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
. 2022 Dec 1;49(12):801-807.
doi: 10.1097/OLQ.0000000000001711. Epub 2022 Sep 27.

The Role of HIV Partner Services in the Modern Biomedical HIV Prevention Era: A Network Modeling Study

Samuel M Jenness  1 , Adrien Le Guillou  1 , Cynthia Lyles  2 , Kyle T Bernstein  3 , Kathryn Krupinsky  1 , Eva A Enns  4 , Patrick S Sullivan  1 , Kevin P Delaney  2
Affiliations

The Role of HIV Partner Services in the Modern Biomedical HIV Prevention Era: A Network Modeling Study

Samuel M Jenness et al. Sex Transm Dis. .

Abstract

Background: HIV partner services can accelerate the use of antiretroviral-based HIV prevention tools (antiretroviral therapy [ART] and preexposure prophylaxis [PrEP]), but its population impact on long-term HIV incidence reduction is challenging to quantify with traditional partner services metrics of partner identified or HIV screened. Understanding the role of partner services within the portfolio of HIV prevention interventions, including using it to efficiently deliver antiretrovirals, is needed to achieve HIV prevention targets.

Methods: We used a stochastic network model of HIV/sexually transmitted infection transmission for men who have sex with men, calibrated to surveillance-based estimates in the Atlanta area, a jurisdiction with high HIV burden and suboptimal partner services uptake. Model scenarios varied successful delivery of partner services cascade steps (newly diagnosed "index" patient and partner identification, partner HIV screening, and linkage or reengagement of partners in PrEP or ART care) individually and jointly.

Results: At current levels observed in Atlanta, removal of HIV partner services had minimal impact on 10-year cumulative HIV incidence, as did improving a single partner services step while holding the others constant. These changes did not sufficiently impact overall PrEP or ART coverage to reduce HIV transmission. If all index patients and partners were identified, maximizing partner HIV screening, partner PrEP provision, partner ART linkage, and partner ART reengagement would avert 6%, 11%, 5%, and 18% of infections, respectively. Realistic improvements in partner identification and service delivery were estimated to avert 2% to 8% of infections, depending on the combination of improvements.

Conclusions: Achieving optimal HIV prevention with partner services depends on pairing improvements in index patient and partner identification with maximal delivery of HIV screening, ART, and PrEP to partners if indicated. Improving the identification steps without improvement to antiretroviral service delivery steps, or vice versa, is projected to result in negligible population HIV prevention benefit.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest and Sources of Funding: None declared.

Figures

Figure 1
Figure 1
General relationship between improved partner services index initiation and partner identification probabilities on the 10-year percent of infections averted (PIA) compared with the base (calibrated) model scenario. Panel A (left) demonstrates the relationship under base downstream services (HIV screening, PrEP, and ART), whereas panel B (right) shows the relationship when all downstream services are set to their theoretical maxima. Improvements to index or partner engagement have no discernable impact on the PIA under base downstream services but are associated with an upward of 20% infections averted when downstream services are maximized.
Figure 2
Figure 2
General relationship between improved partner HIV screening and either partner ART linkage/reengagement for HIV-infected partners (top panels) or PrEP initiation for HIV-negative partners (bottom panels) on the 10-year percent of infections averted (PIA) compared with the base (calibrated) model scenario, assuming 90% of index patients are identified and either 25% of their partners (left panels) or 50% of their partners (right panels) are identified. Higher levels of HIV screening are associated with greater HIV prevention, but ART engagement had a greater relative effect than PrEP initiation. The total benefit was greater when the partner identification was higher because of a larger number of identified partners who eligible for ART or PrEP.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention (CDC) . Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. MMWR Recomm Rep 2008; 57:1–83; quiz CE1-4. - PubMed
    1. Magaziner S Montgomery MC Bertrand T, et al. Public health opportunities and challenges in the provision of partner notification services: The New England experience. BMC Health Serv Res 2018; 18:75. - PMC - PubMed
    1. Katz DA Dombrowski JC Barry M, et al. STD partner services to monitor and promote HIV pre-exposure prophylaxis use among men who have sex with men. J Acquir Immune Defic Syndr 2019; 80:533–541. - PMC - PubMed
    1. Udeagu C-CN Beer L Lu J-F, et al. Partner services among HIV-positive adults receiving medical Care in the United States: Medical Monitoring Project, 2013−2014. AIDS Patient Care STDS 2020; 34:99–101. - PMC - PubMed
    1. Crepaz N Song R Lyss SB, et al. Estimated time from HIV infection to diagnosis and diagnosis to first viral suppression during 2014–2018. AIDS 2021; 35:2181–2190. - PMC - PubMed

Publication types

MeSH terms