HIV Prevention: Partner Services Interventions to Increase HIV Testing

The CPSTF finding is based on evidence from a systematic review of 27 studies. Studies were identified from a previous Community Guide review (search period 1985 to 2004, Hogben et al., 2007), and an update search (search period 2004 to April 2020). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to HIV prevention, treatment, and care.

This recommendation updates and replaces the 2005 findings for interventions to identify people with HIV infection through partner notification by provider referral (recommended), patient referral (insufficient evidence), or contract referral (insufficient evidence ).

Ending the HIV Epidemic in the U.S. (EHE) is the operational plan developed by agencies across the U.S. Department of Health and Human Services (HHS) to pursue the goal of reducing new HIV infections by 75% by 2025 and 90% by 2030. HHS identified four key strategies to achieve these goals in the United States: diagnose people living with HIV as early as possible after infection, treat people with HIV rapidly and effectively to reach sustained viral suppression, prevent new HIV transmission through evidence-based interventions such as pre-exposure prophylaxis, and respond quickly to potential HIV outbreaks. The HIV National Strategic Plan (2021-2025), also developed by HHS, is closely aligned with, and complements, Ending the HIV Epidemic. This plan focuses on collaboration between all sectors of society to prevent new HIV infections, improve health outcomes of people with HIV, and reduce HIV-related disparities and health inequities. Both of the HHS plans identify testing for HIV as the first step, and it is important to implement interventions that increase HIV screening and testing, especially among population groups with the highest rates of diagnosis.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 27 studies.

• Fourteen included studies reported intervention effectiveness for the following outcomes:
  • Identifying partners the median partner index ratio was 2.4, meaning 2.4 index patients were interviewed to identify one sexual or needle-sharing partner (12 studies).
  • Notifying partners a median of 59.8% percent of identified partners were notified 59.8% (10 studies).
  • Getting partners tested a median of 55.1% of notified partners were tested for HIV (11 studies).
  • Diagnosing partners with HIV infections a median of 14.6% of tested partners were diagnosed with HIV infection (14 studies).
    • A median of 9.4 index patients were interviewed to find one partner newly diagnosed with HIV infection (13 studies).
    • A median of 1.7 index patients were interviewed to identify one partner with HIV infection (newly or previously diagnosed (8 studies).
  • Linking index patients and partners with HIV infection to care index patients and partners who received partner services were more likely to be linked to care within 90 days of diagnosis when compared with persons not receiving these services (2 studies).
• Sixteen studies examined whether intervention effectiveness varied with intervention or population characteristics.
  • Context for the initial interview
    • In person interviews were more effective at getting partners tested for HIV (1 study) and finding partners newly diagnosed with HIV infection (1 study) when compared with initial interviews done remotely.
    • Multiple interview sessions with the index patient were more effective at identifying partners newly diagnosed with HIV infection (1 study) when compared with one interview session.
  • Partner notification process
    • Referral approaches provider referral was more effective at notifying, testing, and finding partners newly diagnosed with HIV infection (5 studies) when compared with self or third-party referral.
    • Notification context internet or text notifications were more effective at notifying partners (2 studies) when compared with traditional notification methods such as in-person or over the phone. In-person notifications were more effective at identifying partners newly diagnosed with HIV infection (3 studies) when compared with notification through internet or text.
  • Partner testing site offering point-of-care testing was more effective at getting partners tested than referring partners to clinics for testing (1 study).
  • Index patient, acute or non-acute infection index patients with acute HIV infection identified more partners newly tested positive for HIV infection than did index patients with non-acute or long-standing HIV infection (1 study).
  • Index patient, pregnancy index patients who were pregnant identified more partners newly tested positive for HIV infection than did index patients who were not pregnant (1 study).
  • Partner mode of transmission the number of index patients interviewed to find one partner newly diagnosed with HIV infection was over 10 times lower for index patients’ male-to-male sexual or intravenous drug use contacts than it was for index patients’ heterosexual contacts (1 study).

