Newly diagnosed HIV patients have several options when it comes to notifying partners, but assisted partner notification leads to the best outcomes.
Updated 8/21/17 at 4:00 PM EST.
Although 17 million people worldwide are being treated for HIV with antiretroviral drugs (ART), estimates are that 19 million people who have HIV don’t know that they have it. Clearly, gaps exist in diagnosis and treatment that must be addressed, especially as one of the goals of the United Nations is to ensure that 90% of people worldwide who have HIV are diagnosed by 2020. To meet this objective, it’s crucial that newly diagnosed patients reach out to their sexual or injecting-drug partners to inform them of their risk.
A newly diagnosed patient has a few options in this area. Passive referral, which involves a healthcare provider encouraging a newly-diagnosed person to let past and current partners know of the diagnosis and recommend testing, and assisted partner notification, which, in its various forms, has the provider play an active role in letting the patient’s partners know they may be at risk and encouraging testing. Is one method better than another when it comes to such a fraught and emotional experience?
As it turns out, yes. A team of researchers at the World Health Organization (WHO), the Medical University of South Carolina, and Johns Hopkins University, along with an independent clinical epidemiologist in South Africa, found that assisted partner notification resulted in a 1.5-fold increase in the number of partners who took advantage of HIV testing. The team gathered published studies and pooled results from 5150 patients from 8 different countries to learn the outcomes that resulted from the notification process, including whether partners got tested, how many were diagnosed with HIV themselves, partners’ viral-load measurements, whether partners with HIV received ART, and whether partners who were not diagnosed with HIV pursued the opportunity to learn about HIV prevention.
According to the study’s lead author, assisted partner notification is valuable because it gives the newly diagnosed HIV patient options, as well as room to consider them, which translates to more people learning their own HIV status. “Passive referral can also result in the notification and testing of partners, but far fewer do so with this approach than when assistance is offered,” Shona Dalal, PhD a consultant in the department of HIV/AIDS at WHO, told Contagion®. “This may be for many reasons—people may feel more comfortable notifying/discussing their diagnosis with committed partners than with casual or other short-term partnerships, individual relationship dynamics differ and may impact notification, and so forth. And so, having the option of a provider contacting partners and offering them testing gives people an alternative if they don’t want to have the conversation themselves.”
Assisted partner notification includes contract referral, which involves an HIV-positive person entering into a contract with his or her provider that states he or she will reach out to all partners in a timely manner to let them know of the risk of HIV. If the partners do not come in for testing, or contact a provider within that time, the provider will then contact the partners and encourage them to get tested without revealing who the HIV-positive patient is. Another option is provider referral, which involves the provider contacting all partners directly. Finally, there’s dual referral, in which the provider and the HIV-positive patient together notify partners. The study authors asserted that when HIV-positive patients opted for assisted notification of their partners in any of these forms, more partners got tested, were identified as being HIV positive, and were referred at higher rates to ART providers.
Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.