1. HIV Partner Notification in the U.S.: A National Survey of Program Coverage and Outcomes Matthew Golden MD, MPH Assistant Professor of Medicine, UW Medical Director, PHSKC STD Clinic

2. Background New CDC HIV prevention initiatives emphasize HIV partner notification, or PCRS. Current data on HIV PCRS are limited & mostly anecdotal Several health departments reported success in identifying new cases of HIV in the 1980s & early 1990s A RCT of 74 people found that provider referral was more successful than patient referral Recent, single center studies reported conflicting results San Francisco – virtually no one accepted PCRS North Carolina – 11 index patients interviewed to identify one new case HIV No national data on PN outcomes

3. Methods Survey of health departments in cities reporting >200 cases AIDS in 2001 Directed to HIV program directors If local health department indicated states managed PCRS, survey was forwarded to the state Survey – 2 page instrument Organization of PCRS Aggregate PCRS outcomes – number index patients interviewed, number requesting assistance, disposition of partners

4. Methods Primary outcomes Proportion of persons with HIV/AIDS interviewed Number needed to interview to identify one new case of HIV NNTI= # interviewed / # new HIV cases identified Brought to treatment index=1/NNTI

5. Outcomes: Participation 39 jurisdictions >200 AIDS cases 2001 39 jurisdictions contacted 11 no data 28 (72%) provided data Participating jurisdictions reported 24,006 cases of AIDS in 2001 58% AIDS cases nationally 69% AIDS cases in metropolitan areas >500,000

6. Participating Jurisdictions Person completing survey Surveillance supervisor DIS supervisor HIV/AIDS pgrm director Region Northeast Midwest South West Number AIDS cases <500 501-1000 >1000 N (%) 13 (48) 5 (18) 9 (33) 5 (18) 3 (11) 13 (48) 6 (22) 10 (44) 8 (35) 5 (22)

7. Outcomes: Program Coverage* Aggregate Coverage Median Range 32% 55% 2-100% * Restricted to 22 areas reporting numbers of cases of HIV. Among 20,353 HIV cases reported

8. Program Coverage of PCRS Percentage of jurisdictions providing routine PCRS services in public & private counseling & testing sites Percentage of jurisdictions that restrict routine PCRS to public health testing sites by number of AIDS cases in area P=.04 P=.0001 _

9. Percentage of persons with HIV accepting assistance to notify at least one partner* Aggregate Median Range 41% 57% 4-100 * Among 19 jurisdictions providing information

10. Association of proportion of MSM among AIDS cases & proportion of persons with HIV accepting assistance notifying at least one partner % accepting PCRS assistance Proportion AIDS cases in MSM r=-.44 p=.04

11. HIV PCRS Outcomes Among 6,394 Partners of Persons with HIV in 23 U.S. Public Health Jurisdictions Percent Outcome defined 61% partners

12. Outcomes: NNTI* Aggregate Median Range 13.8 13.4 1-196 * Among 8,349 index cases interviewed in 26 jurisdictions

13. Association of percentage MSM among AIDS cases & number of persons needs to interview to find a new case of HIV NNI to find a new case of HIV Percent AIDS cases in MSM r=.46 p=.02

14. Conclusions HIV PCRS currently affects a minority of persons diagnosed with HIV in the U.S. – Lowest coverage in areas with the most cases Process outcomes suggest PCRS is often successful in identifying new cases –Uncertain how many of these persons would have been referred in the absence of a PCRS program –Success is highly variable –Aggregate data suggest efforts are less successful among MSM

15. Implications Reasonable case finding yields suggest that HIV PCRS is effective & should be expanded Nationally, program coverage is low & areas with the largest number of cases have the greatest need to expand –New, probably federal, resources will be needed PCRS may be less effective in MSM –Data from North Carolina suggests failure is not universal –Future studies should look at individual level data and PCRS success –New models of PCRS may be needed for MSM The inability of large numbers of health departments to provide basic statistics on their PCRS program coverage & outcomes suggests PCRS supervision and data management need improvement

16. University of Washington & PHSKC H. Hunter Handsfield Contributors CDC Matthew Hogben Colorado Springs John Potterat