BENEFITS OF HIV PARTNER SERVICES EXPLAINED, DEFICIENCIES IDENTIFIED, IN PUBLISHED LETTER FROM BEYOND AIDS FOUNDATION

 

A letter from our organization to the journal Sexually Transmitted Diseases on the topic of HIV partner services (contact tracing, partner notification and testing, result-specific follow-up, and other appropriate services), has been published in the August2023 issue. The letter, authored by Ronald Hattis, Gary Richwald, Jeffrey Klausner, and Deanna Stover, had been unanimously approved by our Board, with favorable input from responding members of our Scientific Committee.

In the letter, we commended an article in the journal by Williams et al.,¹ which documented that partner services detect undiagnosed HIV infections. However, we pointed out four additional public health benefits of HIV partner services that were not mentioned in that article:

1.      Many identified partners of a newly diagnosed person with HIV infection, who test positive, are themselves likely to have been recently infected. Initiating treatment for such individuals can both provide the earliest opportunity to prevent additional infections, and achieve the best clinical outcomes.²

2.   One of the contacts may be the source of infection, likely an undiagnosed and untreated person with a high viral load, and capable of causing further infections. Testing and treating such an individual is a high priority for prevention.

 3.   Partners who test negative for HIV infection have been exposed to the virus, and without intervention such exposure may continue. They, too, are a high priority for prevention. Increased attention to at-risk HIV-uninfected individuals, including safer sex counseling and referrals for PrEP, is consistent with CDC’s new “status neutral” initiative.³

4.   Partners can be referred for additional appropriate services, such as screening for syphilis and other STIs along with HIV testing, and linkage of any such infections detected to treatment. Those partners who test positive for HIV can also be provided with access to primary care, housing, Medicaid or Ryan White coverage, nutritional assistance, and other needs, and assisted in achieving viral suppression (and thus becoming non-infectious sexually).  

We included some findings from our survey of U.S. state and territorial HIV/AIDS directors or their designees, which found substantial discrepancies among jurisdictions in methods, content, and consistency of outreach for partner services and linkage to care.⁴  As the Williams article noted,¹ partner services activities are currently required for all CDC-funded health departments, applying the shared guidelines for HIV, syphilis, gonorrhea, and chlamydia.⁵  However, our survey suggested that CDC does not monitor jurisdictions for details on whether and how this is done.  We have recommended that uniform standards for public health outreach after newly reported diagnoses be established and written into CDC grant requirements, with appropriate compliance monitoring.⁴ CDC could require that a portion of grant funds be specifically designated for partner services.

State requirements can supplement federal grant stipulations. In New York State, for example, a law authored by one of our founding officers, the late Nettie Mayersohn, has required since 1998 that the names of any known sexual or needle-sharing partners be included as a part of reporting of new HIV diagnoses, and that local health departments perform contact tracing and partner notification along with HIV education, which may also be done by physicians.^6.7  Other states could consider similar legislation.

The letter also mentioned some heretofore unpublished findings of our earlier study  (1993) of partner services by local public health departments in California. That survey had found that 5% were not performing any partner services for HIV or other STIs, and 66% were performing them but not for all four sexually transmitted diseases for which they were recommended by CDC.⁵  Then-current CDC guidelines on how to conduct partner services were not being followed by 39%, and 27% were not receiving any specific funding for the performance of partner services.

We declared that state public health departments have a responsibility to assure that essential public health programs, including partner services, are available and adequately maintained in all cities and counties. Partner services are valuable components of HIV prevention with multiple benefits, and federal and state policy changes could improve their uniformity, quality, and impact.

 REFERENCES

1.      Williams WO, Song W, Huang T, et al. HIV diagnoses through partner services in the United States in 2019 and opportunities for improvement. Sex Trans Dis 2023; 50:74-78.

2.      National Institutes of Health. Early HIV diagnosis and treatment important for long-term outcomes. October 21, 2022. Available at: https://www.nih.gov/news-events/news-releases/early-hiv-diagnosis-treatment-important-better-long-term-health-outcomes. Accessed March 25, 2023.

3.      Centers for Disease Control and Prevention. Status neutral HIV prevention and care. Available at https://www.cdc.gov/hiv/effective-interventions/prevent/status-neutral-hiv-prevention-and-care/index.html. Accessed March 25, 2023.

4.      Hattis RP, Strydom RY, Gaio J, and Stover DC. HIV prevention practices and non-federal funding among U.S states and non-state regions: a survey of HIV/AIDS directors. AIDS Education and Prevention 2019; 31:82-94.

5.      Centers for Disease Control and Prevention. Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection. MMWR 2008; 57:1-57. Available at: https://www.cdc.gov/mmwr/pdf/rr/rr57e1030.pdf. Accessed March 26, 2023.

6.      Neidl, BF. The lesser of two evils: New York's new HIV/AIDS partner notification law and why the right of privacy must yield to public health. St. John’s Law Review 1999 73;1191-1238. Available at: https://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?article=1506&context=lawreview.

7.      New York State Senate, Legislation. Section 2133, PBH chapter 45, article 21, title 2: contact tracing of cases of AIDS, HIV, related illness, or HIV infection. Available at: https://law.justia.com/codes/new-york/2022/pbh/article-21/title-3/2133/. Accessed March 26, 2023.

8.      Centers for Disease Control and Prevention. Statistics overview, HIV surveillance report, 2020. Available at: https://www.cdc.gov/hiv/statistics/overview/index.html. Accessed March 26, 2023.