav 2017; 21:2551-2560. [PMID: 28299518 PMCID: PMC5533821 DOI: 10.1007/s10461-017-1750-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To meet UNAIDS' 90-90-90 treatment goals, effective approaches to HIV testing services (HTSs) are urgently needed. In 2015, a cross-sectional study was conducted to evaluate effectiveness and feasibility of partner notification for HTS in Tanzania. Men and women newly diagnosed with HIV were enrolled as index clients, listed sexual partners, and given options to notify and link their partners to HTS. Of 653 newly diagnosed individuals, 390 index clients were enrolled, listed 438 sexual partners, of whom 249 (56.8%) were successfully referred. Of 249 partners reaching the facilities, 96% tested for HIV, 148 (61.9%) tested HIV+ (all newly diagnosed), and 104 (70.3%) of partners testing positive were enrolled into HIV care and treatment. Results showed good acceptability, feasibility and effectiveness, as evidenced by high uptake of partner notification among newly diagnosed individuals, over half of listed partners successfully referred, and a very high positivity rate among referred sexual partners.
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Affiliation(s)
| | - Marya Plotkin
- Jhpiego Tanzania, Dar es Salaam, Tanzania.
- , 1660 Thames Street, Baltimore, MD, 21231, USA.
| | | | | | | | - Renatus Kisendi
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Werner Maokola
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | | | - Kelly Curran
- Jhpiego Baltimore, Baltimore, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Rose SB, Garrett SM, Stanley J, Pullon SRH. Retesting and repeat positivity following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoea in New Zealand: a retrospective cohort study. BMC Infect Dis 2017; 17:526. [PMID: 28754106 PMCID: PMC5534075 DOI: 10.1186/s12879-017-2635-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Testing for reinfection at 3 to 6 months following treatment for Chlamydia Trachomatis or Neisseria gonorrhoea is recommended in best practice sexual health management guidelines. This study aimed to describe rates of retesting and repeat positivity following diagnosis of chlamydia or gonorrhoea in a defined geographic region of New Zealand. METHODS Retrospective cohort study in Wellington, New Zealand involving analysis of laboratory data for chlamydia and gonorrhoea tests performed in primary care and sexual health clinics (July 2012-July 2015). OUTCOME MEASURES rate of retesting and rate of repeat positivity 6 weeks to 6 months after a positive result (index event). Kaplan-Meier curves were used to plot time from first index event to retest. Logistic regression modelling was used to determine the odds of retesting and repeat positivity between 6 weeks and 6 months of follow-up, adjusting for potential confounders (age, gender, ethnicity and socioeconomic deprivation). RESULTS Overall 29.4% (1919/6530) of the cohort was retested between 6 weeks and 6 months, with 18% (347/1919) of those retested returning positive results. Lower odds of retesting were observed for males (OR 0.4, 95% CI 0.34-0.48), and individuals of NZ Maori (OR 0.72, 0.61-0.85) and Pacific ethnicities (OR 0.49, 0.39-0.62, reference European). Factors associated with higher odds of repeat positivity on retesting included male gender (OR 2.0, 1.14-2.82), age 15-19 years (OR 1.78, 1.32-2.41, reference 20-24 years), chlamydia/gonorrhoea co-infection (OR 2.39, 1.32-4.35, reference chlamydia only), Maori (OR 1.6, 1.18-2.17) and Pacific ethnicities (OR 1.88, 1.22-2.9, reference European). CONCLUSIONS We observed low adherence to STI retesting guidelines, and marked gender and ethnic disparities in rates of retesting and repeat positivity. Low retesting rates are suggestive of low levels of awareness of this aspect of patient management, and an absence of a systematic approach to retesting. High rates of repeat positivity reinforce the importance of advising patients about reducing their risk of reinfection, including notification and treatment of all recent sexual partners. Greater priority needs to be placed on increasing retesting and reducing rates of reinfection, with strategies implemented to improve these important aspects of patient care and population STI control.
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Affiliation(s)
- Sally B. Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South, 6242 New Zealand
| | - Susan M. Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South, 6242 New Zealand
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, P O Box 7343, Wellington South, 6242 New Zealand
| | - Susan R. H. Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South, 6242 New Zealand
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Clark JL, Segura ER, Oldenburg CE, Rios J, Montano SM, Perez-Brumer A, Villaran M, Sanchez J, Coates TJ, Lama JR. Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial. BMC Med 2017; 15:94. [PMID: 28468648 PMCID: PMC5415724 DOI: 10.1186/s12916-017-0858-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Expedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection. METHODS We enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up. RESULTS The median age of participants was 26 (interquartile range [IQR]: 23-31) with a median of 3 sexual partners (IQR: 2-4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0-2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68-7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0-62.0% versus 36.4%, 95% CI: 27.0-47.4%). CONCLUSIONS Provision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks. TRIAL REGISTRATION ClinicalTrials.gov, NCT01720654 . Registered on 10/29/2012.
