1. 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

2. 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

3. 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

4. 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

5. 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

6. Evidence base – summary

7. 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)

8. 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

9. 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

10. 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 s
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.

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

12. 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

13. 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)

14. Key resources WHO Guidelines: https://bit.ly/2IeVwV8
WHO Policy Brief:
WHO PN slide set:
WHO Index testing slide set:
PATH differentiated PN Brief:
PATH PNS web articles: 
AIDSfree Tools on PN:

15. 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