Hogben Matthew, McNally Tarra, McPheeters Melissa, Hutchinson Angela B
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
Am J Prev Med. 2007 Aug;33(2 Suppl):S89-100. doi: 10.1016/j.amepre.2007.04.015.
Partner counseling and referral services (PCRS) are part of the spectrum of care for HIV-positive people and their sexual or needle-sharing partners. Referral includes notifying partners of exposure, after which they are (ideally) tested and receive prevention or risk reduction counseling or enter into care (if they test positive). Using The Guide to Community Preventive Services's methods for systematic reviews, the effectiveness of PCRS was evaluated, including partner notification, in identifying a population at high risk of HIV infection and in increasing testing in those populations. In this review, PCRS efforts using provider referral were found to be effective in reaching a population with a high prevalence of HIV. Nine studies qualified for the review. In these studies, a range of one to eight partners was identified per index case (a person newly diagnosed with HIV who has partners who should be notified); a mean of 67% of identified partners were found and notified of their potential exposure to HIV, and a mean of 63% of those notified were tested (previously known "positives" were not tested). Of those tested, a mean of 20% were HIV positive. Therefore, even given that not all partners could be found and notified and that some who could be found did not accept testing, 1% to 8% of people named as potentially exposed and not previously known to be HIV positive were identified as HIV positive through partner notification (although these people were not necessarily infected by the index case). Evidence was insufficient to determine whether PCRS, including partner notification, was also effective in changing behavior or reducing transmission because available studies did not generally report on these outcomes. Little empirical evidence was available to assess potential harm of the interventions, but current studies have not shown substantial harms. Based on Community Guide rules of evidence, sufficient evidence shows that PCRS with partner notification by a public health professional ("provider referral") effectively increases identification of a high-prevalence target population for HIV testing.
伴侣咨询与转介服务（PCRS）是针对HIV阳性者及其性伴侣或共用针头伙伴的一系列护理服务的一部分。转介包括告知伴侣暴露情况，之后（理想情况下）他们会接受检测，并接受预防或降低风险咨询，或者进入护理程序（如果检测呈阳性）。使用《社区预防服务指南》的系统评价方法，对PCRS的有效性进行了评估，包括伴侣通知，以确定HIV感染高危人群，并增加这些人群的检测。在本次评价中，发现通过提供者转介开展的PCRS努力在接触HIV高流行人群方面是有效的。有9项研究符合评价标准。在这些研究中，每个索引病例（新诊断出感染HIV且有应被告知的伴侣的人）识别出的伴侣数量在1至8名之间；平均67%的已识别伴侣被找到并被告知其可能接触到HIV，平均63%被告知的伴侣接受了检测（之前已知的“阳性者”未接受检测）。在接受检测的人中，平均20%为HIV阳性。因此，即使并非所有伴侣都能被找到并被告知，且有些能被找到的伴侣不接受检测，通过伴侣通知，1%至8%被列为可能接触者且之前未知感染HIV的人被确定为HIV阳性（尽管这些人不一定是被索引病例感染的）。由于现有研究通常未报告这些结果，因此证据不足以确定包括伴侣通知在内的PCRS在改变行为或减少传播方面是否也有效。几乎没有实证证据可用于评估干预措施的潜在危害，但目前的研究尚未显示出重大危害。根据《社区指南》的证据规则，充分证据表明，由公共卫生专业人员进行伴侣通知的PCRS（“提供者转介”）能有效增加对HIV检测的高流行目标人群的识别。