Economic evidence shows HIV partner services to increase HIV testing are cost-effective, based on cost per quality-adjusted life year (QALY) estimates that were either cost-saving or below a conservative benchmark of $50,000 per QALY gained. The systematic economic review included six studies (search period January 2000 through July 2021). Monetary values are reported in 2020 U.S. dollars.

• The mean intervention cost per person tested was $1,761 (2 studies) and the median intervention cost per person newly diagnosed with HIV was $22,144 (4 studies).
• The mean net cost per QALY gained was $25,526 (2 studies), and two studies reported net cost less than zero indicating cost-savings.

Based on results from the systematic review, the CPSTF finding should be applicable to all urban settings in the United States and all types of index patients and partners, independent of age, gender, race, ethnicity, or HIV transmission category.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How effective are partner services interventions at reconnecting persons out-of-care to HIV medical care? Partners identified by index patients may know their HIV status but out-of-care. Partner services interventions may help link these people with medical care. None of the included studies reported on this outcome.
• How effective are partner services interventions at increasing partners’ access to PrEP or repeat testing? Partners who test negative for HIV and remain at high risk for exposure may be offered HIV prevention services such as PrEP or repeat HIV testing.
• How effective are partner services interventions in rural areas? Is the intervention cost-effective when used in rural settings?
• Does intervention effectiveness differ by racial and ethnic group? How effective are partner services interventions for American Indian and Alaska Native communities?
• Does intervention effectiveness differ by the socioeconomic status (SES) of index patients and partners?
• What are the economic effects of using enhanced technologies such as internet, e-mail, texts, and social media for HIV partner services?
• What are the effects of adding self-testing kits for index patients to distribute to their partners on both the effectiveness and economics of the intervention?

• Included studies were conducted in the United States (22 studies), Canada (1 study), Taiwan, China (1 study), Spain (1 study), Sweden (1 study), and the United Kingdom (1 study).
• Studies evaluated state-wide interventions (5 studies) or programs that were implemented in urban (21 studies) or rural (1 study) areas.
• Index patients were interviewed to identify sexual partners only (7 studies), sexual or needle-sharing partners (18 studies), or sexual, needle-sharing, or social network partners (2 studies).
• Index patients were offered provider referral (19 studies), self and provider referral (7 studies), or a mix of self, third party, and provider referral (1 study).

Effectiveness Review

• Logic Model – Effectiveness Review
• Text Description – Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

• Logic Model – Economic Review
• Text Description – Economic Review

The economic review team develops an analytic framework to align economic outcomes with each stage of the effectiveness review analytic framework. It informs the economic research questions and may be used to summarize the evidence for intervention cost, economic benefit, cost-effectiveness, and cost-benefit.

Effectiveness Review

• Summary Evidence Table – Effectiveness Review

Economic Review

• Summary Evidence Table – Economic Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Ahrens K, Kent CK, Kohn RP, Nieri G, Reynolds A, et al. HIV partner notification outcomes for HIV-infected patients by duration of infection, San Francisco, 2004 to 2006. Journal of Acquire Immune Deficiency Syndrome 2007;46(4):479-84.

Bergman J, Gratrix J, Pillay T, Houston S, Cooper R, et al. Intensive HIV partner notification is effective in identifying new and previously diagnosed HIV infections in Edmonton, Canada. AIDS Patient Care STDS 2015;29(8):419-22.

Bocour A, Renaud TC, Udeagu CCN, Shepard CW. HIV partner services are associated with timely linkage to HIV medical care. AIDS 2013;27(18):2961-3.

Bocour A, Udeagu CC, Renaud TC, Hadler JL, Begier EM. Comparing HIV partner notification effectiveness between blacks and Hispanics in New York City. Sexually Transmitted Diseases 2010;37(12):784-8.

Chiou PY, Lin LC, Chen YM, Wu SC, Lew-Ting CY, et al. The effects of early multiple-time PN counseling on newly HIV-diagnosed men who have sex with men in Taiwan. AIDS Behav 2015;19(10):1773-81.

De Olalla PG, Molas E, Barbera MJ, Martin S, Arellano E, et al. Effectiveness of a pilot partner notification program for new HIV cases in Barcelona, Spain. PLoS ONE 2015;10(4)e121536.

