Successful Partner Notification Research Articles

Factors Associated With Human Immunodeficiency Virus Infections Linked in Genetic Clusters But Disconnected in Partner Tracing.

Successful partner notification can improve community-level outcomes by increasing the proportion of persons living with human immunodeficiency virus (HIV) who are linked to HIV care and virally suppressed, but it is resource intensive. Understanding where HIV transmission pathways may be undetected by routine partner notification may help improve case finding strategies. We combined partner notification interview and HIV sequence data for persons diagnosed with HIV in Wake County, NC in 2012 to 2013 to evaluate partner contact networks among persons with HIV pol gene sequences 2% or less pairwise genetic distance. We applied a set of multivariable generalized estimating equations to identify correlates of disparate membership in genetic versus partner contact networks. In the multivariable model, being in a male-male pair (adjusted odds ratio [AOR], 16.7; P = 0.01), chronic HIV infection status (AOR, 4.5; P < 0.01), and increasing percent genetic distance between each dyad member's HIV pol gene sequence (AOR, 8.3 per each 1% increase, P < 0.01) were all associated with persons with HIV clustering but not being identified in the partner notification network component. Having anonymous partners or other factors typically associated with risk behavior were not associated. Based on genetic networks, partnerships which may be stigmatized, may have occurred farther back in time or may have an intervening partner were more likely to be unobserved in the partner contact network. The HIV genetic cluster information contributes to public health understanding of HIV transmission networks in these settings where partner identifying information is not available.

Human Immunodeficiency Virus Partner Notification Services Among a Representative Sample of Young Black Men Who Have Sex With Men Demonstrates Limited Service Offering and Potential Benefits of Clinic Involvement.

Partner notification (PN) is commonly offered to persons recently diagnosed with human immunodeficiency virus (HIV) to improve linkage to care and prevent onward transmission. Yet, much remains unknown about the factors associated with successful PN participation in populations at highest risk. Data were collected during the first 2 waves (2013-2015) of "uConnect," a population-based cohort study of young black men who have sex with men in Chicago (N = 618). Participants completed a biobehavioral survey and were tested for HIV. Among HIV-infected participants (N = 187), weighted logistic regression models examined the relationship between participant characteristics and being offered PN and providing partner names. 30.3% (n = 187) of the sample was HIV-positive, of which 71.7% (n = 134) were offered PN, including: 8.2% (n = 11) by the city health department; 51.5% (n = 69) by health care providers; and 40.3% (n = 54) by both. Being offered PN was significantly associated with criminal justice involvement history (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.38-4.49), volatile nitrates usage (aOR, 2.88; 95% CI, 1.20-6.94), and recent conversations with HIV outreach workers (aOR, 2.68; 95% CI, 1.25-5.77). Providing partner names was significantly associated with intermittent (aOR, 7.26; 95% CI, 1.75-30.07) and heavy (aOR, 11.47; 95% CI, 2.57-51.22) marijuana use, and being offered PN by both the city health department and health care provider (aOR, 8.36; 95% CI, 2.73-25.62). A substantial proportion of HIV-diagnosed individuals were never offered PN. Being offered PN by multiple sources is associated with participation, and improved collaboration within health systems may improve participation rates.

Public health opportunities and challenges in the provision of partner notification services: the New England experience

