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Effectiveness of Partner Services for HIV in Kenya: A Cluster Randomized Trial
Peter Cherutich1; Mathew R. Golden2; Beatrice Wamuti3; Barbra A. Richardson1; Kristjana H. Ásbjörnsdóttir1; Felix A. Otieno3; Betsy Sambai3; Matt Dunbar1; Carey Farquhar1; for the aPS Study Group
1Univ of Washington, Seattle, WA, USA;2Univ of Washington Sch of Med, Seattle, WA, USA;3Kenyatta Natl Hosp, Nairobi, Kenya
Case finding using HIV assisted partner services (aPS) is widely practiced in the United States and Europe but less so in Africa due to limited data on effectiveness in routine health settings. We report preliminary results of a cluster randomized trial to assess the effect of immediate aPS on rates of 1) HIV testing, 2) case-finding of HIV-infected individuals, and 3) linkages to HIV care for sexual partners.
In this cluster randomized trial, eligible HIV-infected adults were recruited from 18 HIV testing sites randomized to immediate (intervention) or delayed (control) aPS. In both intervention and control arms, index cases were asked to provide names and contact information of sexual partners in the preceding three years. Notification, testing and referral to care (if HIV-infected) of sexual partners occurred immediately in the intervention arm and 6 weeks after enrollment in the control arm. Generalized estimating equations with a Poisson link and independent correlation structure were used to evaluate the effect of the intervention on outcomes. The study was registered in ClinicalTrials.gov (NCT01616420).
The study enrolled 1119 index cases from 18 different clusters (550 immediate arms; 569 delayed arm) who mentioned 1872 sexual partners. Among these mentioned sexual partners, 1292 (69%), [620 immediate arm; 672 delayed arm] were enrolled. Enrollment and follow-up data were available for 579 (63%) and 672 (70%) of sexual partners mentioned in the immediate and delayed arms, respectively. Among 913 partners mentioned, 388 (42.5%) tested for HIV in the immediate arm, and among 959 partners mentioned, 118 (12.3%) tested in the delayed arm. Immediate aPS increased testing rates four-fold (Incidence rate ratio (IRR) 3.78, 95% CI: 3.08-4.65). The IRR comparing rates of first-time testers between immediate and delayed arms was 11.50 (95% CI: 5.56-23.78). Immediate aPS also significantly increased the number testing positive and enrolling into HIV care (IRR 3.22 [95% CI: 2.26-4.61] and 3.95 [95% CI: 2.48-6.28] respectively).
aPS was highly effective and resulted in increased HIV case finding and linkage to care for HIV-infected sexual partners in this sub-Saharan African setting. aPS should be considered as a key strategy to improve delivery of HIV testing and counseling in Kenya and other high HIV prevalence settings where large numbers of the HIV-infected individuals do not know their status.