Although many ministries of health recommend the provision of assisted partner notification services (APS) to selected patients with longstanding HIV diagnoses, few data exist on the effectiveness of APS in this population relative to persons with newly diagnosed HIV. We report APS outcomes among newly diagnosed and previously diagnosed index cases (ICs) in Namibia, a country estimated to be at 90-98-91 achievement of the UNAIDS 95-95-95 targets.
Staff in 22 Namibian Ministry of Health clinics offered APS to patients newly diagnosed with HIV infection and patients with previously diagnosed HIV who interrupted treatment or had viral loads >1,000 copies/mL. APS counselors used a structured interview guide to elicit information on ICs’ sex contacts from the prior 24 months and assisted ICs arrange testing of contacts with unknown HIV status. We present program outcomes from October 2019 through June 2021 along the APS cascade for newly and previously diagnosed ICs, describing the contact index (contacts named per IC), testing index (contacts tested per IC), and case finding index (contacts tested positive per IC), and use generalized estimating equations to determine the association of case-finding with an IC being newly diagnosed (vs. a prior HIV diagnosis).
Staff provided APS to 1,222 (78%) of 1,557 newly diagnosed ICs (Figure 1) identifying 1,155 sex contacts, 855 of whom were eligible for HIV testing. Of those, 401 tested and 150 (37%) were newly diagnosed with HIV. A total of 280 ICs with previously diagnosed HIV named 279 contacts; 93 contacts tested and 25 (27% of those tested) were newly diagnosed with HIV. Comparing new and previously diagnosed ICs, APS acceptance (90% vs. 89%), contact indices (1.06 vs. 1.00), and testing indices (0.37 vs.0.33) were similar. While the case-finding index was higher among newly diagnosed ICs than among previously diagnosed ICs (0.14 vs. 0.09), case finding was not significantly higher in the newly diagnosed ICs (p=0.45).
Although the case finding index was lower in ICs with previously diagnosed than in ICs with new HIV diagnoses, APS provided to patients who interrupted treatment or had viral loads >1,000 copies/mL successfully identified new HIV positive sex contacts in Namibia, a country where an estimated 90% of HIV positive people know their status. These findings support the provision of APS to selected patients with previously diagnosed HIV infection.