Comparison of In-Person Versus Telephone Interviews for Early Syphilis and Human Immunodeficiency Virus Partner Services in King County, Washington (2010–2014)

Abstract

Background The relative effectiveness of in-person versus telephone interviews for HIV/STD partner services (PS) is uncertain. Methods We compared outcomes of in-person versus telephone PS interviews for early syphilis (ES) and newly diagnosed HIV in King County, Washington from 2010-2014. We used multivariable Poisson regression to evaluate indices (number of partners per original patient (OP)) for partners named, notified, tested, diagnosed, and treated (ES only). Analyses controlled for OP age, gender, race/ethnicity, sexual orientation, time to interview, place of diagnosis, and staff performing interviews. Results For ES, 682 and 646 OPs underwent in-person and telephone interviews, respectively. In-person syphilis PS were associated with higher indices of partners named (in-person index [IPI]=3.43, telephone index [TI]=2.06, aRR=1.68 [95% CI=1.55-1.82]), notified (IPI=1.70, TI=1.13, aRR=1.39 [1.24-1.56]), tested (IPI=1.15, TI=0.72, aRR=1.34 [1.16-1.54]), and empirically treated (IPI=1.03, TI=0.74, aRR=1.19 [1.03-1.37]) but no difference in infected partners treated (IPI=0.28, TI=0.24, aRR=0.93 [0.72-1.21]). For HIV, 358 and 489 OPs underwent in-person and telephone interviews, respectively. In-person HIV PS were associated with higher indices of partners named (IPI=1.87, TI=1.28, aRR=1.38 [1.18-1.62]), notified (IPI=1.38, TI=0.92, aRR=1.24 [1.03-1.50]), and newly diagnosed with HIV (IPI=0.10, TI=0.05, aRR=2.17 [1.04-4.50]) but no difference in partners tested (IPI=0.61, TI=0.48, aRR=1.15 [0.88-1.52]). Conclusions Although in-person syphilis PS were associated with some increased PS indices, they did not increase the treatment of infected partners. In contrast, in-person HIV PS resulted in increased HIV case finding. These data support prioritizing in-person PS for HIV and suggest that in-person PS for syphilis may not have major public health benefit.

The Changing Role of Disease Intervention Specialists in Modern Public Health Programs

“…Some supervisors felt that without access to current technology, disease intervention specialists may not evolve with the communities they serve and consequently may be unable to connect both literally and figuratively with their patients. Texting or messaging patients and their partners via mobile apps 1,18 –21 and telephone interviews 22 may be useful tools for disease intervention specialists to efficiently and effectively locate patients and their sexual partners, particularly patients who are unavailable during traditional business hours, live in remote parts of the state, or report large numbers of online partners. To allow for the integration of telephone and internet technology currently used by patients into disease intervention specialist work, state and local government policies will need to be changed.…”

Syphilis Control in the Postelimination Era: Implications of a New Syphilis Control Initiative for Sexually Transmitted Disease/Human Immunodeficiency Virus Programs

“…Among studies evaluating PS for syphilis published 1975-2003, the median brought-to-treatment index was 0.22 (range 0.05-0.53) 34 . More recent studies from North Carolina and King County, WA have reported indices in this same range (0.15 and 0.26, respectively) 35,36 , though a report from New York City, Philadelphia, Texas and Virginia found that only 9% of cases had at least one infected partner brought to treatment (range 5-14%), suggesting a substantially lower level of success 37 . These metrics give one a sense of what is currently being accomplished through field services without clearly defining the impact of the intervention on syphilis transmission.…”

Methods for Sexually Transmitted Disease Prevention Programs to Estimate the Health and Medical Cost Impact of Changes in Their Budget

“…Alternatively, programs can apply a literature-based estimate that each DIS can perform about 400 index patient interviews per year. 22-24 Using the estimate of 400, the change in the number of STD patient interviews per year can be expressed as 400ΔDIS.…”