1. Good afternoon and thank you for joining us for Et AL: The NCSD Journal Club. My name is Leandra Lacy and I am the Capacity Building Manager for the National Coalition of STD Directors. My hope is that this journal club will not only help to keep you abreast of current STD literature but also that you can utilize the findings from articles presented and apply them to your own STD programs whether it’s in regards to STD surveillance, diagnostics, treatment, partner services, or outreach to the populations you serve.
February 11, 2019

2. Logistics
This is just a reminder that this webinar IS being recorded, and the recording will be made available. If you are not speaking, I ask that your phone line or computer speaker is muted.
If you have questions or need technical help during this call, please utilize the chat function in the bottom right corner of your screen. You can also private message me or my colleague Neil Rana, who is listed as a host. All questions will be addressed at the end, but we will keep a queue so please send them our way as they come up.
I also want to flag for you that there is a box called “files” on your screen. In this box, you will find the journal article presented, so you can download and reference it.

3. Agenda Introduction of presenters
Article background, methods, and results
Discussion
Q&A
For our agenda today, we will start with an introduction of our presenters. We will then move into the article background, methods, and results, followed by a time for discussion and engagement with the presenters and the participants. There will also be ample time for questions at the end.
Without further ado. I’ll hand things over to our presenters for the day, to discuss their recent article called “Integrating HIV testing into syphilis partner services in Mississippi to
improve HIV case finding”

4. Integrating HIV testing into syphilis partner services
Tigran Avoundjian, David Peyton, Kendra Johnson, Sara N. Glick, Matthew R. Golden
University of Washington, Public Health Seattle & King County HIV/STD Program, and Mississippi State Department of Health

5. HIV and STDs in the Southeastern US
Rates of HIV diagnosis, among
adults and adolescents, 2016
Rates of reported primary and secondary syphilis cases, 2016

6. HIV/AIDS in Jackson, MS Rates of HIV Diagnoses, 2015
Rates of Stage 3 (AIDS) Diagnoses, 2015
Area of residence
Rate1
Miami–Fort Lauderdale–West Palm Beach, FL
38.7
New Orleans–Metairie, LA
33.3
Baton Rouge, LA
30.2
Atlanta–Sandy Springs–Roswell, GA
29.4
Orlando–Kissimmee–Sanford, FL
27.4
Jackson, MS
25.0
Memphis, TN–MS–AR
22.9
Jacksonville, FL
Las Vegas–Henderson–Paradise, NV
21.8
Houston–The Woodlands–Sugar Land, TX
Area of Residence
Rate1
Jackson, MS
16.8
Baton Rouge, LA 16
Miami–Fort Lauderdale–West Palm Beach, FL
15.9
New Orleans–Metairie, LA
14.9
Columbia, SC
13.0
Jacksonville, FL
12.8
Baltimore–Columbia–Towson, MD
12.7
Durham–Chapel Hill, NC
12.3
Atlanta–Sandy Springs–Roswell, GA
12.1
Winston–Salem, NC
11.8

7. Syphilis Partner Services
Syphilis is a known risk factor for HIV acquisition
High rates of syphilis and HIV co-infection in the US, particularly among MSM
As part of syphilis partner services activities, DIS already contacting partners of early syphilis cases
In 2017, 45.5% of reported primary and secondary syphilis case records among MSM were HIV-positive; compared to 8.9% among MSW and 4.5% among women

8. Objective
Mississippi State Department of Health (MSDH) and University of Washington (UW) collaboration to evaluate the integration of new HIV-related activities into the MSDH STD Partner Services (PS) program
Aim 1: To evaluate the utility of STD PS as a means to increase HIV testing and case-finding
Aim 2: To assess the utility of STD PS to reengage persons with HIV to care and promote effective antiretroviral therapy
Aim 3: To assess the utility of STD PS for syphilis and gonorrhea as a means to increase HIV testing in high-risk MSM and to link MSM to pre-exposure prophylaxis (PrEP)

9. Syphilis PS Workflow As of 2014: PRISM
New syphilis diagnosis/positive serological test reported to MSDH
DIS contact index cases and conduct interview
As of 2014:
PRISM
DIS contact named partners to test for syphilis, and collect demographic information
DIS refer partners to STD clinic for rapid HIV testing OR offer blood draw in the field
Index case interview – verify treatment, collect demographic and risk information, identify sex partners
Full partner services interview – verify treatment and collect additional risk information
Epidemiologic treatment: minimize delays in treating truly infected case-patients and ensure treatment of people with incubating syphilis
HIV testing integrated in 2014: DIS encourage partners to get rapid HIV test at STD clinic; all DIS trained to perform blood draw, and offer HIV blood test in the field as an alternative to rapid testing in the STD clinic
Case record assigned to DIS for investigation
DIS offer all partners treatment for syphilis at time of syphilis testing (epi treatment)
For partners with new early syphilis infection, DIS conduct full partner services interview

