Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;11(5):e749-e758.
doi: 10.1016/S2214-109X(23)00153-5.

Real-world impact of integrating HIV assisted partner services into 31 facilities in Kenya: a single-arm, hybrid type 2 implementation-effectiveness study

Monisha Sharma  1 , Brienna Naughton  2 , Harison Lagat  3 , George Otieno  3 , David A Katz  1 , Beatrice M Wamuti  4 , Sarah Masyuko  5 , Rose Bosire  6 , Mary Mugambi  7 , Unmesha Roy Paladhi  8 , Bryan J Weiner  1 , Edward Kariithi  3 , Carey Farquhar  9
Affiliations

Real-world impact of integrating HIV assisted partner services into 31 facilities in Kenya: a single-arm, hybrid type 2 implementation-effectiveness study

Monisha Sharma et al. Lancet Glob Health. 2023 May.

Abstract

Background: Assisted partner services (APS), or exposure notification and HIV testing for sexual partners of individuals diagnosed with HIV (index clients), have been shown to be safe and effective in clinical trials. We assessed the real-world effectiveness of APS when integrated into HIV clinics in western Kenya.

Methods: In this single-arm, hybrid type 2 implementation science study, we facilitated APS implementation in 31 health facilities in Kenya by training existing health-care staff. We focused on male partner outcomes to assess the impact of APS in reaching male individuals in sub-Saharan Africa, who have lower rates of HIV testing than female individuals. Female individuals (aged ≥18 years or emancipated minor) who tested positive for HIV at participating facilities in Kenya were offered APS; consenting female participants provided contact information for all male sexual partners in the past 3 years. Male partners were notified of their potential HIV exposure and offered a choice of community-based or facility-based HIV testing services (HTS). Female index clients and male partners with HIV were followed up at 6 weeks, 6 months, and 12 months after enrolment, to assess linkage to antiretroviral treatment. Viral load was assessed at 12 months.

Findings: Between May 1, 2018, and March 31, 2020, 32 722 female individuals received HTS; 1910 (6%) tested positive for HIV, of whom 1724 (90%) received APS. Female index clients named 5137 male partners (median 3 per index [IQR 2-4]), of whom 4422 (86%) were reached with exposure notification and HTS. 524 (12%) of the male partners tested were newly diagnosed with HIV and 1292 (29%) reported a previous HIV diagnosis. At 12 months follow-up, 1512 (88%) female index clients and 1621 (89%) male partners with HIV were taking ART, with few adverse events: 25 (2%) female index clients and seven (<1%) male partners reported intimate partner violence, and 60 (3%) female index clients and ten (<1%) male partners reported relationship dissolution.

Interpretation: Evidence from this real-world APS scale-up project shows that APS is a safe, acceptable, and effective strategy to identify males with HIV and retain them in care.

Funding: The US National Institutes of Health.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests CF, MS, BJW, and DK report grants from the National Institutes of Health, outside of the submitted work. MS reports grants from the Bill & Melinda Gates Foundation, outside of the submitted work. All other authors declare no competing interests.

Figures

Figure 1:
Figure 1:. APS care cascade of female index clients and testing outcomes of male partners
(A) APS care cascade and linkage to care outcomes for female index clients. (B) Male partner testing outcomes. APS=assisted partner services. ART=antiretroviral therapy.
Figure 2:
Figure 2:. APS care cascade of male partners
(A) APS care cascade and linkage to care outcomes for male partners with newly diagnosed with HIV. (B) APS care cascade and linkage to care outcomes for male partners with a previous HIV diagnosis (known HIV-positive status). APS=assisted partner services. ART=antiretroviral therapy.
See this image and copyright information in PMC

Comment in

References

    1. Kharsany ABM, Karim QA. HIV infection and AIDS in sub-Saharan Africa: current status, challenges and opportunities. Open AIDS J 2016; 10: 34–48. - PMC - PubMed
    1. Giguère K, Eaton JW, Marsh K, et al. Trends in knowledge of HIV status and efficiency of HIV testing services in sub-Saharan Africa, 2000–20: a modelling study using survey and HIV testing programme data. Lancet HIV 2021; 8: e284–93. - PMC - PubMed
    1. Quinn C, Kadengye DT, Johnson CC, Baggaley R, Dalal S. Who are the missing men? Characterising men who never tested for HIV from population-based surveys in six sub-Saharan African countries. J Int AIDS Soc 2019; 22: e25398. - PMC - PubMed
    1. Staveteig S, Croft TN, Kampa KT, Head SK. Reaching the ‘first 90’: gaps in coverage of HIV testing among people living with HIV in 16 African countries. PLoS One 2017; 12: e0186316. - PMC - PubMed
    1. De Cock KM, Barker JL, Baggaley R, El Sadr WM. Where are the positives? HIV testing in sub-Saharan Africa in the era of test and treat. AIDS 2019; 33: 349–52. - PubMed

Publication types