Golden MR, Dombrowski JC, Wood RW, Fleming M, Harrington RD. A controlled study of the effectiveness of public health HIV partner notification services. AIDS 2009;23(1):133-5.

Green N, Hoenigl M, Chaillon A, Anderson CM, Pond SLK, et al. Partner services in adults with acute and early HIV infection. AIDS 2017;31(2):287-93.

Heumann CL, Katz DA, Dombrowski JC, Bennett AB, Manhart LE, et al. Comparison of in-person versus telephone interviews for early syphilis and human immunodeficiency virus partner services in King County, Washington (2010-2014). Sexually Transmitted Diseases 2017;44(4):249-54.

Hightow-Weidman L, Beagle S, Pike E, Kuruc J, Leone P, et al. “No one’s at home and they won’t pick up the phone”: using the Internet and text messaging to enhance partner services in North Carolina. Sexually Transmitted Diseases 2014;41(2):143-8.

Hood JE, Katz DA, Bennett AB, Buskin SE, Dombrowski JC, et al. Integrating HIV surveillance and field services: data quality and care continuum in King County, Washington, 2010-2015. American Journal of Public Health 2017;107(12):1938-43.

Landis SE, Schoenbach VJ, Weber DJ, Mittal M, Krishan B, et al. Results of a randomized trial of partner notification in cases of HIV infection in North Carolina. New England Journal of Medicine 1992;326(2):101-6.

Lee JH, Branan L, Hoff GL, Datwyler ML, Bayer WL. Voluntary human immunodeficiency virus testing, recidivism, partner notification, and sero-prevalence in a sexually transmitted disease clinic: a need for mandatory testing. Sexually Transmitted Diseases 1990;17(4):169-74.

Malave MC, Shah D, Sackoff JE, Rubin S, Begier EM. Human immunodeficiency virus partner elicitation and notification in new york city: public health does it better. Sexually Transmitted Diseases 2008;35(10):869-76.

Marcus JL, Bernstein KT, Klausner JD. Updated outcomes of partner notification for human immunodeficiency virus, San Francisco, 2004-2008. AIDS 2009;23(8):1024-6.

Pattman RS, Gould EM. Partner notification for HIV infection in the United Kingdom: a look back on seven years experience in Newcastle upon Tyne. Genitourinary Medicine 1993;69(2):94-7.

Pavia AT, Benyo M, Niler L, Risk I. Partner notification for control of HIV: results after 2 years of a statewide program in Utah. American Journal of Public Health 1993;83(10):1418-24.

Ramstedt K, Hallhagen G, Lundin BI, Hakansson C, Johannisson G, et al. Contact tracing for human immunodeficiency virus (HIV) infection. Sexually Transmitted Diseases 1990;17(1):37-41.

Renaud TC, Wong MR, Bocour A, Udeagu CCN, Pickett L, et al. The effect of HIV field-based testing on the proportion of notified partners who test for HIV in New York City. American Journal of Public Health 2011;101(7):1168-71.

Rutherford GW, Woo JM, Neal DP, Rauch KJ, Geoghegan C, et al. Partner notification and the control of human immunodeficiency virus infection. Two years of experience in San Francisco. Sexually Transmitted Diseases 1991;18(2):107-10.

Spencer NE, Hoffman RE, Raevsky CA, Wolf FC, Vernon TM. Partner notification for human immunodeficiency virus infection in Colorado: results across index case groups and costs. International Journal of STD AIDS 1993;4(1):26-32.

Torrone EA, Wright J, Leone PA, Hightow-Weidman LB. Pregnancy and HIV infection in young women in North Carolina. Public Health Report 2010;125(1):96-102.

Tsega A, Udeagu CCN, Begier EM. A comparison of partner notification effectiveness in African-, Caribbean-, and United States-born HIV-infected Blacks in New York City. AIDS Patient Care STDs 2012;26(7):406-10.

Udeagu CCN, Bocour A, Shah S, Ramos Y, Gutierrez R, et al. Bringing HIV partner services into the age of social media and mobile connectivity. Sexually Transmitted Diseases 2014a;41(10):631-6.

