HIV partner notification: which interviews yield the most new positive partners in NYC

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HIV partner notification which interviews yield
the most new positive partners in NYC?

• Angelica Bocour, Chi-Chi Udeagu, Rodolfo
  Gutierrez, Yasmin Ramos, Tamar Renaud, Elizabeth
  Begier

NYC Department of Health and Mental Hygiene (NYC
DOHMH) Bureau of HIV/AIDS Prevention and
Control HIV Epidemiology and Field Services
Program
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(No Transcript)
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HIV/AIDS in NYC, 2006

• 3,745 new HIV diagnoses
• Median Age at HIV diagnosis 37
• 7 IDU
• 27 Foreign-born

Sex
Race/Ethnicity
Other 2
MSM 53
White 16
Male 73
Black 51
Hispanic 31
Female 27
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NYC Public Health Issues

• Persistent problem of late HIV diagnosis
• 26 newly diagnosed HIV concurrent with AIDS
• Delayed linkage to care
• 25 with no VL/CD4 1 year after initial
  diagnosis
• Untreated patients have poorer health outcomes
  and higher viral loads increasing transmission
  risk
• Partner notification outside city-run STD clinics
  was limited

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Field Services Unit (FSU)

• FSU staff based in 8 large hospitals in areas of
  high HIV prevalence and mortality
• FSU partner counseling and referral services
  (PCRS) steps

negative or unknown serostatus
Offered HIV testing
New HIV partner
Interview with HIV person
Partner elicitation
Partner notification
Linked to care
self discloses HIV
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Rationale for Partner Counseling and Referral
Services (PCRS)

• Nearly every person diagnosed with HIV infection
  has at least one sex/needle sharing partner
• Cost effective way to identify new cases
• Especially where testing programs have lt1
  seroprevalence
• Provider/health department notification delivery
  identifies more HIV cases than notification
  conducted by index cases

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Objectives of PCRS

• Case finding partner notification identifies
  previously undiagnosed HIV persons
• Improve health outcomes by linking HIV persons
  to care
• Prevent new infections by providing risk
  reduction education

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Study Objective

• Identify which index case interviews result in
  the most newly diagnosed partners

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Study Methods

• Outcome Measure Number needed to be interviewed
  to identify one newly diagnosed HIV-infected
  partner (NNTI)
• NNTI Interviewed cases/newly diagnosed partners
• Calculated overall and by index case
  characteristics
• NNTI lower with more efficient case-finding
• Chi-squared or Fischer exact test to identify
  significant differences

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Study PopulationFSU Index Patient
CharacteristicsReported July 2006November 2007
NYC data limited to new 2006 diagnoses. FSU
data represents all patients interviewed (new
and prevalent cases)
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NNTI (number needed to interview)Overall and by
Sex and Age
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NNTI (number needed to interview)Race and Time
from Diagnosis
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NNTI (number needed to interview)Transmission
Risk
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Summary Highest yield interviews

• PCRS interviews with following index cases more
  likely to result in newly diagnosed partner
• Men
• Persons under 40 years old
• Hispanics
• Persons recently diagnosed

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Potential Reasons for Lower NNTI (I)

• Men
• More likely to transmit HIV because more likely
  to engage in insertive sex
• Recent resurgence in NYC MSM epidemic
• Persons under 40 years old of age
• More sexual partners than older people

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Potential Reasons for Lower NNTI (II)

• Hispanics
• Increased trust in healthcare system
• Better rapport with largely Hispanic staff FSU
• Recently diagnosed with HIV infection
• Better recall of more recent partners
• Reduced risk behavior after diagnosis results in
  fewer recent exposed partners

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Limitations

• Multivariate analyses limited by rare outcome but
  are currently being explored
• Limited qualitative data on why partners not
  named to explain differences observed
• Focused on areas hardest hit by epidemic so might
  not be generalizable to entire city

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Next steps

• Expansion plans focus on facilities reporting
  large numbers of men
• Patient focus groups and interviews to understand
  differences between blacks and Hispanics
• Patients diagnosed gt2 years prior to report not
  interviewed unless provider requests

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Conclusion

• Analysis of case-finding by index case
  characteristics can guide PCRS program
  improvement

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Acknowledgments

• Field Services Unit

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Additional Slides
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ReferencesCost-effectiveness of Partner
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ReferencesProvider vs. Patient Partner
Notification

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ReferencesDistrust

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ReferencesDistrust

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ReferencesInterviewer/Patient Concordance

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ReferencesInterviewer/Patient Concordance

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NNTI-Age x Time from Diagnosis
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NNTI-Race x Sex
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NNTI-Race x Time from Diagnosis
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NNTI-Age x Sex
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NNTI-Race x Age
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NNTI-Time from Diagnosis x Sex
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Prevalent Partners by Age
P0.003
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Prevalent Partners by Time from Diagnosis
P0.01
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Number of Partners by Age
Plt.0001