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The power of partners: positively engaging networks of people with HIV in testing, treatment and prevention

Year: 2019

Type: article

Abstract: Journal of the International AIDS SocietyVolume 22, Issue S3 e25314 EditorialOpen Access The power of partners: positively engaging networks of people with HIV in testing, treatment and prevention David A Katz, Corresponding Author David A Katz [email protected] Department of Global Health, University of Washington, Seattle, WA, USACorresponding author: David A Katz, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104, USA. Tel: +1 (206) 744 5877. ([email protected])Search for more papers by this authorVincent J Wong, Vincent J Wong Global Health Bureau, Office of HIV/AIDS, United States Agency for International Development (USAID), Washington, DC, USASearch for more papers by this authorAmy M Medley, Amy M Medley Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USASearch for more papers by this authorCheryl C Johnson, Cheryl C Johnson HIV Department, World Health Organization (WHO), Geneva, SwitzerlandSearch for more papers by this authorPeter K Cherutich, Peter K Cherutich National AIDS/Sexually Transmitted Diseases Control Programme, Ministry of Health, Nairobi, KenyaSearch for more papers by this authorKimberly E Green, Kimberly E Green HIV & TB Program, PATH, Hanoi, VietnamSearch for more papers by this authorPhan Huong, Phan Huong Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, VietnamSearch for more papers by this authorRachel C Baggaley, Rachel C Baggaley HIV Department, World Health Organization (WHO), Geneva, SwitzerlandSearch for more papers by this author David A Katz, Corresponding Author David A Katz [email protected] Department of Global Health, University of Washington, Seattle, WA, USACorresponding author: David A Katz, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104, USA. Tel: +1 (206) 744 5877. ([email protected])Search for more papers by this authorVincent J Wong, Vincent J Wong Global Health Bureau, Office of HIV/AIDS, United States Agency for International Development (USAID), Washington, DC, USASearch for more papers by this authorAmy M Medley, Amy M Medley Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USASearch for more papers by this authorCheryl C Johnson, Cheryl C Johnson HIV Department, World Health Organization (WHO), Geneva, SwitzerlandSearch for more papers by this authorPeter K Cherutich, Peter K Cherutich National AIDS/Sexually Transmitted Diseases Control Programme, Ministry of Health, Nairobi, KenyaSearch for more papers by this authorKimberly E Green, Kimberly E Green HIV & TB Program, PATH, Hanoi, VietnamSearch for more papers by this authorPhan Huong, Phan Huong Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, VietnamSearch for more papers by this authorRachel C Baggaley, Rachel C Baggaley HIV Department, World Health Organization (WHO), Geneva, SwitzerlandSearch for more papers by this author First published: 19 July 2019 https://doi.org/10.1002/jia2.25314Citations: 4 In any reproduction of this article there should not be any suggestion that WHO or the article endorse any specific organization or products. The use of the WHO logo is not permitted. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat When HIV diagnostic tests first became available in 1985, HIV testing was offered with caution. No treatment was available, prevention options were limited, and stigma and discrimination against people with HIV was pervasive. Concerns about preventing breaches of confidentiality and forced or mandatory testing, especially among groups at high risk for HIV infection, were dominant in early guidance released by the World Health Organization (WHO). An offer of an HIV test required extensive counselling both before and after the test to ensure the individual was able to cope with a possible reactive result. Then the development of point of care rapid HIV tests in 1987 offered the opportunity for immediate results in clinical and community settings 1. When antiretroviral therapy (ART) became available globally in the early 2000s, WHO launched its "3 × 5" Initiative to provide 3 million people in low and middle-income countries (LMIC) with ART by 2005. Scale-up of HIV testing through client-initiated approaches using rapid test kits to provide same day results was a core component to the success of this Initiative 2, 3. Yet by 2007, HIV testing coverage was still low. Surveys in sub-Saharan Africa showed that a median of 12% of men and 10% of women had been tested for HIV and received their results 4. In an effort to increase testing coverage, WHO released its Provider-Initiated Testing and Counselling Guidelines 5, recommending a routine offer of HIV testing