HIV Partner Services: Outcomes Impacting Public Health San Francisco

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HIV Partner ServicesOutcomes Impacting Public
Health San Francisco

• Jeffrey D. Klausner, MD, MPH
• STD Prevention and Control Services
• San Francisco Department of Public
  HealthDivision of Infectious Diseases,
  Department of MedicineUniversity of California,
  San Francisco
• Peninsula AIDS Research Center

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Implementation of HIV Safety Net and Partner
Services

• January 2005
• Assured newly diagnosed City Clinic cases of HIV
  infection learned test results
• Interviewed new cases to identify risk behaviors,
  venues and elicit contacts for partner
  notification
• July 2005
• Expanded safety net and partner notification
  services throughout County hospital and clinics
• July 2006
• UCSF Positive Health Program Response Team

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JAIDS, in press, 2007
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Partner notification cases by year and site of
diagnosis
through February 2007
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Partner notification cases by gender and year
N 285
Through February 2007
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Partner notification cases by race/ethnicityN
285
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Partner notification interviews by duration of
infection, 2005-2007
Ahrens K et al, JAIDS, in press, 2007
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Interview outcomes

• Complete data on 158 (55) cases
• Risk behaviors
• Substance use
• Meeting venues
• Contact elicitation for partners
• New HIV case detection

Ahrens K et al, JAIDS, in press, 2007
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Select risk behaviorsN158
Ahrens K et al, JAIDS, in press, 2007
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Substance useN158
Ahrens K et al, JAIDS, in press, 2007
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Meeting placesN158
Ahrens K et al, JAIDS, in press, 2007
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Contact elicitationN158

• 76 (48) named any recent partners
• 202 partners with contact information
• Average 2.7 named partners
• Average 1.3 named partners per interview

Ahrens K et al, JAIDS, in press, 2007
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Partner notification outcomesN202
18 (9) newly identified HIV-infected
Ahrens K et al, JAIDS, in press, 2007
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Cost analysis of contact elicitation and partner
notification

• Number Needed to Interview (NNTI)
  158/ 18 8.8 interviews/ case
• 9 interviews to find 1 new case of HIV
  infection
• Each interview with average partner follow-up
  8 hours of staff time
• Cost 2016 / new case of HIV infection
  detected
• At NNTI 18, cost 4032 per new case

At 28/ hour of staff time
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HIV infection and care referral Characteristics
of 160 cases

• 49 in 2006 51 in 2007
• 33 from STD clinic 67 from county
  hospital/clinics
• 95 male/MtF 78 G/MSM
• 48 white 25 Latino 19 black
• Median age 35 years old (range, 18-81)
• 76 interviewed by DCI
• 37 reported methamphetamine use
• 40 met partners on the Internet

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Proportion of viral load and CD4 T cell count by
data sourceN160
CD4 T cell
Viral load
Data obtained by DCI and HIV/AIDS Registry
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Distribution of time to first care visit
n 110
n 17
About 75 had a documented or reported primary
care visit
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Entry into primary care by interview status
Interviewed cases associated with first primary
care visit lt 90 days
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Distribution of initial CD4 T cell count
AIDS
25 with CD4 T cell count lt 200 cells/ mm3 40
lt 350 cells/ mm3
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Distribution of initial viral load value
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Acknowledgements

• SFDPH STD Prevention and Control Section
• Susan Philip Medical Director, City Clinic
• Romeo De LaRoca
• Bob Kohn, Katherine Ahrens
• Giuliano Nieri, Andrew Reynolds
• SFDPH Laboratory
• Sally Liska, Mark Pandori, MaryAnn Williams
• SFDPH HIV Prevention Section
• Teri Dowling, Tracey Packer,Grant Colfax
• SFDPH HIV Epidemiology Section
• Willi McFarland
• SFDPH Surveillane Section
• Susan Scheer, Ling Hsu

• California HIV/AIDS Research Program
  CH05-SMCHC-612
• Nicola Zetola
• National Genetics Institute
• Centers for Disease Prevention and Control
• UCSF Positive Health Program
• Brad Hare, Diane Jones
• UCSF Division of Infectious Diseases
• Chip Chambers
• UCSF Clinlabs
• Ebi Fiebig, Barbara Haller, Patricia Nassos, Mary
  Clancy
• UCSF Dept. Emergency Medicine
• Beth Kaplan
• ISIS-Inc.org and Deb Levine

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Thank you!