Internet Partner Notification: Outcomes from a Community- Based DIS Program Beau Gratzer 1,2, Daniel Pohl 1, Laurie Anderson 3,4 1 Howard Brown Health Center, Chicago, Illinois; 2 University of Illinois at Chicago-School of Public Health, Chicago, Illinois; 3 Centers for Disease Control and Prevention, Atlanta, Georgia; 4 Chicago Department of Public Health, Chicago, Illinois.

Howard Brown Health Center Background Founded in 1974 by Northwestern University medical school students for STD testing and treatment for gay and bisexual men Founded in 1974 by Northwestern University medical school students for STD testing and treatment for gay and bisexual men Currently the Midwest’s largest provider of LGBT health Currently the Midwest’s largest provider of LGBT health 205 FTEs 205 FTEs Budget of ~ $15 million Budget of ~ $15 million Three clinical locations, four resale stores Three clinical locations, four resale stores

Howard Brown Services FQHC, “One Stop Shop” Model Program Departments: Program Departments: Primary Medical Care Primary Medical Care Behavioral Health Behavioral Health HIV/STD Prevention HIV/STD Prevention Elder Services Community Initiative Elder Services Community Initiative Women’s Health Women’s Health HIV/AIDS Case Management HIV/AIDS Case Management Research Research Broadway Youth Center Broadway Youth Center Brown Elephant Resale Shops Brown Elephant Resale Shops Serve over 23,000 clients/year Serve over 23,000 clients/year

HB DIS Program HB diagnoses a significant proportion of syphilis morbidity in Chicago since outbreak among MSM began in HB diagnoses a significant proportion of syphilis morbidity in Chicago since outbreak among MSM began in Innovative partnership between HB and Chicago Department of Public Health. Innovative partnership between HB and Chicago Department of Public Health. Employees of HB fully trained as DIS and selected by HB to provide peer services. Employees of HB fully trained as DIS and selected by HB to provide peer services. Program outcomes presented at 2006 STD Conference and 2006 NCSD Conference. Program outcomes presented at 2006 STD Conference and 2006 NCSD Conference.

IPN Literature Klausner, Wolf, Fischer-Ponce, Katz. Tracing a Syphilis Outbreak Through Cyberspace. JAMA. 2000; 284 (4): 401. Klausner, Wolf, Fischer-Ponce, Katz. Tracing a Syphilis Outbreak Through Cyberspace. JAMA. 2000; 284 (4): 401. Concluded that sex seeking online was associated with syphilis acquisition in SF. Concluded that sex seeking online was associated with syphilis acquisition in SF. Argued that new avenues for disease control should be explored. Argued that new avenues for disease control should be explored. Several jurisdictions began eliciting s/screennames from original patients, and then used that info to contact exposed partners in early 2000s. Several jurisdictions began eliciting s/screennames from original patients, and then used that info to contact exposed partners in early 2000s. Currently several published articles that indicate the feasibility and acceptability of IPN for syphilis control among MSM. Currently several published articles that indicate the feasibility and acceptability of IPN for syphilis control among MSM.

Objectives Identify effective supplemental approaches to STD partner management. Identify effective supplemental approaches to STD partner management. Build upon the current literature by: Build upon the current literature by: Comparing dispositions of partners initiated via Internet Partner Notification (IPN) to those contacted via phone (PPN). Comparing dispositions of partners initiated via Internet Partner Notification (IPN) to those contacted via phone (PPN). Determine contribution of IPN to overall program success. Determine contribution of IPN to overall program success. Selection of IPN vs. PPN: Selection of IPN vs. PPN: Two most common methods of contact at HB. Two most common methods of contact at HB. Agency perspective on DIS methods (CBO, population, resources, effectiveness). Agency perspective on DIS methods (CBO, population, resources, effectiveness).

HB and the Internet Original patients talked about internet use during interviews; for some partners, / screenname was the only locating information Original patients talked about internet use during interviews; for some partners, / screenname was the only locating information Developed protocol and started using internet for partner services in 2003 Developed protocol and started using internet for partner services in 2003 Initially used AOL, AIM, gay.com, most commonly by or chat-based functions Initially used AOL, AIM, gay.com, most commonly by or chat-based functions Currently, majority of partners elicited from Manhunt.net, adam4adam.com, and others Currently, majority of partners elicited from Manhunt.net, adam4adam.com, and others

Methods Retrospective case audit of all cases interviewed by HB DIS staff from January 2005 to September Retrospective case audit of all cases interviewed by HB DIS staff from January 2005 to September Construction of database: Construction of database: Sex Partner Coding: Sex Partner Coding: Method of Contact: IPN, PPN, Patient-referred, Notified in field, Out of Jurisdiction, Other Method of Contact: IPN, PPN, Patient-referred, Notified in field, Out of Jurisdiction, Other Disposition using form Disposition using form

Partner Locating

Dispositions and Outcomes

Limitations Data were based on retrospective program data; this was not an experimental study. Data were based on retrospective program data; this was not an experimental study. This data was only from HB program, so it is unclear if these results are replicable in other jurisdictions. This data was only from HB program, so it is unclear if these results are replicable in other jurisdictions.

Conclusions Partners initiated via PPN were significantly more likely to be located and notified versus IPN. Partners initiated via PPN were significantly more likely to be located and notified versus IPN. Once partners were notified, however, there was no statistical association between contact method and disposition. Once partners were notified, however, there was no statistical association between contact method and disposition. 121 partners who may not have otherwise been notified were located by IPN, resulting in approximately 40% of program success. 121 partners who may not have otherwise been notified were located by IPN, resulting in approximately 40% of program success.

Implications STD programs should utilize IPN to complement other strategies, especially if high morbidity populations meet sex partners on the internet. STD programs should utilize IPN to complement other strategies, especially if high morbidity populations meet sex partners on the internet. Research agenda should include assessing cost- effectiveness of various contact methods, particularly because of dwindling resources. Research agenda should include assessing cost- effectiveness of various contact methods, particularly because of dwindling resources.

Acknowledgements Howard Brown DIS Staff: Daniel Pohl, Mark Hartfield, Jeff Savage Howard Brown DIS Staff: Daniel Pohl, Mark Hartfield, Jeff Savage Laurie Anderson, Dr. Carol Ciesielski Laurie Anderson, Dr. Carol Ciesielski Howard Brown Medical Staff Howard Brown Medical Staff John Cummins John Cummins

Contact Info: Beau Gratzer Beau Gratzer Director of HIV/STD Prevention Howard Brown Health Center Daniel Pohl Daniel Pohl Manager of Disease Intervention Services Howard Brown Health Center Laurie Anderson Laurie Anderson Syphilis Elimination Coordinator CDC/Chicago Dept of Public Health