by healthcare providers in clinical settings. These guidelines suggest the benefits of HIV status disclosure and partner testing and recommended providers to discuss possible disclosure of the result, when and how this may happen and to whom and to encourage and offer referral for testing and counselling of partners and children as part of post-test counselling. However, little emphasis was given to partner testing in practice. Thus, while HIV testing coverage increased enormously over the next five years in clinical settings, especially among pregnant women as part of a push to prevent HIV transmission from mothers to their infants, the vast majority of HIV tests were conducted on people who tested as individuals. Early efforts at partner HIV testing and disclosure were documented, but this approach was rarely implemented and never successfully scaled 6. Evidence for the benefits of partner testing and disclosure, however, was growing. In addition, population-based surveys and surveillance efforts indicated that many people with HIV were unaware that they were living in sero-discordant couples 7, leaving the HIV-negative partner at high risk for HIV acquisition. This led WHO to recommend partner and couple HIV testing for all adults with HIV in all epidemic contexts and for HIV uninfected individuals living in high HIV burden settings in 2012 8. The preventive benefits of ART 9 and the effectiveness of HIV pre-exposure prophylaxis (PrEP) 10 in preventing HIV acquisition added to the motivation to scale-up partner and couple HIV testing. Over the four years following the release of these guidelines partner testing services were not widely adopted or scaled in most LMICs. However, there were notable exceptions: Cameroon adopted an ambitious partner notification programme in 2007 11; while Kenya, Malawi and Tanzania undertook pivotal implementation studies of partner HIV testing services 12-14. Rwanda supported male partner involvement and testing at the first antenatal care visit and reported 87% of male partners attending this first visit by 2010 15. To accelerate uptake of partner testing, WHO released additional guidelines in 2016 on the implementation and scale-up of ethical, effective, acceptable and evidence-based approaches to assisted HIV partner notification services (PNS) 16. This guidance was based on a review of available evidence and included the recommendation that voluntary assisted PNS be offered as part of a comprehensive package of testing and care offered to people with HIV. Since its launch, the number of countries including PNS in their national testing policies and guidelines has increased from 77 in 2016 to 111 by the end of 2017 (C Johnson, personal communication), although many countries were not yet implementing PNS at scale. PNS, or "index testing" as it is referred to in the 2019 President's Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plan Guidance (see A Note on Terminology) are also now prioritized as a major HIV case finding strategy in all 37 PEPFAR-supported countries and regions. PEPFAR programmes have been actively supporting and expanding index testing approaches since 2016. This expansion has been aided by the development of training materials for index partner and family testing that include information on approaches and steps for conducting PNS, how to screen for intimate partner violence (IPV), brief motivational interviewing as a strategy for partner elicitation, and documentation and monitoring of PNS. PEPFAR also provides technical support to country programmes to assist implementing partners to deliver and monitor PNS 17. In addition, WHO and PEPFAR have supported the development of the AIDSFree HIV Testing Knowledge Base as a publicly available, online resource library of high quality tools (e.g. training materials, standard operating procedures, data collection forms) to support PNS programme development and implementation 18. As a result of this support, implementation of PNS within PEPFAR-supported programmes has continued to expand. For example, Jhpiego undertook an operational research pilot in Njombe, Tanzania, in 2016 to integrate a free-choice PNS intervention into health centres which led to successful outcomes at reaching partners 19. As PNS has expanded, it has also undergone differentiation based on population needs and preferences, ranging from models that centre on assisted PNS provided by healthcare workers, to those that include secondary distribution of HIV self-testing as part of PNS, to lay providers from key populations using social media and other online tools to trace listed partners. Ongoing challenges to assisted PNS scale-up include the large amount of human and fin

Source: Journal of the International AIDS Society

DOI: 10.1002/jia2.25314