Implementation experiences and insights from the scale-up of an HIV assisted partner notification intervention in Central Asia.

Kristen M Little,Nina S Hasen,Maxim Kan,Faridun Ishokov,Robert Gray,Altynai Rsaldinova,Daniyar Saliev,Olga Samoylova

doi:10.1002/jia2.25313

Abstract

IntroductionWHO recommends assisted partner notification (APN) for people living with HIV (PLHIV). These services have not been widely scaled in Central Asia. We describe the results from an APN intervention implemented within a programme focused on PLHIV and people who inject drugs in Kazakhstan, the Kyrgyz Republic and Tajikistan.MethodsRoutine data from index cases and their partners were analysed from equal‐length periods before and after APN launch. Prior to APN index cases could recruit partners using passive referral, and under APN, had their choice of passive referral or APN (provider, contract or dual‐referral). We compared the demographic characteristics of index cases and their sexual/injecting partners from the pre‐APN and APN periods, described the number/proportion of HIV cases found (positivity rate) and evaluated predictors of HIV infection among partners using logistic regression.ResultsUnder APN 2676 PLHIV served as index cases and recruited 3735 partners for testing, compared to 4418 index cases and 2240 partners during the pre‐APN period. A total of 322 (8.6%) partners were rapid test positive during APN versus 161 (7.2%, p = 0.048) before APN. Women represented 38% of APN index cases (vs. 42% pre‐APN), 52% of partners tested (vs. 50% pre‐APN) and 56% of all PLHIV identified (vs. 63% pre‐APN). Compared to the pre‐APN period, the number of partners tested per index case recruited increased (0.5 to 1.4, p < 0.001) and the number of index cases needed to find one HIV‐positive partner decreased significantly (27.4 to 8.3, p < 0.001) under APN.ConclusionsAPN was feasibly integrated within a people who inject drugs and PLHIV‐focused HIV programme, and was acceptable to high‐risk populations in Central Asia. Under APN, large numbers of sexual and injecting partners of PLHIV – including women and non‐marital partners – were tested while maintaining high positivity rates. Relative to the pre‐APN period, APN approximately tripled the number of partners recruited per index case and reduced the number of index cases needed to find a positive partner by >3 times.

Highlights

World Health Organization (WHO) recommends assisted partner notification (APN) for people living with HIV (PLHIV)
To address the high risk of HIV acquisition among sexual partners of people living with HIV (PLHIV), the World Health Organization (WHO) recommends the implementation of partner notification services, defined as a “voluntary process where trained health workers . . . ask people diagnosed with HIV about their sexual or drug injecting partners, and with the consent of the HIV-positive client, offer these partners voluntary HIV testing” [8]
While overall casefinding improved substantially, positivity rates increased only slightly (7.2% vs. 8.6%), and were not significantly higher in the APN period than the pre-APN period for any country. This may be partially attributable to passive, partner notification services provided by non-governmental organizations (NGOs) prior to the rollout of APN, and partner testing through routine epidemiological investigations conducted by the AIDS Centers for new HIV cases

Summary

| INTRODUCTION

The HIV epidemics in Central Asia are highly concentrated, disproportionately impacting people who inject drugs (PWID) and their sexual partners. Ask people diagnosed with HIV about their sexual or drug injecting partners, and with the consent of the HIV-positive client, offer these partners voluntary HIV testing” [8]. While these services can be passive or active, assisted partner notification (APN) services – including provider, contract or dual-referral options – have been shown to improve the uptake and positivity rates [9,10,11,12], and the WHO recommends that multiple APN options be offered [8] to meet clients’ diverse needs. We compare case-finding outcomes, and positivity rates before and after APN implementation, and lessons learned

| METHODS

| RESULTS

Findings

| DISCUSSION

| CONCLUSIONS