Partner notification services - 101 July 23, 2019 Partner notification services - 101 The power of partners! Positively engaging networks of people with HIV in testing, treatment, and prevention Dr. Kimberly Green Global Director, HIV & TB

What are partner notification services? Partner notification services (PNS) is defined as a voluntary process whereby a trained provider asks people diagnosed with HIV about their sexual partners and/or drug injecting partners and then, if the HIV-positive client agrees, offers these partners HIV testing services. Partner notification is provided using passive or assisted approaches. Assisted partner notification services couple counseling at G-link clinic. PATH Source: WHO, Guidelines on HIV Self-Testing and Partner Notification: Supplement to Consolidated Guidelines on HIV Testing Services. 2016

Why partner notification services? Longstanding component of infectious disease management to identify those who have been exposed to infections & to enable more rapid access to treatment Including for sexually transmitted infections (STI) and tuberculosis Until last decade, HIV PNS limited to some high income countries Increasing evidence of safety & effectiveness  global scale-up Sexual and drug injecting partners of PLHIV have increased likelihood of being… HIV-positive OR At high risk for future HIV acquisition Opportunity for: High yield HIV case-finding Linking partners to HIV prevention and treatment  Accelerates epidemic control – decreasing HIV transmission & morbidity Acute and recent infections

What is partner notification versus index testing services? Trained providers Ask PLHIV about sexual and/or drug injecting partners Notify named contacts about potential exposure and offer HIV testing Voluntary Passive and active referral options Ask PLHIV about sexual and/or drug injecting contacts, households, and children Offer HIV testing to household contacts who could have been exposed to HIV – e.g. sexual/drug injecting partners and children Passive and active referral options Content from: C. Johnson. Understanding and Implementing Assisted Partner Notification to increase HIV Diagnosis in the Caribbean, Dec 2018

Options for notifying partners Provider Referral = Health care provider contacts partner(s) to notify them of exposure and offer testing Assisted Approaches Contract Referral = Client agrees to notify partner(s) within specific time period after which the provider will contact the partner(s) with the client’s permission Dual referral = Client and provider notify partners together Passive Client Referral = Index client tells partner(s) about HIV risk and encourages them to get tested

Evidence base – summary

WHO guidance: assisted partner notification services (APN) WHO recommendation: Voluntary assisted partner notification services should be offered as part of a comprehensive package of testing and care offered to people with HIV (strong recommendation, moderate quality evidence) Source: WHO 2016 (Slide from: C. Johnson. Understanding and Implementing Assisted Partner Notification to increase HIV Diagnosis in the Caribbean, Dec 2018)

Principles of PNS and index testing Client centered and focused Voluntary and non-coercive Confidential Culturally and linguistically appropriate Comprehensive and integrative Non - judgmental Accessible and available to all Free

Partner notification services Person with HIV is newly or previously diagnosed (community, HIVST, facility) If client consents, provider elicits sexual and drug- injecting partners Trained provider introduces PNS to client & seeks client’s consent Provider and/or client notifies partner(s) of HIV exposure Partner(s) offered HIV testing and linkage to prevention or treatment Client and provider select notification method for partner(s) Results in increased partner testing, diagnosis, and linkage to prevention and treatment

Potential methods for contacting partners No one size fits all; differentiate by PN preferences since they differ by population, age, geography, and partner type (primary or non-primary) Assisted partner notification methods can include: Face-to-face conversations with partners Phone calls Text messages Emails Video and Internet-based messaging systems Care is needed when using phone calls and text messaging to ensure that the correct person receives the message and that the anonymity of both the HIV-positive client and notified partner is maintained.

Example of differentiated partner notification services… The “spirit” of MI is like dancing, rather than wrestling. It is collaborative and honoring of patient autonomy.

4 countries + 4 epidemics = 4 differentiated approaches KENYA: PNS cascade, October 2018—March 2019 (PEPFAR/USAID/PATH Afya Ziwani) DRC: PNS cascade, October 2018—March 2019 (PEPFAR/USAID/PATH IHAP-HK/L) VIETNAM: PNS cascade, June 2017—March 2019 (PEPFAR/USAID/PATH Healthy Markets) UKRAINE: PNS cascade, February—March 2019 (PEPFAR/USAID/PATHServing Life) Facility, community, in-person, SMS and social media-based tracing…Men, KP, AGYW, children

Key considerations and takeaways Do no harm and implement based on the 5Cs; voluntariness and confidentiality are essential Laws/policies that criminalize populations complicate aPNS delivery and uptake Enable strong community leadership and engagement (and aPNS service delivery) Differentiate aPNS based on population preferences (community, facility, HIVST – online engagement…) Offer periodically – PNS is a process and acceptability or need may change over time Time intensive and requires well-trained providers Integrate as part of HIV testing, prevention, and treatment; and link to other needs and services (e.g. STIs, mental health)

Key resources WHO Guidelines: https://bit.ly/2IeVwV8 WHO Policy Brief: https://bit.ly/2IJX7C5 WHO PN slide set: https://bit.ly/2IJXc8R WHO Index testing slide set: https://bit.ly/2jYsJFW PATH differentiated PN Brief: https://bit.ly/2Y1Vms7 PATH PNS web articles: https://bit.ly/2JSQVpy AIDSfree Tools on PN: https://bit.ly/32Jlkzj

Acknowledgements Cheryl Johnson, WHO Rachel Baggaley, WHO David Katz, University of Washington Davina Canagasabey, PATH Bao Vu Ngoc, USAID/PATH Healthy Markets, Vietnam Didier Kamerhe, USAID/PATH IHAP-HK/L, DRC Svitlana Leontyeva, PATH, Ukraine Asha Hegde, PATH, India