Human immunodeficiency virus partner elicitation and notification in new york city: public health does it better

Abstract

Background: Partner notification (PN) is an effective strategy to identify undiagnosed human immunodeficiency virus (HIV) infections and to likely reduce HIV transmission. Whereas published literature has documented the benefits of provider referral for HIV PN, determination of the optimal provider--health department staff or community clinician--has not been previously studied. This study examined whether PN conducted by New York City (NYC) Disease Intervention Specialists (DIS) is more successful than PN conducted by community clinicians.

Methods: PN results overall and by index case-patient characteristics were compared for new HIV cases diagnosed in public sexually transmitted disease (STD) clinics versus those diagnosed in non-STD facilities.

Results: In NYC in 2004, 206 new HIV cases were diagnosed in STD clinics and 3460 in non-STD facilities. STD DIS personnel elicited 4 times as many partners per case diagnosed (0.87 vs. 0.22, P <0.01). Index case-patient characteristics differed between STD clinics and non-STD facilities, but STD DIS elicited more partners within all demographic and risk subgroups. Excluding partners previously HIV+, the proportion of partners notified was 70.9% for partners elicited by STD DIS and 48.3% for partners elicited by community clinicians (P <0.01). Among tested partners with previously unknown or negative status, the proportion of new HIV diagnoses was similar between those elicited by DIS and community clinicians (27.0% vs. 22.2%, P = 0.56).

Conclusions: NYC STD DIS appear to be more effective than community clinicians at both partner elicitation and notification. NYC has stationed DIS at large healthcare facilities to assist community clinicians with the PN process.