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Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,Department of Medicine, Division of Infectious Diseases, UCLA Geffen School of Medicine, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | - Eddy R Segura
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Escuela de Medicina, Universidad de Ciencias Aplicadas, Lima, Peru
| | | | - Jessica Rios
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | | | | | | | - Jorge Sanchez
- Universidad Nacional Mayor San Marcos, Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru
| | - Thomas J Coates
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
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Fu X, Qi J, Hu Y, Pan X, Li Y, Liu H, Wu D, Yin W, Zhao Y, Shan D, Zhang NN, Zhang D, Sun J. Partner notification in cooperation with community-based organizations among HIV-positive men who have sex with men in two Chinese cities. Int J STD AIDS 2016; 27:821-31. [PMID: 27140946 PMCID: PMC5004245 DOI: 10.1177/0956462416648827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
The epidemic of HIV/AIDS among Chinese men who have sex with men (MSM) is rapidly escalating. We implemented partner notification among HIV-infected MSM, cooperating with MSM-serving community-based organizations (CBOs) in two Chinese cities from June 2014 to May 2015. CBOs participated in identifying new HIV-positive MSM utilizing rapid HIV tests and partner notification among index cases. 253 index cases were recruited and 275 sexual partners were notified and tested with 10.5% screened positive. Compared with previously identified index cases, the proportion of contactable sexual partners of newly identified index cases was higher, but the testing rate was lower (p < 0.001). Overall, 83.7% of sexual partners were casual with a contactable rate of 24.9% and a HIV testing rate of 71.1%. Having no contact information for sexual partners and fear of disclosure of HIV status are the main reasons for declining partner notification. It is feasible and effective to perform partner notification in cooperation with CBOs serving Chinese MSM.
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Affiliation(s)
- Xiaojing Fu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China Graduate School of Chinese Center for Disease Control and Prevention, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Health, Capital Medical University, China
| | - Xiaohong Pan
- Department of HIV/AIDS Prevention and Control, Zhejiang Provincial Center for Diseases Control and Prevention, China
| | - Youfang Li
- Department of HIV/AIDS Prevention and Control, Yunnan Provincial Center for Diseases Control and Prevention, China
| | - Hui Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Di Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Wenyuan Yin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yuan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Duo Shan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Nanci Nanyi Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Dapeng Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Jiangping Sun
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
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Clark JL, Perez-Brumer A, Salazar X. "Manejar la Situacion": Partner Notification, Partner Management, and Conceptual Frameworks for HIV/STI Control Among MSM in Peru. AIDS Behav 2015; 19:2245-54. [PMID: 25821149 DOI: 10.1007/s10461-015-1049-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Previous analyses of partner notification (PN) have addressed individual, interpersonal, social, and structural issues influencing PN outcomes but have paid less attention to the conceptual framework of PN itself. We conducted 18 individual interviews and 8 group discussions, in a two-stage qualitative research process, to explore the meanings and contexts of PN for sexually transmitted infections (STI) among men who have sex with men (MSM) and men who have sex with men and women (MSMW) in Lima, Peru. Participants described PN as the open disclosure of private, potentially stigmatizing information that could strengthen or disrupt a partnership, structured by the tension between concealment and revelation. In addition to informing partners of an STI diagnosis, the act of PN was believed to reveal other potentially stigmatizing information related to sexual identity and practices such as homosexuality, promiscuity, and HIV co-infection. In this context, the potential development of visible, biological STI symptoms represented a risk for disruption of the boundary between secrecy and disclosure that could result in involuntary disclosure of STI status. To address the conflict between concealment and disclosure, participants cited efforts to "manejar la situacion" (manage the situation) by controlling the biological risks of STI exposure without openly disclosing STI status. We use this concept of "managing the situation" as a practical and theoretical framework for comprehensive Partner Management for HIV/STI control systems among MSM in Latin America.
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Carnicer-Pont D, Barbera-Gracia MJ, Fernández-Dávila P, García de Olalla P, Muñoz R, Jacques-Aviñó C, Saladié-Martí MP, Gosch-Elcoso M, Arellano Muñoz E, Casabona J. Use of new technologies to notify possible contagion of sexually-transmitted infections among men. Gac Sanit 2015; 29:190-7. [PMID: 25707605 DOI: 10.1016/j.gaceta.2015.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/14/2015] [Accepted: 01/14/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Among men who have sex with men (MSM), the association between searching for sexual partners' on the Internet and increased risk of sexually transmitted infections (STIs)/HIV infection, together with current low levels of partner notification (PN), justifies a study to explore the intention to use new communication technologies for PN in Spain. METHODS Two cross-sectional surveys were performed: the first was administered online to visitors to web pages where the survey was advertised; the second was administered on paper to patients attending an STI Unit and centres similar to Community-Based Voluntary Counselling and Testing centres. RESULTS The study population comprised 1578 Spanish residents (median age, 34 years [range: 18 to 74]); 84% lived in urban areas, and 69% reported searching for sexual partners on the Internet. Thirty-seven per cent would be willing to use a website for PN, 26% did not know if they would use one, and 37% would not want to use one. The main reasons for not intending to notify STI/HIV were "shame or fear" (stable partner) and "not knowing how to contact them" (casual partner). The preferred method of notification was face to face (73%) for both stable and casual partners, although using new technologies (Short Messaging System, e-mail, web page, phone applications) was widely accepted for notifying casual partners. CONCLUSIONS Fighting stigma and promoting alternative methods of PN among MSM and health professionals through new technologies could increase the frequency of PN. This approach will improve early detection and reduce transmission in Spain.
