Poster THP 55; Contact: David Katz, [email protected] Sexually Transmitted Disease Partner Services Increase HIV Testing among Partners of Men Who Have Sex with Men David A. Katz1,2, Teal R. Bell3, Julia C. Dombrowski1,2, Roxanne P. Kerani1,2, Mark R. Aubin3, Zandt Bryan3, David A. Kern4, David D. Heal3, Matthew R. Golden1,2

University of Washington1, Seattle, WA; Public Health – Seattle & King County2, Seattle, WA; Washington State Department of Health3, Olympia, WA; Chicago Department of Public Health4, Chicago, IL

Abstract Methods Results Results (cont.) Limitations BACKGROUND: Men who have sex with men (MSM) with bacterial sexually transmitted diseases Partner Services Intervention • Index cases may have notified partners and partners may have tested for (STDs) are at elevated risk for HIV infection. We instituted and evaluated a program promoting HIV Characteristics of 16,944 MSM Diagnosed with Bacterial HIV Testing and HIV Case-Finding among Partners of MSM testing through public health STD partner services (PS). • Medical providers in Washington State complete STD case report STDs in Washington State, January 2010-December 2015 with Bacterial STDs – Number per Interviewed Index Case HIV in the absence of PS; difficult to determine the direct effect of PS forms that include gender of sex partner, allowing health METHODS: In May 2012, health departments in Washington State revised PS programs to provide PS Pre-Intervention Intervention • Relied primarily on self-reported outcomes to all MSM with early syphilis, gonorrhea, or chlamydial infection and promote HIV testing among departments to identify MSM for potential intervention Pre-Intervention Intervention MSM and their partners as an explicit, measured PS objective. We compared the number of partners Characteristic Jan 2010-Apr 2012 May 2012-Dec 2015 • HIV incidence decreased and STD diagnoses increased during the study tested for and newly diagnosed with HIV following notification of exposure to the index STD case • In May 2012, health departments in WA revised PS programs to: 2.50 period, possibly affecting ability to detect increase in HIV case-finding before (January 2010-April 2012) and during the revised program (May 2012-December 2015) using N % N % Poisson regression. Analyses adjusted for index STD, county of residence, and HIV status and, for case- • Provide PS to all MSM with gonorrhea (GC) or chlamydial Total cases in MSM 4740 - 12204 - finding, statewide HIV incidence among MSM. 2.00 • Increased use of geosocial networking apps (e.g. Grindr) over the study infection (CT) [already provided PS for all early syphilis] Sexually transmitted infection period affected partner-seeking behaviors and the ability of DIS to elicit RESULTS: In the intervention period, 8695 (71%) of 12,204 MSM STD cases received PS and provided Early syphilis^ 897 19% 1672 14% 1.50 information for a total of 13,600 partners, compared with 2994 (63%) of 4740 cases and 5974 partners • Promote HIV testing among sex partners of MSM as an contactable partners Urethral GC 1147 24% 2484 20% pre-intervention (p<0.001 for both). The number of partners tested for HIV per interviewed index case explicit and measured STD PS objective • Observational study so cannot adjust for all potential confounding increased from 0.254 (760/2994) pre-intervention to 0.426 (3703/8695) during the intervention [adjusted Rectal GC 732 15% 2308 19% 1.00 2.00 incidence rate ratio (aIRR)=1.63, 95%CI=1.50-1.76]. The number of partners newly diagnosed with HIV • Low intensity PS model: most interviews by phone and minimal Pharyngeal GC 626 13% 2511 21% 1.56 per interviewed index was stable (0.0094 pre-intervention vs. 0.0060 during; aIRR=1.05, 95%CI=0.65- field investigation, particularly for GC/CT 0.50 0.43 1.72). In multivariable analysis, index diagnosis with urethral gonorrhea, pharyngeal gonorrhea, and Urethral CT 1335 28% 2487 20% 0.25 early syphilis and residence outside King County were associated with new HIV diagnosis in partners Rectal CT 898 19% 3580 29% 0.009 0.006 0.006 0.005 (p<0.01 for all). Of 52 new partner HIV diagnoses during the intervention, 44 (85%) occurred following No. per interviewed case 0.00 Summary initial PS interview with the index. Pharyngeal CT 126 3% 715 6% Data Sources Partners HIV tested Newly HIV- HIV-diagnosed Diagnosed in King County (incl. Seattle) 3427 72% 8885 73% • Refocusing STD PS was associated with increased receipt of PS among CONCLUSIONS: Promoting HIV testing among partners of MSM diagnosed with STDs through PS elicited diagnosed after PS was feasible and increased HIV testing but not case-finding. Fewer than one new HIV case was • WA State HIV/STD surveillance data, 1/1/2010-12/31/2015 HIV co-infected 1571 33% 3782 31% MSM with bacterial STDs and an increase in the number of partners to identified for every 100 index cases receiving PS. IRR .78 (.76-.81) 1.68 (1.55-1.81) .64 (.40-1.01) .80 (.47-1.37) • STD surveillance and partner services data are matched with HIV be reached ^Early syphilis = primary, secondary, or early latent. GC = gonorrhea. CT = chlamydial infection. Adjusted IRR .81 (.78-.83) 1.63 (1.50-1.76) 1.05 (0.65-1.72) 1.28 (.73-2.25)

