Partners of people living with HIV more likely to test when encouraged by health worker
Research findings on ‘voluntary assisted HIV partner notification’ inform new WHO testing guidelines.
A systematic review conducted by the WHO found more partners of people living with HIV came forward for HIV testing when notified by a health provider of their possible exposure to the virus, compared to ‘passive referral’ programmes, which puts the onus on the person with HIV to encourage sexual or injecting partners to get tested.
The findings, released in this month’s AIDS journal, were used to inform WHO’s updated consolidated HIV testing guidelines, which recommend that the intervention, known as ‘voluntary assisted HIV partner notification’, be offered to people newly diagnosed with HIV, and periodically throughout their care and treatment.
WHO analysed the results of four randomised controlled trials and six observational studies on partner notification from the United States of America (USA), Kenya, Malawi, Cameroon, Mozambique, Spain and Tanzania, which were published between 1992 and 2016, and included results from 5,150 people with HIV who identified 6,127 partners.
Higher proportions of partners getting tested for HIV following assisted notification were recorded across all studies, while the three individually-randomised trials included in the analysis found this method resulted in a 1.5-fold increase in HIV testing among partners, compared to passive referral.
Assisted notification also resulted in higher proportions of partners being diagnosed with HIV (ranging from between 12-86%) and linked to antiretroviral treatment (ART) services.
The analysis found low levels of social harm or other adverse events following passive or assisted HIV partner notification, which is of particular concern in situations where certain behaviours associated with HIV are criminalised or where one partner is economically or socially dependent on the other.
This indicates that, while programme implementers should be sensitive to the potential for harm arising from disclosure of HIV status and assisted partner notification, it should be balanced against the benefit of diagnosing HIV infection and linking people to treatment.
One of the perceived challenges to partner notification has been that key populations and people with casual partners may be less able or willing to identify partners, while spouses and steady partners are more likely to be notified. However, the analysis found that assisting people from key populations to notify partners, while potentially requiring more intensive efforts to locate partners and assuring their confidentiality and anonymity, still resulted in higher uptake of HIV testing services overall, particularly among men who have sex with men and people who inject drugs.
WHO’s updated consolidated HIV testing guidelines, which also include new recommendations on self-testing, were released in December 2016.