HIV Partner Notification in Malawi: Comparing Methods and Predicting Partner Testing

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  • March 22, 2019
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  • Brown, Lillian B.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • HIV transmission in sub-Saharan Africa is predominately heterosexual. Sexual partners of persons with newly diagnosed HIV infection require HIV counseling, testing and, if necessary, evaluation for therapy. However, many African countries do not have a standardized protocol for partner notification and the effectiveness of partner notification has not been evaluated in developing countries. We conducted a randomized trial of HIV partner notification to determine the rates of counseling, testing and new HIV diagnoses among partners. Individuals with newly diagnosed HIV infection presenting to STI clinics in Lilongwe, Malawi were randomized to one of three methods of partner notification: passive referral, contract referral, or provider referral. The passive referral group was responsible for notifying their partners themselves. The contract referral group was given seven days to notify their partners, after which a health care provider contacted partners who had not reported for counseling and testing. In the provider group, a health care provider notified partners immediately. Partners to index patients enrolled in the passive and contract referral arms were used to identify characteristics of partners unlikely to report for counseling and testing. Overall, 240 index patients named 302 sexual partners and provided locator information for 252. Among locatable partners, 107 returned for HIV counseling and testing. The proportion of partners returning was 24% (95% CI 15 - 34%) in the passive referral arm, 51% (95% CI 41 - 62%) in the contract referral arm, and 51% (95% CI 40 - 62%) in the provider referral arm (p<0.001). Among returning partners (n=107), 67 (64%) were HIV-infected with 54 (81%) newly diagnosed. Partner's failing to report for testing was associated with male partner sex, relationship duration less than 6 months or between 6 and 24 months, and index education greater than primary. This research is the first to provide evidence on the most effective method of partner notification in sub-Saharan Africa. Active partner notification was feasible, acceptable, and effective among STI clinic patients. Using a risk score to identify partners unlikely to report on their own can reduce the resources required to attempt to locate all partners in the community while increasing the testing yield compared to patient-referral.
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology.
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  • Miller, William
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