1. Evaluating the Use of HIV Surveillance Data for Initiating Partner Services in Houston, Texas, US 2012 International AIDS Conference Washington, D.C. Shirley Chan Houston Department of Health and Human Services Bureau of Epidemiology, HIV Surveillance Program

2. Why Use Surveillance Data For Partner Services (PS) Surveillance has the first report –Surveillance investigates and confirms physician diagnoses for surveillance purposes –Surveillance can provide an epidemiologic window of opportunity to identify new diagnoses Surveillance and Prevention Programs working together –HIV surveillance system provides contact information –Disease Intervention Specialist (DIS) follows up for patient and partner services

3. Awareness and Serostatus among People with HIV and Estimates of Transmission ~ 25% unaware of infection ~75% aware of infection People Living with HIV/AIDS 1,039,000-1,185,000 New Sexual Infections Each Year: ~32,000 ~ 54% of new infections ~46% of new infections Mark, et. al. AIDS 2006;20:1447-50 Accountable for

4. Rationale for Partner Services Plays an essential role in preventing and controlling HIV Increases the identification of HIV-infected persons in a high-prevalence population* –20% to 25% of persons living with HIV are not aware –Transmission rate from these persons was 3 ½ times higher than persons who know –One to eight partners were identified per index case –Approximately 20% partners tested were found to be new HIV positive Is cost effective *Hogben et. al., Am J Prev Med.2007 Aug;33(2 Suppl):S89-100

5. What is Partner Services –Also known as – Partner Counseling and Referral Services (PCRS) Partner Notification (PN) Public Health Follow-Up (PHFU) –Assist persons with HIV infection notifying their sexual and or/needle-sharing partners of their possible exposure to HIV The primary goal of PS is to prevent transmission of HIV and other STDs, to identify new HIV+ individuals and their partners, and to offer PS

6. Who Benefits From Partner Services For the patient –Provide the patients with support and link to care and interventions –Ensure their partners are confidentially informed For the partner –Maximize the proportion of partners who are notified –Maximize early linkage to test, care and prevention interventions For the community –Aid in early diagnosis, treatment and provide prevention services to reduce rate of transmission

7. Houston DIS - HIV Partner Services  Patient and partner notification  Prevention counseling and testing/risk reduction/treatment  Linkage to care Out Of Jurisdiction Cases HIV Surveillance Program Community Based Organizations Lab Reports STD Surveillance Program Private Physician Reports Other Facility Reports Insurance City of Houston Health Clinics Correctional Facilities STD*MIS

8. Using Surveillance Data to Initiate Partner Services, 2005-2010, Houston, TX

9. 200520062007200820092010 New HIV cases New HIV cases assigned to DIS 447642841104810611099 # interviewed (%) 339 (76%)501 (78%)689 (82%)810 (77%)855 (81%)904 (82%) # partners identified and initiated for notification - average/index case 542 (1.6)724 (1.4)864 (1.3)866 (1.1)1009 (1.2)1118 (1.2) # clusters identified and initiated for notification - average/index case 332 (1)592 (1.2)464 (0.7)416 (0.5)885 (1)1144 (1.3) # of new positives interviewed were successfully referred to early intervention %) 312 (92%)464 (93%)635 (92%)746 (92%)795 (93%)826 (91%) Partners and clusters # new partners and clusters were notified 50380476375513631766 # new partners and clusters were tested for HIV (%) 388 (77.14%)722 (89.80%)679 (88.99%)688 (91.13%)1287 (94.42%)1702 (96.38%) # new partners and clusters were new positives (%) 18 (4.64%)35 (4.85%)28 (4.12%)39 (5.67%)35 (2.72%)39 (2.29%) # new partners and clusters were previous positive (%) 104 (11.90%)170 (12.92%)221 (16.64%)192 (14.98%)274 (14.47%)323 (14.28%) Partners only # new partners were notified 260311382411536659 # new partners were tested for HIV (%) 198 (76.15%)274 (88.10)327 (85.6%)364 (88.56%)485 (90.49%)608 (92.26%) # new partners were new positives (%) 17 (8.59%)33 (12.04%)27 (8.26%)39 (10.71%)28 (5.77%)39 (6.41%) # new partners were previous positive (%) 98 (18.08%)145 (20.03%)193 (22.34%)175 (20.21%)247 (24.48%)308 (27.55%) Table 1. Partner Services Outcomes 2005 to 2010 Houston STD*MIS Data

10. Partner Services Outcomes Houston STD*MIS Data – 2005 to 2010

11. Partner Services Outcomes Houston Data 2005 to 2010 The number of HIV infected patients offered PS has increased Average number of partners identified and initiated per index case = 1.3 Average number of clusters identified and initiated per index case = 0.95 92% of new positives interviewed were successfully referred to early intervention HIV positivity among both partners & clusters tested = 4% HIV positivity among partners tested = 9%

12. Key Points Using surveillance data for PS has proven to be effective (HIV positivity rate among partners tested was 9%) Linking surveillance with case management services must not compromise the quality or integrity of the surveillance system (HIV surveillance program and prevention program should establish policies and procedures based on both principles and practices) Adhere the principles of PS PS programs should be monitored and evaluated to ensure quality of care are delivered Security and confidentiality guidelines should be strictly enforced

13. Acknowledgements HIV Surveillance Program Staff Bureau of HIV, STD, and Viral Hepatitis Prevention Staff Co-authors –Dr. Biru Yang –Marcia Wolverton –Dr. Raouf R. Arafat Special thanks –Dr. Karen Chronister –Nick Sloop –Lupita Thornton Sources of Support: This study was supported by Cooperative Agreement Number PS08- 802 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not represent the official views of the Centers for Disease Control and Prevention

14. Contact Information Shirley Chan shirley.chan@houstontx.gov Houston Department of Health and Human Services Bureau of Epidemiology, 4 th Floor 8000 N. Stadium Drive Houston, TX 77054 Tel: 1-832-393-5080 Fax: 1-832-393-5233