Evaluating the Use of HIV Surveillance Data for Initiating Partner Services

in Houston, Texas, US

2012 International AIDS ConferenceWashington, D.C.

Shirley ChanHouston Department of Health and Human ServicesBureau of Epidemiology, HIV Surveillance Program

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

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

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

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 ofHIV and other STDs, to identify new HIV+

individualsand their partners, and to offer PS

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

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

ProgramCommunity Based Organizations

Lab Reports

STD Surveillance

ProgramPrivate Physician Reports

Other Facility Reports Insurance

City of HoustonHealth Clinics

Correctional Facilities

STD*MIS

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

0

200

400

600

800

1000

1200

1400

2005 2006 2007 2008 2009 2010

Year of HIV Diagnosis

Num

ber o

f HIV

Cas

es A

ssig

ned

to D

IS

New Diagnosis

Eligible for PS

Provider Opt-Out

Referred for PS

  2005 2006 2007 2008 2009 2010

New HIV cases            New HIV cases assigned to DIS 447 642 841 1048 1061 1099# 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 503 804 763 755 1363 1766# 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 260 311 382 411 536 659# 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 2010Houston STD*MIS Data

Partner Services OutcomesHouston STD*MIS Data – 2005 to 2010

0

200

400

600

800

1000

1200

1400

2005 2006 2007 2008 2009 2010

Year of HIV Diagnosis

Num

ber o

f HIV

Cas

es A

ssig

ned

to D

IS

New HIV casesassigned to DIS

# partners identified

# clusters identified

# interviewed

Partner Services OutcomesHouston 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%

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

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

Contact Information

Shirley Chan shirley.chan@houstontx.gov

Houston Department of Health and Human ServicesBureau of Epidemiology, 4th Floor8000 N. Stadium DriveHouston, TX 77054

Tel: 1-832-393-5080Fax: 1-832-393-5233