Enhanced HIV Partner Notification is Highly Effective at Diagnosing HIV in Vancouver, Canada

Transcription

1 Enhanced HIV Partner Notification is Highly Effective at Diagnosing HIV in Vancouver, Canada Canadian Public Health Association Conference 2015 Logan Chinski, RN HIV Nurse Educator Vancouver Coastal Health Authority Co-Authors: Demlow E, MacDonald L, Zerr L, Chu T, Smythe M, Sandhu J, Gustafson R On behalf of the VCH CDC Public Health Nursing Team

2 Conflict of Interest We have no conflicts of interest to disclose

3 Background Partner notification of newly diagnosed HIV positive people is a critical public health action that offers testing, treatment and support to those people at highest risk for HIV transmission. A systematic review of partner notification found that an average of 20% of partners notified and tested for HIV were positive 1. BC Public Health Act mandates the offer of partner notification to all new HIV diagnoses. In 2011, VCH created an enhanced partner notification tool to measure this practice in the region. 1 Hogben M, McNally T, McPheeters M, Hutchinson AB (2007) The effectiveness of HIV partner counseling and referral services in increasing the identification of HIV-positive individuals a systematic review. American Journal of Preventative Medicine 33: S

4 HIV Epidemiology in VCH (January 1, 2011-June 30, 2014) N= 546 people newly diagnosed positive for HIV VCH annual rate: 12.9/100,000 BC annual rate: 5.6/ 100,000 Gender: 91% male (concentrated epidemic) Age Category: years: 25% years: 28% years: 25% Exposure Category: - 73% MSM (80% of males) - 10% Injection drug use - 16% Heterosexual Stage of Disease at Diagnosis: -16% Acute Stage Disease Source: Public Health Surveillance Unit: HIV/STI Surveillance Database Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit: April 14, 2015

5 Objective To measure the impact of a regional HIV partner notification program to identify new cases of HIV. 5

6 Methods Enhanced partner notification tool developed to document multiple stages of contact tracing for each partner elicited Standard Practice Documentation Partner demographics, relationship status, type of contact (ex. MSM, STW, IDU) Whether partner is notified and who notified (ex. case, PHN, HCW) Enhanced Practice Documentation Partner HIV status at time of notification: If Positive: review of partner s engagement in care and adherence to treatment If Negative/Unknown: Document if partner is tested or referred to test Document test result to determine testing yield

7 Monitoring and Evaluation Methods Evaluation period: January 1, 2011 June 30, 2014 Population of Focus: Partners of cases who test positive for HIV in our region Indicators developed to monitor key partner notification outcomes and inform practice Statistical significance is determined by p<0.05 Limitations Partner notification is a voluntary process. All data is dependent on the index case and their partners level of engagement in the process.

8 Results Partner Demographics N= 2,247 partners elicited from 546 cases Gender: 89% Male Relationship to Index Case: 48% Anonymous 36% Acquaintance/Casual Partner 14% Steady Partner Type of Contact: 82% MSM 10% Heterosexual 6% IDU 2% Other Source: Public Health Surveillance Unit: Enhanced Contact Tracing Database Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit: April 14, 2015

9 100% Proportion of Partners Notified of HIV Exposure by Year 90% 80% Proportion of Partners 70% 60% 50% 40% 30% 20% 10% 0% Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Not Notifed (Other Reason) Not Notified (Anonymous Partner) Notified Average of 46% of partners are notified 76% of partners not notified are anonymous to index case

10 Previously Positive Partners January 1, 2011-June 30, 2014 N=177 (17%) partners known to be previously positive N=106 (60%) Known to be receiving HIV care N=60 (34%) Unknown Care Status N=11 (6%) Known to not be receiving HIV care N=66 (62%) Prescribed ARVs N=25 (24%) Unknown ARV Status N=15 (14%) Not prescribed ARVs

11 Percent Tested (%) Proportion of Partners Tested or Referred to Test* for HIV and Testing Yield by Year p <0.001 Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Year Proportion tested for HIV significantly increasing over study period Average testing yield for partner notification = 7% *Among contacts who are notified of their exposure and are not previously diagnosed positive for HIV Testing Yield (%)

12 Implications on Practice: Previously Positive Partner Enhanced follow up provides a critical safety net in our community to re-engage those who are lost to care. Among those already engaged, we review treatment adherence and suppression.

13 Implications on Practice: Effects on nursing practice Testing and Yield Not just informing of one s exposure! Partner notification utilizes a case management approach. Referral for HIV testing is followed up by public health to ensure support or testing is offered first hand by public health. Result follow up ensures appropriate referrals, supports, counseling, and education.

14 Effects for partner Implications on Practice: Allows for a variety of different interventions based on test result If positive, a therapeutic relationship with PHN has already been initiated & linkage to HIV health care and support services can be more streamlined If negative Testing and Yield If partner exposure is within 72 hours of partner notification then PEP is offered (Very important if case is diagnosed with acute stage disease) Risk reduction education provided To those who need further engagement, referrals to prevention services are made Services include: Health care provider, counseling, social support, housing support, food security

15 Conclusion Partner notification is a vital practice to diagnose new cases of HIV in our region given the high testing yield among contacts. The routine reporting of indicators that describe multiple stages of the partner notification process can identify gaps and successes over time to consistently inform practice. Enhanced practice allows us to establish a clinical relationship early with partners to better facilitate linkage to care and risk reduction strategies as needed.

16 Acknowledgements VCH CDC Public Health Nursing Team Kelly Yu Dana Sherman Chris Skinner Tony Rees Mila Lukomskyj Nishat Dhillon Heather Everson Rose Kavanagh Susanne Fremming Matthew Harmer Anthea Falode Pia Fasan STOP HIV/AIDS Outreach Team Nurses Lesa Dumsha Tracy D souza Geoff Ford Steven Lofton Sandy Finn Cherlyn Cortes Community Partners BCCDC STI Clinic Nurses VCH Community Health Clinic Nurses