BackgroundPartner notification services (PNS) are recommended by the Centers for Disease Control and Prevention as a public health intervention for addressing the spread of HIV and other sexually transmitted diseases (STDs). Barriers and facilitators to the partner notification process from a public health perspective have not been well described.MethodsIn 2015, a coalition of New England public health STD directors and investigators formed to address the increasing STD prevalence across the region (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and to promote communication between state STD programs. To evaluate barriers and facilitators of PNS programs, a survey was administered to representatives from each state to describe PNS processes and approaches.ResultsOf the six PNS programs, Connecticut, Maine, Massachusetts, Vermont, and New Hampshire had combined HIV and STD PNS programs; Rhode Island’s programs were integrated but employed separate disease intervention specialists (DIS). All states performed PNS for HIV and syphilis. Maine, New Hampshire and Vermont performed services for all gonorrhea cases. Rhode Island, Connecticut, and Massachusetts performed limited partner notification for gonorrhea due to lack of resources. None of the six states routinely provided services for chlamydia, though Maine and Vermont did so for high-priority populations such as HIV co-infected or pregnant individuals. Across all programs, clients received risk reduction counseling and general STD education as a component of PNS, in addition to referrals for HIV/STD care at locations ranging from Planned Parenthood to community- or hospital-based clinics. Notable barriers to successful partner notification across all states included anonymous partners and index cases who did not feel comfortable sharing partners’ names with DIS. Other common barriers included insufficient staff, inability of DIS to identify and contact partners, and index cases declining to speak with DIS staff.ConclusionsIn New England, state health departments use different strategies to implement PNS programs and referral to STD care. Despite this, similar challenges exist across settings, including difficulty with anonymous partners and limited state resources.

Partner Notification for Youth Living With HIV in 14 Cities in the United States.

Identifying factors associated with partner notification among youth living with HIV is critical for effective HIV prevention and treatment strategies. A total of 924 male and female behaviorally infected youth aged 13-24 across 14 U.S. cities completed an audio computer-assisted self-interview including questions about demographics and experiences with patient- and provider-referral partner notification. The majority of participants self-identified as male (82.5%), Black/non-Hispanic (70.1%), and Hispanic/Latino (18.2%). Most males (93.4%) reported engaging in male-to-male sexual contact. Over three-quarters (77.6%) reported that all or some of their partners were contacted, while 22.4% indicated that none were contacted regarding potential HIV exposure. Most (52.4%) reported that only one person talked to them about notifying partners including the HIV tester (36.5%) followed by their health care provider/doctor (27.6%). Less than a fifth (18.3%) were themselves notified of their own exposure to HIV. Using multivariable logistic regression, 3 factors were associated with successful partner notification: (1) when more than one person talked to participants about partner notification (AOR = 1.87, 1.33-2.62); (2) if they themselves had been notified of their own HIV exposure (AOR = 1.83, 1.13-2.95); and (3) if their education included some college or technical school versus less than high school (AOR = 1.72, 1.04-2.85). Partner notification among youth living with HIV is unsuccessful at least 22.4% of the time, although minimal criteria for partner services are being met almost universally. Partner notification might benefit from enhanced guidelines that call for both HIV testers and HIV care providers to discuss this important strategy with HIV-positive youth.

Overcoming challenges associated with partner notification following chlamydia and gonorrhoea diagnosis in primary care: a postal survey of doctors and nurses

INTRODUCTION Sexual health guidelines recommend that partner notification and testing for reinfection are undertaken when individuals are diagnosed with bacterial sexually transmitted infections (STIs). AIM To understand factors influencing the effective delivery of partner notification and follow up after diagnosis of STIs in primary care, and to identify strategies that might facilitate these processes. METHODS A postal survey was sent to 216 primary care doctors and nurses working in 72 Wellington primary care settings. Eligible clinicians were identified from laboratory testing data, and included clinicians who had diagnosed relatively high numbers of chlamydia and/or gonorrhoea cases during a 12-month period. Response frequencies were tabulated and chi-squared testing was used to test for significant differences between doctor and nurse responses for selected items. RESULTS In total, 121 surveys were completed (56% response rate) by 78 doctors and 43 nurses, from 55 primary care settings (76% of sites surveyed). Responding health professionals thought that patients were open to partner notification discussion, but appreciated that this sometimes raised difficult issues for patients. Lack of time or resources to follow up, and difficulty getting hold of patients, were cited as key factors that limit assessment of partner notification success. Factors deemed likely to facilitate partner notification included readily available patient resources, training to upskill practice team members, guidance on what to say and record, and access to external advice and assistance. DISCUSSION This study provides insight into provider- and patient-level factors perceived to be hindering successful partner notification. Strategies that could facilitate partner notification were identified, and suggestions made as to how these could be integrated into practice.

