The Organization, Content, and Case-Finding Effectiveness of HIV Assisted Partner Services in High HIV Morbidity Areas of the United States

Abstract

Background:The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain.Setting:State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative.Methods:The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity.Results:Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015–0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019.Conclusions:HIV case-finding resulting from APS in the United States is low.

Priorities in the implementation of partner services for HIV/STIs in high-income nations: a narrative review of evidence and recommendations

“…16,19 HIV PN effectiveness also appears to have declined over time in both the US and UK. [19][20][21][22][23] Overall, these studies suggest that provider or conditional referral can increase PN and treatment, but the magnitude of that effect is uncertain, and most recent studies suggest the impact of the intervention is small.…”

Field Services–Facilitated Treatment and Prevention: Challenges and Opportunities

“…Now, in addition to linking patients to clinic for STI treatment, linkage to HIV PrEP or HIV antiretroviral rapid start initiation is feasible. A recent analysis demonstrated that 88% of surveyed high HIV morbidity state and local jurisdictions endorsed that their HIV APS programs routinely integrated APS with routine linkage to HIV care and HIV PrEP referrals 5 . However, geographic heterogeneity in the role of DIS in linkage to care activities is highly likely, and although it is certain that variation exists, the extent of variation and the predictors of successful integration of HIV prevention activities into the DIS role are not clear and should be the focus of future research.…”

HIV Diagnoses Through Partner Services in the United States in 2019 and Opportunities for Improvement

“…A recent network modeling study found HIV PS to be highly efficient, requiring lower resources per infection averted 10 . Despite the benefits of HIV PS in promoting diagnoses of HIV among those infected, evidence suggests that partner identification through HIV PS in the United States is declining 7 . An important first step in addressing this decline is to identify areas for improvement in HIV PS implementation.…”

“…A systematic review conducted in 2007 found that 14% to 20% of partners named and tested were newly diagnosed with HIV 6 . A more recent analysis focusing on US counties and states included in the Ending the HIV Epidemic in the U.S. initiative found that 20% of HIV PS partners who were tested in 2019 were newly diagnosed with HIV 7 . Two studies found HIV PS to be cost saving.…”

“…6 A more recent analysis focusing on US counties and states included in the Ending the HIV Epidemic in the U.S. initiative found that 20% of HIV PS partners who were tested in 2019 were newly diagnosed with HIV. 7 Two studies found HIV PS to be cost saving. In New York State, one study found HIV PS to be a cost-saving intervention after accounting for total program costs.…”