An Evaluation of HIV Partner Counseling and Referral Services Using New Disposition Codes
Public Health-Seattle & King County, Seattle, Washington, USA. Sexually transmitted diseases
(Impact Factor: 2.84).
02/2009; 36(2):95-101. DOI: 10.1097/OLQ.0b013e31818d3ddb
New Centers for Disease Control recommendations suggest that all persons with newly diagnosed HIV receive partner counseling and referral services (PCRS).
We evaluated the King County, WA, PCRS program using a new set of disposition codes that disaggregate the components of PCRS (notification, testing, and test results), distinguish verified and unverified outcomes, and differentiate outcomes that occur before and after cases receive PCRS.
Between 2005 and 2007, 427 (65%) of 659 persons with newly diagnosed HIV received PCRS. The number of cases staff needed to interview to identify 1 new case of HIV varied from 12.2 to 47.4 depending on whether number needed to interview was defined to include both verified and unverified outcomes and whether it excluded partners diagnosed with HIV before cases' receipt of PCRS. Age <25, testing HIV negative within the last year, receipt of PCRS within 58 days of HIV diagnoses, and participation in a program to link persons with HIV to medical care were significantly associated notifying more partners.
PCRS evaluations may overestimate success because of limitations inherent in Centers for Disease Control PCRS disposition codes. Efforts to promote frequent HIV testing, assure timely provision of PCRS, and integrate PCRS with programs that link patients to care may improve PCRS outcomes.
Available from: John J Potterat
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ABSTRACT: The objective of this study was to define the scope and case-finding success of HIV partner notification (PN) in the United States.
The authors conducted an analysis of PN data from metropolitan areas >500,000 reporting > or =200AIDS cases in 2001.
Data were collected from 28 (72%) of 39 eligible jurisdictions. In 22 jurisdictions with reportable HIV, health departments interviewed 32% of 20,353 persons with newly reported HIV. Among 6394 sex or needle-sharing partners, 19% had been previously HIV-diagnosed; 10% tested HIV-positive; 32% tested HIV-negative; and 39% were not notified, denied previous HIV diagnosis and refused HIV testing, or outcome was unknown. Health departments interviewed 13.8 persons to identify 1 new case of HIV (range, 1.0-196). Areas in which larger proportions of AIDS cases occurred among men who have sex with men reported less success identifying new cases of HIV through PN.
HIV PN programs identify new cases of HIV but have variable success and affect a minority of persons reported with HIV.
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ABSTRACT: The reliability of CDC HIV partner notification (PN) disposition codes has not been evaluated.
Disease Intervention Specialists (DIS) working for health departments in high HIV/STD-morbidity metropolitan areas completed a questionnaire that presented vignettes describing PN interviews. Questionnaires asked DIS to indicate whether they would record a disposition and what codes they would assign to each partner.
A total of 136 DIS from 28 of 29 eligible states participated. Partner 1: The index case says he will inform his partner of his HIV diagnosis and, at follow-up, reports that the partner has tested negative. Seventeen percent of DIS indicated they would record a partner disposition. DIS used 7 different codes to define the PN outcomes. Partner 2: The index case says she will inform her partner, who attends the clinic, indicates no history of testing, and tests HIV-negative. 93% of DIS reported they would record a disposition, 90% of whom used code 6, "Not Previously Tested, New Negative." Partner 3: The index case with partner 2 (above) agrees to have DIS notify her second partner. When contacted, the partner tells DIS that he had previously tested negative and will arrange to be tested himself. He subsequently reports testing HIV-negative, but DIS do not confirm this. Seventy-three percent of DIS recorded a disposition for the partner, of whom 84% used code J, "Located, Refused Counseling and Testing."
CDC HIV PN disposition codes are reliable for simple scenarios with verified outcomes, but less reliable when DIS elicit partner-reported outcomes.
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ABSTRACT: Recent US national efforts taken to prevent human immunodeficiency virus (HIV) infection have emphasized HIV case-finding, including partner services (PS).
We collected data on HIV PS procedures and outcomes in 2006 from health departments in US metropolitan areas with the highest number of cases of acquired immunodeficiency syndrome, gonorrhea, chlamydial infection, and primary and secondary syphilis, and compared our results with the data collected through a similar study carried out in 2001.
Of the 71 eligible jurisdictions, 51 (72%) participated in this study. In 2006, health departments interviewed 11,270 (43%) of the 26,185 persons with newly reported HIV, which was an increase from the 32% reported in 2001 (P < 0.01). Among 10,498 potentially exposed partners, 2228 (21%) had been previously diagnosed with HIV, 803 (8%) were newly HIV-diagnosed, 3337 (32%) tested HIV-negative, and 4130 (39%) were not successfully notified, were notified but refused HIV testing and denied previous diagnosis, or did not have an outcome recorded. Combining data from all jurisdictions, public health staff needed to interview 13.6 persons with HIV to identify one new case of infection; this number was unchanged from 2001 (13.8; P = 0.75).
In the United States, the proportion of persons diagnosed with HIV receiving PS has increased since 2001, whereas HIV case-finding yields have remained stable. Despite this, most people newly diagnosed with HIV still do not receive PS.
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