P209 Outcomes of partner notification (PN) for sex partners of people with chlamydia, managed via theOnline Chlamydia Pathway.

Background/introduction Within the eSTI2 consortium, we conducted exploratory studies of an innovative Online Chlamydia Pathway (OCP: results service, automated clinical consultation, electronic prescription via community pharmacy, with telephone helpline support), which included optional online partner management. Aim(s)/objectives To evaluate PN outcomes and sex partner uptake of online management. Methods Participants: untreated GUM clinic attenders (two London services) and people tested through six London NCSP online postal testing areas: 21.07.14–13.3.15. The OCP offered index patients an SMS/email containing a unique code and link to forward to partners permitting them to access online care via OCP (patient referral). Outcomes were captured by OCP and index-reported at telephone follow-up (2 weeks post diagnosis) Results Outcomes: 221 index patients consented to the study and 172 (78%) were followed up by telephone (median age 23, 62% female). These 172 index patients reported 371 partners; 317/371 (85%) were contactable and 256/317 (81%) of these were notified. Index patients reported 120/317 (38%) as treated. Online outcomes: 154 index patients reached PN stage of OCP (some had already been routed to clinic). 94/154 (61%) requested online partner access. They reported 280 partners: 28 went online; 19 received treatment at their chosen pharmacy; and 4 were treated elsewhere. Discussion/conclusion 38% of partners treated compares favourably with outcomes for routine PN within similar studies. Online management of sex partners through patient referral is feasible but uptake was low and most successful PN was achieved offline. Pathway optimisation could include anonymised sex-partner PN messaging and provision of partner STI self-sampling kits.

Using smartphone apps in STD interviews to find sexual partners.

Smartphone applications (apps) are increasingly used to facilitate casual sexual relationships, increasing the risk of sexually transmitted diseases (STDs). In STD investigations, traditional contact elicitation methods can be enhanced with smartphone technology during field interviews. In 2013, the Monroe County Department of Public Health conducted a large, multi-infection STD investigation among men who have sex with men (MSM) using both index case and cluster interviews. When patients indicated meeting sexual partners online, disease intervention specialists (DISs) had access to smartphone apps and were able to elicit partners through access to inboxes and profiles where traditional contact information was lacking. Social network mapping was used to display the extent of the investigation and the impact of access to smartphones on the investigation. A total of 14 index patient interviews and two cluster interviews were conducted; 97 individuals were identified among 117 sexual dyads. On average, eight partners were elicited per interview (range: 1-31). The seven individuals who used apps to find partners had an average of three Internet partners (range: 1-5). Thirty-six individuals either had a new STD (n=7) or were previously known to be HIV-positive (n=29). Of the 117 sexual dyads, 21 (18%) originated either online (n=8) or with a smartphone app (n=13). Of those originating online or with a smartphone app, six (29%) partners were located using the smartphone and two (10%) were notified of their exposure via a website. Three of the new STD/HIV cases were among partners who met online. Smartphone technology used by DISs in the field improved contact elicitation and resulted in successful partner notification and case finding.

HIV Partner Notification

HIV Partner Notification

P3.379 Comparison in 2004 and 2011 on the Efficacy of Partner Notification For Chlamydia Trachomatis Among Young Adults in Youth Health Centres in Uppsala County, Sweden

The study was conducted in 2004 and repeated in 2011 to compare the contact-tracing success rate of the partner notification services routinely provided by the community-based youth health centres in...