Udeagu CCN, Bocour A, Shepard CW. For partner services, do we need face-time, or facetime? Trends in relative proportion of in-person notifications and HIV testing after introduction of a telephone option for HIV exposure notification by public health. Sexually Transmitted Diseases 2014b;41(11):671-3.

Udeagu CCN, Shah D, Shepard CW, Bocour A, Guiterrez R, et al. Impact of a New York City health department initiative to expand HIV partner services outside STD clinics. Public Health Reports 2012;127(1):107-14.

Wykoff RF, Jones JL, Longshore ST, Hollis SL, Quiller CB, et al. Notification of the sex and needle-sharing partners of individuals with human immunodeficiency virus in rural South Carolina: 30-month experience. Sexually Transmitted Diseases 1991;18(4):217-22.

Economic Review

Ahrens K, Kent CK, Kohn RP, Nieri G, Reynolds A, Philip S, et al. HIV partner notification outcomes for HIV-infected patients by duration of infection, San Francisco, 2004 to 2006. J Acquir Immune Defic Syndr 2007;46(4):479-84.

Cohen DA, Wu SY, Farley TA. Comparing the cost-effectiveness of HIV prevention interventions. J Acquir Immune Defic Syndr 2004;37(3):1404-14.

Johnson BL, Tesoriero J, Feng W, Qian F, Martin EG. Cost analysis and performance assessment of partner services for human immunodeficiency virus and sexually transmitted diseases, New York State, 2014. Health Serv Res 2017;52 Suppl 2(Suppl 2):2331-42.

Li XC, Kusi L, Marak T, Bertrand T, Chan PA, Gal rraga O. The cost and cost-utility of three public health HIV case-finding strategies: evidence from Rhode Island, 2012-2014. AIDS Behav 2018;22(11):3726-33.

Lin F, Farnham PG, Shrestha RK, Mermin J, Sansom SL. Cost effectiveness of HIV prevention interventions in the U.S. Am J Prev Med 2016;50(6):699-708.

Shrestha RK, Begley EB, Hutchinson AB, Sansom SL, Song B, et al. Costs and effectiveness of partner counseling and referral services with rapid testing for HIV in Colorado and Louisiana, United States. Sex Transm Dis 2009;36(10):637-41.

Implementation Resource

Rural Health Information Hub, HIV Prevention and Treatment Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of HIV prevention programs in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

• Provider Referral Partner Notification

Effectiveness Review

The systematic review science team completed a broad search for English-language papers that evaluated the impact of partner services interventions to increase HIV screening. Searches were conducted in the following databases: PubMed, Embase, PsycINFO, Scopus, Cochrane Library, and ClincalTrials.gov. The search period was January 1, 1985 to April 7, 2020. Two team members independently screened each paper to determine eligibility. Uncertainties and disagreements were resolved by consensus among review team members.

Notes: Duplicates were identified using EndNote automated “find duplicates” function with preference set to match on title, author, and year. There will likely be additional duplicates found that EndNote was unable to detect.

Database: PubMed

(((((((((HIV[MeSH]) OR (((HIV[Title/Abstract]) OR “human immunodeficiency virus”[Title/Abstract]) OR “sexually transmitted infection”[Title/Abstract])))) AND ((((((((“partner notification”[Title/Abstract]) OR “contact examination”[Title/Abstract]) OR “contact detection”[Title/Abstract]) OR “partner notifications”[Title/Abstract]) OR “partner tracing”[Title/Abstract]) OR “partner counseling”[Title/Abstract]) OR “referral services”[Title/Abstract]) OR ((contract tracing[MeSH]) OR “contract tracing”[Title/Abstract])))) NOT (animals[MeSH Terms] NOT “Humans”[Mesh])) AND English[lang])) AND English[lang])

Database: Embase

1 exp Human immunodeficiency virus/ 189695

2 (HIV* or human immunodeficiency virus or sexually transmitted infection).ti,ab. 415912

3 1 or 2 435314

4 exp contact examination/ 3660

5 ((contact adj3 examination) or (contact adj3 detection) or (contact adj3 tracing) or (partner adj3 notification) or (partner adj3 notif*) or (partner adj3 tracing) or (partner adj3 services) or ((partner adj3 counseling) and (referral adj services))).ti,ab. 4464

6 4 or 5 6865

7 3 and 6 1774

8 exp Animal/ not exp Human/ 3641322

9 7 not 8 1770

10 limit 9 to english language 1701

Database: PsycInfo

Comm Guide HIV and Partner notice PsycInfo 040720

exp hiv/

OR

(HIV OR human immunodeficiency virus or sexually transmitted infection).ti,ab.

