Beyond Disease Intervention: Exploring an Expanded Role for Partner Services in the MATRix-NC Demonstration Project

Abstract

Background: Disease intervention specialists (DIS) provide partner services for sexually transmitted infections (STIs). We assessed an expansion of DIS services for clients with HIV and/or syphilis, and contacts within their social and sexual networks.Methods: Black and Latinx cisgender men and transgender women who have sex with men diagnosed with HIV and/or syphilis in 4 urban North Carolina counties were referred to designated DIS, who were trained to recruit clients as "seeds" for chain-referral sampling of sociosexual network "peers." All received HIV/STI testing and care; referrals for preexposure prophylaxis (PrEP) and social, behavioral, and non-STI medical services were offered. Participants completed baseline, 1-month, and 3-month computerized surveys.Results: Of 213 cases referred to DIS from May 2018 to February 2020, 42 seeds (25 with syphilis, 17 with HIV) and 50 peers participated. Median age was 27 years; 93% were Black and 86% were cisgender men. Most peers came from seeds' social networks: 66% were friends, 20% were relatives, and 38% were cisgender women. Incomes were low, 41% were uninsured, and 10% experienced recent homelessness. More seeds than peers had baseline PrEP awareness; attitudes were favorable, but utilization was poor. Thirty-seven participants were referred for PrEP 50 times; 17 (46%) accessed PrEP by month 3. Thirty-nine participants received 129 non-PrEP referrals, most commonly for housing assistance, primary care, Medicaid navigation, and food insecurity.Conclusions: Chain-referral sampling from partner services clients allowed DIS to access persons with significant medical and social service needs, demonstrating that DIS can support marginalized communities beyond STI intervention.

Costs Associated With Incorporation of Network Approaches Into Sexually Transmitted Disease Program Activities

“…Our cost analysis only covered 9 months of the MATRix-NC program, and Hurt et al 9 provide more complete information on the demographics of participants enrolled in the program. Consistent with data on HIV/STI patients in North Carolina, they found that MATRix-NC participants generally had lower levels of socioeconomic status 9,11 .…”

“…Our cost analysis only covered 9 months of the MATRix-NC program, and Hurt et al 9 provide more complete information on the demographics of participants enrolled in the program. Consistent with data on HIV/STI patients in North Carolina, they found that MATRix-NC participants generally had lower levels of socioeconomic status 9,11 . Compared with initial seeds, peers were more commonly recruited from social networks than from sexual networks, and peers were significantly more likely to be heterosexual, cisgender women.…”

“…In addition to providing partner services for seeds and testing of peers, MATRix-NC DIS provided patient navigation to link persons living with HIV to care or at-risk persons for PrEP and other social services. 9 All participants with confirmed HIV infection were referred to an HIV provider for antiretroviral therapy and those with confirmed syphilis were referred to STD or HIV clinics for treatment as per DIS protocols. All of the MATRix-NC services were provided at no cost for study participants, and none of the seeds or peers were billed for HIV/ STI testing at the health departments and referral to other services.…”

“…Peers who met the seed eligibility requirements with HIV or syphilis were further classified as “potential” seeds, or “converted” seeds depending on whether they declined or agreed to participate, respectively. In addition to providing partner services for seeds and testing of peers, MATRix-NC DIS provided patient navigation to link persons living with HIV to care or at-risk persons for PrEP and other social services 9 . All participants with confirmed HIV infection were referred to an HIV provider for antiretroviral therapy and those with confirmed syphilis were referred to STD or HIV clinics for treatment as per DIS protocols.…”

“…In 2018, the North Carolina Division of Public Health implemented the “Combined HIV and STD Prevention and Care for Vulnerable Men who Have Sex with Men (MSM) and Transgender Women (TGW) via Network Methods” (MATRix-NC) project. MATRix-NC was a longitudinal demonstration project built upon the established infrastructure of the state's DIS program, which follows a traditional model of field and partner services for HIV and syphilis 9,10 . DIS were given enhanced training to engage the social and sexual networks of patients recently diagnosed with syphilis and/or HIV in order to facilitate testing, treatment, and referral to specialized services.…”