Partner Notification of Sexually Transmitted Diseases: Practices and Preferences

Timely notification and treatment of sex partners exposed to a sexually transmitted disease (STD) is essential to reduce reinfection and transmission. Our objectives were to determine factors associated with patient-initiated notification of sex partners and preferences regarding standard partner referral versus expedited partner therapy (EPT). Participants diagnosed with gonorrhea, chlamydia, trichomoniasis, or nongonococcal urethritis within the previous year were administered a baseline survey asking about demographics, sexual history, and partner treatment preferences (standard partner referral vs. EPT). They identified up to 4 sex partners within the past 2 months, and answered questions on relationship characteristics, quality, and notification self-efficacy. At follow-up, participants with a current STD were asked whether they notified their partners. Generalized estimating equations were used to evaluate the associations between predictor variables and partner notification. Of the 201 subjects enrolled, 157 had a current STD diagnosis, and 289 sex partners were identified. The rate of successful partner notification was 77.3% (157/203 sex partners). Partner notification was increased if the subject had a long-term relationship with a sex partner (odds ratio: 3.07; 95% confidence interval: 1.43, 6.58), considered the partner to be a main partner (odds ratio: 2.53; 95% confidence interval: 1.43, 6.58), or had increased notification self-efficacy. Overall, participants did not prefer EPT over standard referral; however, females, those with higher education levels, and those with a prior STD preferred EPT. Patient-initiated partner referral is more successful in patients with increased self-efficacy who have stronger interpersonal relationships with their sex partners.

Exploring the limited impact of patient-centred counselling and standardised health messages aimed at improving STI partner notification

The present study set out to explore the limited impact of a randomised controlled trial comparing standardised health messages and patient-centred counselling for improving partner notification by patients with sexually transmitted infections (STIs) at Alexandra Health Centre and University Clinic in South Africa. Using contextual information collected throughout the course of the trial, it was possible to assess whether the proportion of patients asking questions after receiving the standardised health message, and/or the duration of counselling sessions, were associated with the number of patients whose partners subsequently sought treatment at the Health Centrefs pharmacy. By analysing transcribed audio-recordings of standardised health messages and counselling sessions it was also possible to compare what was said during each intervention and to assess the quality of information, advice and problem-solving discussions contained therein. While female STI patients were more likely to ask questions after receiving the standardised health message and were more likely to have longer counselling sessions than male patients, there was little evidence that either events were associated with more than a marginally (p.0.1) significant increase in the number of patients whose partners subsequently sought treatment at the Health Centre. However, partners successfully notified by patients who had received longer counselling sessions were more likely to present for treatment more than a day later, which could indicate that longer counselling sessions encouraged STI patients to contact partners who took time to trace. While patient language appeared to influence the amount of time spent counselling each patient, qualitative analyses of transcribed audio-recordings suggested that the less structured format of counselling sessions undermined the delivery of comprehensive information and advice, even though the counsellors involved often went to some lengths to tailor what was said to suit what they perceived to be each patientfs needs. Indeed, very few of the transcribed counselling sessions contained interactive problem-solving between counsellors and patients, and many counsellors failed to create a non-judgemental atmosphere in which to facilitate problem-solving by STI patients. Since most of the transcribed standardised health messages successfully delivered comprehensive information in a non-judgemental fashion, albeit with little interaction between nurse educator and patient, it may not be surprising that this intervention had a similar impact on partner notification as lay-counselling. Indeed, these findings may explain why a combination of both interventions was required to elicit a significant increase in successful partner notification in the randomised controlled trial. They suggest that counselling may need to include standardised health messages, delivered in a non-judgemental atmosphere, if it is to improve partner notification for STIs; and/or the delivery of healthcare messages in different formats by different health care practitioners may be necessary to elicit a significant change in subsequent health behaviour.

Variation in partner notification outcomes for chlamydia in UK genitourinary medicine clinics: multilevel study

ObjectivesTo compare different ways of measuring partner notification (PN) outcomes with published audit standards, examine variability between clinics and examine factors contributing to variation in PN outcomes in genitourinary medicine...

A prospective study of the effectiveness of electronic patient records in rapid-cycle assessment of treatment and partner notification outcomes for patients with genital chlamydia and gonorrhoea infection

ObjectiveTo assess the effectiveness of electronic patient records (EPRs) in facilitating multiple, rapid measurements of treatment and partner notification (PN) outcomes for chlamydia and gonorrhoea.MethodsIn two sexual health clinics, the...

