National Online HIV/STI Partner Notification Service

1
National Online HIV/STI Partner Notification
Service

• Presented by
• Dónal Heath Project Manager, GMFA

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Presentation Outline

• Project background
• Project aims
• Proof of concept
• How the new service will work
• The current schedule

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Project background

• Where we began
• GMFA always looking for ways to improve the
  usefulness of its websites
• In 2008 we began to think about developing an
  online Partner Notification service with a small
  feasibility study

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Project background

• Where we began
• Feasibility study findings
• An new online service would have value, but a
  non-clinical PN service, such as www.inspot.org
  is flawed, with a high proportion of erroneous /
  spoof notifications. To be really effective a
  new PN service would need to be presented at the
  point of diagnosis.

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Project background

• Where we began
• January 2009, GMFA wrote a proposal for an online
  service exclusively accessible to patients with a
  clinical diagnosis.
• September 2009, GMFA obtained funding from the
  Elton John AIDS Foundation (EJAF) to develop a
  new online PN service.

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Partner Notification a definition

• the process of contacting the sexual partners
  of an individual with a sexually transmitted
  infection including HIV, and advising them that
  they have been exposed to infection.
• AIM To reduce undiagnosed infection.

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Project aim

• This project aims to assist gay men in the UK who
  have been diagnosed with HIV (or another STI) in
  reaching their recent sexual partners with
  notifications via text message, email and dating
  site website message.

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HIV / STI prevention aims

• To reduce undiagnosed HIV and other STI
  infections amongst men who have sex with men.
• To develop a new service that, if successful, can
  be replicated for other target groups.

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Proof of concept

• 1999 the first reported use of the Internet to
  carry out contact tracing.
• Health professionals notified and evaluated more
  than 40 of named partners Previous studies
  among similar populations reported a
  substantially smaller number of partners per
  index case undergoing medical evaluation 1
• 1 Tracing a Syphilis Outbreak Through Cyberspace

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Proof of concept - Dating sites
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Proof of concept survey results

• 2010 - GMFA surveyed 3000 men on 3 gay dating
  websites. Of those who were diagnosed with HIV
  or an STI in the last five years
• 19 say they were not advised by the clinic to
  notify their partners.
• 22 did not notify their partners, and a quarter
  of these men said it was because they were too
  embarrassed.

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Proof of concept survey results

• Of 923 men in the survey who notified their
  partners, only 65 notified all their partners.
• 97.5 of men say they would like to be informed
  if a recent partner is diagnosed.
• 96 of men say they would be willing to inform
  their partners.

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Proof of concept current practise

• Dating site PN is being successfully carried out
  in the US in some states by health professionals
  who have special accounts set up to deliver PN on
  Manhunt.
• Dating site PN is carried out by a handful of
  clinics in the UK on Gaydar with varying degrees
  of success.
• Most clinics have limited by time / freedom to
  set up profiles on gay dating sites. Our system
  will provide one interface that allows delivery
  of notifications to profiles on multiple dating
  sites, mobile numbers and email addresses.

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How the new service will work
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John is diagnosed
John is tested and receives a positive
result. The clinic presents him with partner
notification options. One of the options is to
notify partners in a dating site message, text
message or email using GMFAs PN website.
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John is given a PN card
The clinic writes down on a small card (the PN
card) Johns clinic number and a restricted
access key for the PN website. John (leaves the
clinic) takes the card to a computer and signs on
to the PN website.
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John sends notifications

• John chooses which partners he wants to notify
  and how (dating site, SMS, email). He enters the
  relevant details and sends the notifications.
• If his clinic has the resources to offer him
  assistance or Provider Referral, John is given
  the details he needs to request their help at
  this stage.

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Johns partners receive notifications

• The notifications include
• A PN Reference Number
• Links to information about clinics and any STIs
  named in the notification at www.gmfa.org.uk
• Assurances about the intention of the
  notification, that mistakes and mischief are
  unlikely but possible and that every effort is
  made to reduce this happening.
• The National Sexual Health Helpline number

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Happylads response

• One of Johns partners (profile name Happylad)
  takes his PN number with him to a clinic. The
  clinic staff type the PN number into the system
  and it records that he has visited.
• If no clinic visit from Happylad is recorded, an
  automatic follow-up will be sent to ask him if he
  has been for a check-up and if he has would he
  let us know.

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Provider referrals

• Clinics can
• use the PN website in the same way John does to
  deliver Provider Referrals via dating sites, text
  messages and email.
• use the PN website to monitor delivery status of
  and responses to Provider Referrals.
• generate reports on performance (in due course)

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Measuring outcomes

• System will record
• Notifications sent, received / not received,
  responded to and acted on (with details)
• Feedback from users
• The PN website will record the number of
  notification recipients who refer to it
• The GMFA website will record visitors to its
  sexual health information pages that come from
  the PN site
• Further surveys of the target group may be
  carried out

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The current schedule

• Six month pilot to launch early 2011
• First phase roll-out to follow during second half
  of 2011
• Final phase roll-out to all clinics in England to
  follow from January to October 2012.