Improving partner services by embedding disease intervention specialists in HIV-clinics

Abstract

Background/objectives: Notifying partners of HIV-infected persons and referring them for testing and treatment is an effective method of disease control and identification of undiagnosed STD and/or HIV. To improve partner elicitation interviews, disease intervention specialists (DIS) were placed in 3 HIV clinics during 2008 and 2009.

Methods: We reviewed the Arizona state STD surveillance database for 2007 to identify the providers (outside of the public STD clinics) reporting the highest number of syphilis cases. DIS were placed in the clinics for half a day per week (2 clinics) or on an on-call basis (1 clinic) to deliver penicillin and interview patients. We calculated changes in the number of patients interviewed, days elapsed from specimen collection to treatment (time to treatment), days elapsed from specimen collection to initial DIS contact (time to interview), and number of reported and locatable partners from these 3 clinics before and after the clinic placement of DIS.

Results: Before the placement of clinic-based DIS, 219 syphilis cases were diagnosed at the 3 clinics (January 2006 through January 2008). After DIS placement, 115 syphilis cases were diagnosed (February 2008 through September 2009) for a total of 334 cases in this analysis. A greater percent of patients completed a partner elicitation interview during the period of DIS placement (94% after vs. 81% before, P = 0.001). There were increases in the average number of locatable partners (1.1 after vs. 0.6 before, P = 0.004) and an increase in the average number of partners exposed and brought to treatment (CDC Disposition A) or infected and brought to treatment (CDC Disposition C) (0.6 after vs. 0.3 before, P = 0.02), and the time to interview decreased (18 days before vs. 9 days after, P = 0.02).

Conclusions/implications: Placing DIS within community HIV clinics improved partner services. STD and/or HIV programs should consider this method to improve partner notification.