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van Aar F, van Weert Y, Spijker R, Götz H, Op de Coul E. Partner notification among men who have sex with men and heterosexuals with STI/HIV: different outcomes and challenges. Int J STD AIDS 2014; 26:565-73. [PMID: 25141854 DOI: 10.1177/0956462414547398] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/17/2014] [Indexed: 11/17/2022]
Abstract
Partner notification effectiveness among index clients diagnosed with HIV, syphilis and/or gonorrhoea at sexually transmitted infection (STI) clinics was evaluated between 2010 and 2012. We explored percentages of identifiable, notified and tested partners by sexual preference and gender. Partner notification trends were studied using the national STI database. Men who have sex with men (n = 304), heterosexual men (n = 33) and women (n = 35) reported, respectively, 6.7, 3.8 and 2.3 partners per index. Percentages of identifiable partners differed between groups (men who have sex with men: 46%, heterosexual men: 63%, women: 87%, p < 0.001). The percentage of notified partners (of those identifiable) was lowest for heterosexual men (76%; men who have sex with men: 92%; women: 83%; p < 0.001). STI positivity rates among notified partners were high: 33%-50% depending on sexual preference. Among men who have sex with men, having HIV was associated with not notifying all identifiable partners. Percentages of notified clients at STI clinics increased between 2010 and 2012: from 13% to 19% among men who have sex with men, from 13% to 18% among heterosexual men and from 8% to 11% among women (p < 0.001 for all groups). The percentage of STI/HIV detected through partner notification increased among men who have sex with men (from 22% to 30%) and women (from 25% to 29%; p < 0.001). Unidentifiable partners among men who have sex with men, lower partner notification effectiveness for HIV and the relative large proportion of heterosexual men not notifying their partners appear to be important partner notification challenges.
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Affiliation(s)
- Fleur van Aar
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Yolanda van Weert
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Hannelore Götz
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands Department Infectious Disease Control, Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands
| | - Eline Op de Coul
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Op de Coul ELM, Spijker R, van Aar F, van Weert Y, de Bruin M. With whom did you have sex? Evaluation of a partner notification training for STI professionals using motivational interviewing. Patient Educ Couns 2013; 93:596-603. [PMID: 24054950 DOI: 10.1016/j.pec.2013.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 08/20/2013] [Accepted: 08/25/2013] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To enhance partner notification (PN) practices in Dutch STI clinics, a PN training using motivational interviewing as core strategy was offered to STI professionals and evaluated. METHODS The effectiveness of PN training on professionals' attitude, self-efficacy, skills and behavior toward PN, was examined using within-subject and between-subject comparison. Before the training and at three months follow-up, a questionnaire was completed by the intervention group (n=54) and a non-random control group (n=37). RESULTS In the within-subject comparison, positive changes were observed in self-efficacy, skills, and PN behaviors (all p<.05), but not in attitudes toward PN. When we examined differences in change-scores between the intervention and control group, self-efficacy was no longer significant. CONCLUSION The PN training significantly improved PN skills and -behavior, but had no effect on professionals' attitudes or self-efficacy toward PN. The selection of a convenience control sample seems to offer a more rigorous test of hypotheses than pre-post evaluation only. PRACTICE IMPLICATIONS The beneficial effect of PN training of STI professionals seems to support a wider roll-out of the training to all STI clinics in the Netherlands, although effects on the number of partners notified and transmissions prevented need to be examined in future research.
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Affiliation(s)
- Eline L M Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Arunkumar S, Kamoji SG, Kasatti G. Partner notification and treatment Institute of Venereology-experience. Indian J Sex Transm Dis AIDS 2013. [PMID: 23919048 PMCID: PMC3730467 DOI: 10.4103/2589-0557.112863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There has been a significant increase in general awareness about Sexually transmitted diseases (STD's) among the general public. However, rates of partner notification and treatment which are an integral part of STD awareness is still questionable. METHODOLOGY AND RESULTS We analyzed the statistics for prevalence of partner notification (which is about 52%) as well as the possible reasons for non-compliance. An overview of various ways of partner notification has been given as patient delivered partner medication (PDPM) and patient based partner referral (PBPR) of which PDPM is the most acceptable and effective method worldwide.
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Affiliation(s)
- S. Arunkumar
- Department of STD, Chengalpattu Medical College, Chennai, Tamil Nadu, India,Address for correspondence: Dr. S. Arunkumar, Department of STD, Chengalpattu Medical College, Chengalpattu - 603 001, Chennai, Tamil Nadu, India. E-mail:
| | | | - Gajendran Kasatti
- Institute of Venereology, Madras Medical College, Chennai, Tamil Nadu, India
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