AND

((contact adj3 examination) or (contact adj3 detection) or (contact adj3 tracing) or (partner adj3 notification) or (partner adj3 notif*) or (partner adj3 tracing) or (partner adj3 services) or ((partner adj3 counseling) and (referral adj services))).ti,ab.

NOT

(Cancer OR disease ).mp.

not (animals not humans).sh.

AND

Limit to English.

Database: Scopus

( ( ( TITLE-ABS ( “HIV” ) OR TITLE-ABS ( “human immunodeficiency virus'” ) ) ) OR ( TITLE-ABS ( “sexually transmitted infection” ) ) ) AND ( ( ( TITLE-ABS ( “contact examination” ) OR TITLE-ABS ( “contact detection” ) OR TITLE-ABS ( “contact tracing” ) OR TITLE-ABS ( “partner notification” ) OR TITLE-ABS ( “partner notifications” ) OR TITLE-ABS ( “partner tracing” ) OR TITLE-ABS ( “partner services” ) ) OR ( TITLE-ABS ( “partner counseling” ) AND TITLE-ABS ( “referral services” ) ) ) ) AND NOT ( animal* AND NOT human* ) AND ( LIMIT-TO ( LANGUAGE , “English” ) )

Database: Cochrane

#1 HIV:ti,ab 23563

#2 (“human immunodeficiency virus” OR “sexually transmitted infection”):ti,ab 4467

#3 MeSH descriptor: [HIV] explode all trees 2971

#4 #1 OR #2 OR #3 24491

#5 “partner counseling”:ti,ab 2

#6 “referral services”:ti,ab 26

#7 # 4 AND #6 12

#8 (“contact examination” OR “contact detection” OR “contact tracing” OR “partner notification” OR “partner notifications” OR “‘partner tracing” OR “partner services”):ti,ab 169

#9 MeSH descriptor: [Contact Tracing] explode all trees 72

#10 #7 OR #8 OR #9 209

#11 #4 AND #10 (Word variations have been searched)

Database: ClinicalTrials.gov

“contact examination” OR “contact detection” OR “contact tracing” OR “partner notification” OR “partner notifications” OR “partner tracing” OR “partner services” | HIV OR “human immunodeficiency virus” OR sexually transmitted infection”

Cannot limit by country name must hand search

Number of Studies

World Map 31

Economic Review

In July 2021, a research librarian used the terms listed below to search the following databases: PubMed, Embase, PsycInfo, Scopus, Cochrane, and EconLit. The search period covered January 2000 through July 2021.

The search was limited to high income countries as defined by the World Bank. The review team also screened reference lists of included studies and consulted subject matter experts about additional studies that may have been missed. Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software.

Database: PubMed

Date Searched: 07/14/2021
Results: 24

(((((((((HIV[MeSH]) OR (((HIV[Title/Abstract]) OR “human immunodeficiency virus”[Title/Abstract]) OR “sexually transmitted infection”[Title/Abstract])))) AND ((((((((“partner notification”[Title/Abstract]) OR “contact examination”[Title/Abstract]) OR “contact detection”[Title/Abstract]) OR “partner notifications”[Title/Abstract]) OR “partner tracing”[Title/Abstract]) OR “partner counseling”[Title/Abstract]) OR “referral services”[Title/Abstract]) OR ((contact tracing[MeSH]) OR “contact tracing”[Title/Abstract])))) NOT (animals[MeSH Terms] NOT “Humans”[Mesh])) AND English[lang])) AND English[lang])