surveillance data (eHARS) as follows: • Number of STDs diagnosed annually, in particular extragenital STDs, increased during • Despite a decrease in the number of partners elicited per interviewed intervention period IRR = incidence rate ratio. Adjusted analyses included index STD diagnosis, county of • Weekly automated probabilistic matching algorithm based on residence, HIV status and, for new HIV diagnosis, statewide HIV incidence among MSM. case, the number of partners HIV tested per interviewed case increased Background legal and alias names, date of birth, and sex • Fewer partners were elicited per interviewed index case during intervention (p<0.001) substantially and HIV case-finding remained stable • US CDC estimates that 16% of men who have sex with men • Bimonthly manual review of STD cases without eHARS STD Partner Services Process from Index Case STD • Intervention was associated with a 1.63-fold increase in the number of partners tested for • Most new HIV diagnoses in partners occur following PS intervention HIV per interviewed case (p<0.001) (MSM) living with HIV are unaware of their infection match but with indication of HIV infection in STD Diagnosis through New HIV Diagnosis in Partners with index cases • After adjusting for confounding, the number of partners newly HIV-diagnosed per index surveillance data 4740 760 case (i.e. case-finding) remained stable (p=0.83) Fewer than 1 new HIV case was identified for every 100 index cases • MSM with bacterial sexually transmitted diseases (STDs) and their 2994 (63%) 5974 4632 (78%) 28 (3.7%) • Pre- STD (16%) interviewed partners HIV-neg or newly HIV- • HIV incidence among MSM decreased over time and had a large effect on IRR partners are at elevated risk for HIV infection Intervention cases in HIV receiving PS for PS elicited unknown diagnosed MSM tested • Most new HIV diagnoses in partners occurred following PS interview Outcomes & Analyses • Number needed to interview to diagnose 1 partner with HIV • STD partner services (PS) provide an opportunity to ensure these • Pre-intervention: 19 (68%) of 28 total new HIV diagnoses 12204 3703 8695 (71%) 13600 11065 (81%) 52 (1.4%) was lowest for early syphilis or urethral gonorrhea high risk men are tested for HIV, yet: • Pre/post analysis comparing outcomes among partners of MSM STD (33%) • During intervention: 44/52 (85%) Intervention interviewed partners HIV-neg or newly HIV- cases in HIV diagnosed during pre-intervention and intervention periods: for PS elicited unknown diagnosed • In multivariable analysis, index diagnosis with urethral gonorrhea, pharyngeal • Few public health departments provide PS to persons with MSM tested • Residence outside Washington State’s core metropolitan county was gonorrhea, and early syphilis and residence outside King County were associated with associated with new HIV diagnosis in partners STDs other than syphilis and HIV and • Pre-Intervention = January 2010 – April 2012 new HIV diagnosis in partners (p<0.01 for all) • HIV testing is generally not an explicit and measured • Intervention = May 2012 – December 2015 HIV Testing and Case-Finding among Partners of MSM with objective of STD PS Outcome Definition Ascertainment Bacterial STDs – Total Number per Year Number of Index Cases Needed to Interview (NNTI) to Newly Conclusions Individual, named sex • We previously found that promoting HIV testing through STD PS Partner Recorded by PS staff Diagnose One Partner with HIV by Index Case STD* is effective at increasing testing among MSM (Katz et al, AIDS partner reported by index Pre-Intervention Intervention • Promoting HIV testing among partners of MSM diagnosed with STDs 600 HIV tested after notification Self-report by case or partner or 517 through PS increased HIV testing but not case-finding Patient Care STD 2016) Partner HIV tested 4000 of STD exposure medical record review 500 • Prioritizing MSM with specific STDs or in certain settings for PS may • The effectiveness of promoting HIV testing among partners of Partner newly HIV Newly HIV-diagnosed after Self-report by case or partner or 400 320 increase efficiency of HIV case-finding MSM with STDs has not been evaluated diagnosed notification of exposure medical record review 3000 300 • Health departments should consider partner HIV testing, in addition to • Compared partners elicited, HIV tested, and newly HIV diagnosed 167 192 200 139 increased index patient HIV testing and recruitment for PrEP: per index case interviewed for PS using Poisson regression 2000 125 3709 100 74 83 • As additional explicit outcomes of STD PS and Objective • Compared test positivity (% newly diagnosed of those tested) using • When considering expanding PS to MSM with GC and CT 2560 0 chi-square tests and logistic regression 1000 We instituted and evaluated a program promoting HIV testing among partners Number per year • Adjusted analyses included index STD, county of residence, HIV 326 1010 of MSM with STDs through public health STD partner services in Washington 12 14 8 12 Acknowledgments status and, for case-finding, statewide HIV incidence among MSM 0 State. This program and its evaluation were supported by the U.S. Centers for Disease Control and Prevention (CDC PS12-1201 Partners HIV tested Newly HIV- HIV-diagnosed • Number needed to interview (NNTI) = number index cases and 3H25PS004364), the Washington State Department of Health, and Public Health – Seattle & King County. This elicited diagnosed after PS evaluation was also supported by the the University of Washington Center for AIDS Research, a National Institutes of interviewed ÷ outcome of interest *During intervention period. STDs not mutually exclusive. Health-funded program (P30 AI027757).