Achieving successful partner notification: putting together the pieces of the puzzle

Partner notification as a public health measure to reduce transmission of sexually transmitted infections (STIs) is a cornerstone of STI control in most countries. The success of any partner notification strategy is conditional on its acceptability and feasibility to both patients and health-care professionals, its compliance with relevant professional and legislative guidance, and its cost-effectiveness.

Efficacy of partner notification for Chlamydia trachomatis among young adults in youth health centres in Uppsala County, Sweden

The study was conducted to define the contact-tracing success rate of the partner notification services routinely provided by the community-based youth health centres and the county medical officer for communicable disease control (CMO) in Uppsala County, Sweden. The study had three goals, (i) to register the number of sexual partners routinely reported by each diagnosed index case with CT and the success rate in tracing and testing these partners for CT infection. (ii) To analyse the current notification practices in reporting the number of cases of unsuccessful contact tracing to the CMO. (iii) To determine the contact tracing success rate of the partner notification services provided by the CMO. Each diagnosed case of CT is obliged by law to participate in the contact-tracing procedure performed by the physician managing the patient or by a specialised sexually transmitted infection (STI) adviser. Successful contact-tracing is defined as the confirmed attendance of a sexual contact within 12 months of the contact with the index case. The number of CT cases diagnosed by the youth health centres during the study period was 463 (299 females and 164 males). The females reported 660 male sexual contacts and the males reported 386 female contacts. Successful partner notification was achieved for 73% of all sexual contacts. 284 (190 females and 94 males) unsuccessful partner notifications were reported to the CMO of whom 98 (52%) of the female contacts and 20 (21%) of the male contacts were successfully notified by the CMO. However, for 134 (71 females and 63 males) partners, personal details given by the index case were insufficient for identification of the partner. When asymptomatic, genital CT infection spreads among sexually active young adults with multiple, unidentified sexual partners, appropriate methods of partner notification are not sufficient to achieve its aims at the population level.

A comparison of two methods of partner notification for sexually transmitted infections in South Africa: patient-delivered partner medication and patient-based partner referral

The objective of this study was to determine acceptability and feasibility of patient-based partner referral (PBPR) and patient-delivered partner medication (PDPM) among female sexually transmitted infection (STI) patients in a community-based STI screening study. Women were randomized to STI screening at home or at a clinic. STI patients could choose between PBPR and PDPM. Six-week follow-up interviews, and in-depth interviews, were conducted. STI prevalence was high. Most of the 106 women with an STI chose PDPM, mainly because partners would not have time or would not want to attend a clinic, and to ensure that partners received treatment. Nearly all partners reportedly took medication (94; 89% took it in front of the woman) or went to a clinic for treatment (92%). No adverse events were reported. Good communication emerged as the key to successful partner notification. In conclusion, PDPM could be used as a strategy to improve STI treatment coverage.

Case-Finding Effectiveness of Partner Notification and Cluster Investigation for Sexually Transmitted Diseases/HIV

To assess the case-finding effectiveness of partner notification(PN) and cluster investigation for sexually transmitted disease (STD)/human immunodeficiency virus (HIV). Literature review and quantitative summary. Since 1975, the median case-finding yield for syphilis, gonorrhea, and chlamydia PN reported in the literature is about 1 new case found for every 4 or 5 cases interviewed. The yield from HIV PN is approximately half as large, although there is substantial variability in yield across reports for each disease. Published reports underline the central role provider referral plays in effective PN and case-finding. Successful PN is more likely with index cases who are of majority ethnicity and detected through screening or spontaneous presentation for care with symptoms and with partners with whom index cases have had sexual contact that is recent, frequent, and of long duration. The case-finding yield for HIV PN also is much higher when cases are diagnosed through confidential, rather than anonymous, testing. Cluster investigation and related strategies tend to have lower case-finding yields than PN but can play a very useful case-finding role, especially in settings with high disease incidence. STD/HIV PN and cluster investigation can contribute meaningfully to case finding. More research is needed to strengthen the empiric foundation of PN and related strategies, including the impact they have on disease transmission.