AND

Economics[majr:noexp] OR “costs and cost analysis”[majr] OR (economic[tiab] AND model*[tiab]) OR cost minimi*[tiab] OR cost-utilit*[tiab] OR health utilit*[tiab] OR economic evaluation*[tiab] OR economic review*[tiab] OR cost outcome[tiab] OR cost analys*[tiab] OR economic analys*[tiab] OR (budget*[tiab] AND impact analys*[tiab]) OR cost-effective*[ti] OR cost-benefit[ti] OR costs[ti] OR cost-effective*[ot] OR cost-benefit[ot] OR costs[ot] OR daly [tiab] OR cost per daly[tiab] OR cost per qaly[tiab] OR qaly*[tiab] OR cost-benefit analys*[tiab] OR cost-effectiveness analys*[tiab] OR ((cost[ti] OR economic*[ti] OR cost[ot] OR economic*[ot]) AND (costs[tiab] OR cost-effectiveness[tiab] OR markov[tiab]))

English, from 2000 – 2021

Database: Embase

Date Searched: 07/14/2021
Results: 117

1 exp Human immunodeficiency virus/

2 (HIV* or human immunodeficiency virus or sexually transmitted infection).ti,ab.

3 1 or 2

4 contact examination/

5 ((contact adj3 examination) or (contact adj3 detection) or (contact adj3 tracing) or (partner adj3 notification) or (partner adj3 notif*) or (partner adj3 tracing) or (partner adj3 services) or ((partner adj3 counseling) and (referral adj services))).ti,ab.

6 4 or 5

7 3 and 6

8 *economics/ or costs.ti,ab

9 cost effective.ti,ab

10 exp *”costs and cost analysis”/

11 (qaly* or daly* or cost per qaly or cost per daly or cost-benefit analys* or cost-benefit* or cost-effectiveness*).ti,ab

12 health care cost.sh

13 (cost or economic*).ti. and (costs or cost-effectiveness or markov).ab

14 8 or 9 or 10 or 11 or 12 or 13

15 7 and 14

16 limit 15 to (english language and yr=”2000 -Current”)

Database: PsycInfo

Date Searched: 07/14/2021
Results: 15

1 exp Human immunodeficiency virus/

2 (HIV* or human immunodeficiency virus or sexually transmitted infection).ti,ab

3 1 or 2

4 contact tracing/

5 ((contact adj3 examination) or (contact adj3 detection) or (contact adj3 tracing) or (partner adj3 notification) or (partner adj3 notif*) or (partner adj3 tracing) or (partner adj3 services) or ((partner adj3 counseling) and (referral adj services))).ti,ab

6 4 or 5

7 3 and 6

8 *economics/

9 costs.ti,ab

10 cost effective.ti,ab

11 exp *”costs and cost analysis”/

12 (qaly* or daly* or cost per qaly or cost per daly or cost-benefit analys* or cost-effectiveness*).ti,ab

13 (cost or economic*).ti. and (costs or cost-effectiveness or markov).ab

14 8 or 9 or 10 or 11 or 12 or 13

15 7 and 14

16 limit 15 to (english language and yr=”2000 -Current”)

Database: Scopus

Date Searched: 07/14/2021
Results: 63

( ( TITLE-ABS ( “HIV” ) OR TITLE-ABS ( “human immunodeficiency virus'” ) ) ) OR ( TITLE-ABS ( “sexually transmitted infection” ) ) AND ( ( TITLE-ABS ( “contact examination” ) OR TITLE-ABS ( “contact detection” ) OR TITLE-ABS ( “contact tracing” ) OR TITLE-ABS ( “partner notification” ) OR TITLE-ABS ( “partner notifications” ) OR TITLE-ABS ( “partner tracing” ) OR TITLE-ABS ( “partner services” ) ) ) OR ( TITLE-ABS ( “partner counseling” ) AND TITLE-ABS ( “referral services” ) ) ) AND ( ( ( TITLE-ABS-KEY ( ( cost OR economic* ) AND ( cost* OR cost-effectiveness OR markov ) ) ) OR ( TITLE-ABS-KEY ( “life years” OR “life years” OR qaly* OR daly* OR cost-benefit AND analys* OR cost-effectiveness AND analys* ) ) OR ( TITLE-ABS-KEY ( “cost minimi*” OR “cost-utilit*” OR “health utilit*” OR “economic evaluation*” OR “economic review*” OR “cost outcome” OR “cost analy*” OR “economic analys*” OR “budget* impact analys*” ) ) OR ( TITLE-ABS-KEY ( “life year” OR “life years” OR qaly* OR daly* OR “cost-benefit analys*” OR “cost-effectiveness analys*” ) ) OR ( TITLE-ABS-KEY ( “cost minimi*” OR “cost-utilit*” OR “health utilit*” OR “economic evaluation*” OR “economic review*” OR “cost outcome” OR “cost analy*” OR “economic analys*” OR “budget* impact analys*” ) ) OR ( TITLE-ABS-KEY ( cost-effective* OR cost-benefit OR cost OR costs ) ) ) ) AND NOT INDEX ( embase ) AND PUBYEAR > 1999

