A health communication intervention to integrate partner testing with antiretroviral therapy service among men who have sex with men in China: an observational cohort study

Yuting Lian,Xiaoli Wei,Xia Wang,Hongxia Wei,Yan Luo,Min Zhao,Joyce Wang,Zunyou Wu,Guohui Wu,Kerong Wang,Cynthia Shi,Yan Zhao

doi:10.1186/s12889-018-6147-5

Abstract

BackgroundIn China, antiretroviral therapy (ART) clinics focus on treating people living with HIV and are not required to undertake testing of high-risk populations. To improve partner testing among MSM, we implemented a health communication pilot intervention integrating partner testing with ART services. We aimed to assess the feasibility of the partner referral service and identify the predictors of both successful partner referral for HIV testing and HIV-positive test results among referred partners.MethodsThis program ran from April 2014 through December 2015 at designated ART clinics in six cities. The index participants, men living with HIV enrolled at an ART clinic, were assigned a case manager who assumed responsibility for routine ART-related counseling and mobilization of HIV-positive index participants for partner referral testing. Case managers were either nurses or contract staff. The successful referral rate was the proportion of index participants who referred a sexual partner for HIV testing. The HIV-positive partner rate was the proportion of the newly referred contacts who tested HIV-positive. Factors associated with the successful referral rate and the HIV-positive partner rate were assessed.ResultsTwo thousand three hundred eighty-two index participants were enrolled. The median age was 30 years (IQR 26–37). 829index participants (34.80%) successfully referred at least one sexual partner for screening, and 92 (11.10%) referred partners were HIV-positive. Having a hospital nurse as case manager was associated with both successful partner referral (AHR = 1.56, 95% CI = 1.36–1.80) and having a HIV-positive partner (AHR = 2.35, 95% CI = 1.45–3.92). Index participants who were married (AHR = 1.44, 95% CI = 1.20–1.73) or employed (AHR = 1.29, 95% CI = 1.11–1.49) were more likely to successfully refer a partner for testing. Stable male partner relations were more likely to result in a referred partner testing HIV-positive (AHR = 5.50, 95% CI = 1.85–16.39).ConclusionOur findings indicated that integration of MSM partner testing with ART services via health communication was feasible. Nurses as case managers effectively encouraged index participants to refer their sexual partners for HIV testing.

Highlights

In China, antiretroviral therapy (ART) clinics focus on treating people living with HIV and are not required to undertake testing of high-risk populations
Characteristics of participants A total of 2382 HIV-positive index participants were enrolled in this partner testing pilot program: 752 in Beijing, 424 in Nanjing, 422 in Wuhan, 394 in Xian, 212 in Hangzhou, and 178 in Chongqing
Stable male partner relations were more likely to result in a referred partner testing HIV-positive (AHR = 5.50, 95% confidence intervals (CIs) = 1.85–16.39)

Summary

Introduction

In China, antiretroviral therapy (ART) clinics focus on treating people living with HIV and are not required to undertake testing of high-risk populations. Key populations—including sex workers, intravenous drug users, transgender people, and men who have sex with men (MSM)—remain at much higher risk of HIV infection [1]. In order to curb this epidemic, UNAIDS established the “90–90-90” targets in 2014 [2, 3]. This strategy calls for 90% of people living with HIV to be diagnosed, 90% of diagnosed patients to be sustained on antiretroviral therapy (ART), and 90% of treated patients to achieve viral suppression by 2020. 40% of people living with HIV around the world are still unaware of their serostatus [1]

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