10. Study Population
Identified all early syphilis cases and their partners from July 2014 through December 2016
Index case: case record in PRISM with diagnosis code for primary, secondary, or early latent syphilis (710, 720, 730)
Excluded index cases newly diagnosed with HIV within 30 days of early syphilis infection
July 2014 – HIV testing first integrated into syphilis PS
Excluded newly diagnosed HIV cases: partners would have received HIV testing as part of HIV partner services activities regardless of index case’s syphilis infection status. We were interested in HIV case finding through syphilis partner services specifically (which is the new activity under evaluation here)

11. Outcomes: Syphilis case finding
Syphilis testing: evidence of a syphilis serological test in PRISM after being named as a partner
New syphilis case: partner had diagnosis code for primary, secondary, or early latent syphilis after being named as a partner

12. Outcomes: HIV case finding
HIV testing: HIV test reported within 30 days after being named as a partner
New HIV case: partner had HIV diagnosis within 30 days after being named as a partner AND no evidence of previous HIV diagnosis
Looked for evidence of HIV testing/diagnosis in PRISM, Apollo, and eHARS

13. Partner Services Metrics
Partners named/contacted
Partners epidemiologically treated: number of partners who did not test positive for syphilis but received preventative treatment after DIS contact
Partners brought to treatment: partners tested positive for syphilis and received treatment after DIS contact
Number needed to Interview (NNTI): number of index cases needed to interview to identify one new case of HIV or syphilis among partners
Test positivity: number of partners testing positive for syphilis or HIV divided by the number of partners tested

14. Index Case Characteristics
1619 Index Cases reported
1535 Index Cases Interviewed
2267 partners named
1867 partners contacted
Gender/
gender of sex partners
HIV Status
Race
53% of MSM previous HIV+ (vs. 5% of MSW/women)

15. Partner Services Indices1
1Index: outcome divided by total number of index cases(n = 1619)

16. Syphilis/HIV Case Finding
NNTI: 2.21
NNTI: 64

17. HIV case finding by index case characteristics

18. HIV Test Positivity

19. Summary of Findings
Syphilis PS yielded substantial number of new syphilis and HIV cases
HIV case finding was highest among partners of black MSM and index cases who were previously HIV+
High HIV test positivity among these groups
Improving HIV testing rates could result in increased HIV case finding as a result of syphilis partner services

20. Discussion Low syphilis NNTI in MS compared to other jurisdictions
HIV outcomes not as good as other jurisdictions
Only 50% of partners received HIV testing
May be due to the high burden of undiagnosed syphilis in the area & syph PS tapping into high prevalence networks
May also be due to MSDH’s prioritization of syphilis PS – DIS recognize partner elicitation and testing as important aspects of syph PS, and low NNTI reflects their efforts
HIV outcomes could be reflection of low proportion of partners receiving HIV testing; increasing HIV testing could lead to improved case finding that’s similar to other jurisdictions
However, low testing could be reflection of data issues (discuss how we addressed this in analysis)

21. Syphilis PS as HIV prevention opportunity
Setting to reduce disparities among MSM
Integration of other high impact HIV prevention activities into syphilis PS
PrEP uptake
Relinkage to HIV care
Disparities: especially Black MSM. MSDH DIS interacted with 719 HIV negative MSM over a 30 month period, including 538 B/AA HIV negative MSM

22. Implications for STD Programs
Integrating HIV testing into syphilis PS is an effective strategy for identifying people newly infected with HIV
Syphilis PS can be leveraged to improve PrEP uptake and HIV care delivery
Standard outcomes/framework for evaluating STD partner services programs

23. Future Directions
Facilitators/barriers to integrating HIV testing into syphilis PS
Evaluating impact of integrating PrEP referrals/HIV relinkage activities into syphilis PS

24. Acknowledgements Co-authors MSDH DIS Christine Khosropour
Christie Lewis
James Stewart
MSDH DIS

25. Group Discussion
What strategies has your health department employed with DIS in the integration of HIV testing into syphilis partner services?
What challenges has your health department faced in integrating HIV testing into syphilis partner services?
What successes has your health department seen in integrating HIV testing into syphilis partner services?

26. Questions?
Feel free to type your question into the chat box or unmute your line to ask it on the phone line.

27. Christine M. Khosropour
Additional questions?
Tigran Avoundjian
David Peyton
Kendra Johnson
Matthew R. Golden
Christine M. Khosropour
Leandra Lacy
With that, I’d like to say thanks to all of you who attended the Journal Club today. I have included the presenter’s contact info, in addition to mine on this slide. Feel free to reach out for additional questions. In the chat box, there is a link for the very brief webinar evaluation that you will also be redirected to once I close the webinar. Please complete it so that it can inform future journal club webinars. Today’s recording and slides will be sent to all those who registered. Be on the look out for the blog related to this article in March and then the next journal club meeting in April. Have a great week!