Database: Cochrane

Date Searched: 07/14/2021
Results: 20

#1 HIV:ti,ab

#2 (“human immunodeficiency virus” OR “sexually transmitted infection”):ti,ab

#3 #1 OR #2

#4 “partner counseling”:ti,ab

#5 (“contact examination” OR “contact detection” OR “contact tracing” OR “partner notification” OR “partner notifications” OR “‘partner tracing” OR “partner services”):ti,ab

#6 #4 OR #5

#7 #3 AND #6

#8 costs:ti,ab

#9 cost effective:ti,ab

#10 (qaly* or daly* or “cost per qaly” or “cost per daly” or “cost-benefit analys” or cost-effectiveness):ti,ab

#11 (cost or economic*):ti and (costs or cost-effectiveness or markov):ab

#12 #8 OR #9 OR #10 OR #11

#13 #7 AND #12

Database: EconLit

Date Searched: 07/14/2021
Results: 3

S1 AB ( HIV OR “human immunodeficiency virus” OR “sexually transmitted infection” ) OR TI ( HIV OR “human immunodeficiency virus” OR “sexually transmitted infection” )

S2 AB ( “contact examination” OR “contact detection” OR “contact tracing” OR “partner notification” OR “partner notifications” OR “partner tracing” OR “partner services” ) OR TI ( “contact examination” OR “contact detection” OR “contact tracing” OR “partner notification” OR “partner notifications” OR “partner tracing” OR “partner services” )

S3 S1 AND S2

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion from the CPSTF, as noted below.

• In the United States during 2018, CDC-funded partner services programs interviewed 33,498 index patients, identified 29,455 sexual or needle-sharing partners, notified 63.1% of identified partners, tested 38.6% of notified partners, diagnosed 14.3% of tested partners with HIV, and linked 47.9% of partners diagnosed with HIV infection to care (CDC 2018). These numbers are comparable with findings from the current review.
• Partner services interventions are available across the United States for HIV infection and other sexually transmitted diseases, though programs differ with regard to the services offered and notification methods used. Some states have been evaluating different ways to deliver partner services, such as establishing service units in neighborhoods with high HIV prevalence, interviewing index patients face-to-face or by telephone, identifying partners from index patients’ social network in addition to sexual or needle-sharing partners, using the Internet or text to contact partners, or offering partners different testing options.
• Among U.S. adults in 2021, about 85% owned a smartphone, 77% had high-speed broadband service at home, and 93% used the Internet.
• Advances in communication technology allow more people to arrange temporary sexual relationships through the Internet. This makes it more difficult to obtain partners’ full contact information.
• The partner services program in New York City incorporated internet and text partner services and were able to reach partners who were otherwise untraceable using traditional modes of communication. Internet partner services made it easier for health departments to contact young men exposed to HIV through MSM who were previously untraceable.
• Programs adding internet or text components may want to consider the investment in additional equipment, data plan, and staff time, and have staff members who are savvy with technology.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the number of new HIV infections — HIV-01
• Increase knowledge of HIV status — HIV-02
• Reduce the number of new HIV diagnoses — HIV-03
• Increase linkage to HIV medical care — HIV-04
• Increase viral suppression — HIV-05