Department of Global Health, University of Washington, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
Lancet Glob Health. 2023 May;11(5):e749-e758. doi: 10.1016/S2214-109X(23)00153-5.
Assisted partner services (APS), or exposure notification and HIV testing for sexual partners of individuals diagnosed with HIV (index clients), have been shown to be safe and effective in clinical trials. We assessed the real-world effectiveness of APS when integrated into HIV clinics in western Kenya.
In this single-arm, hybrid type 2 implementation science study, we facilitated APS implementation in 31 health facilities in Kenya by training existing health-care staff. We focused on male partner outcomes to assess the impact of APS in reaching male individuals in sub-Saharan Africa, who have lower rates of HIV testing than female individuals. Female individuals (aged ≥18 years or emancipated minor) who tested positive for HIV at participating facilities in Kenya were offered APS; consenting female participants provided contact information for all male sexual partners in the past 3 years. Male partners were notified of their potential HIV exposure and offered a choice of community-based or facility-based HIV testing services (HTS). Female index clients and male partners with HIV were followed up at 6 weeks, 6 months, and 12 months after enrolment, to assess linkage to antiretroviral treatment. Viral load was assessed at 12 months.
Between May 1, 2018, and March 31, 2020, 32 722 female individuals received HTS; 1910 (6%) tested positive for HIV, of whom 1724 (90%) received APS. Female index clients named 5137 male partners (median 3 per index [IQR 2-4]), of whom 4422 (86%) were reached with exposure notification and HTS. 524 (12%) of the male partners tested were newly diagnosed with HIV and 1292 (29%) reported a previous HIV diagnosis. At 12 months follow-up, 1512 (88%) female index clients and 1621 (89%) male partners with HIV were taking ART, with few adverse events: 25 (2%) female index clients and seven (<1%) male partners reported intimate partner violence, and 60 (3%) female index clients and ten (<1%) male partners reported relationship dissolution.
Evidence from this real-world APS scale-up project shows that APS is a safe, acceptable, and effective strategy to identify males with HIV and retain them in care.
The US National Institutes of Health.
辅助伴侣服务（APS），即对诊断出 HIV 的个体（索引客户）的性伴侣进行暴露通知和 HIV 检测，已在临床试验中证明是安全有效的。我们评估了在肯尼亚西部的 HIV 诊所中整合 APS 的实际效果。
在这项单臂、混合 2 型实施科学研究中，我们通过培训现有医护人员，在肯尼亚的 31 个卫生机构中促进 APS 的实施。我们专注于男性伴侣的结果，以评估 APS 在接触撒哈拉以南非洲的男性个体方面的影响，这些男性个体的 HIV 检测率低于女性个体。在肯尼亚参与机构检测出 HIV 呈阳性的年龄在 18 岁及以上或已成年的女性个体（年龄≥18 岁或已成年的未成年个体），将获得 APS；同意的女性参与者将提供过去 3 年内所有男性性伴侣的联系方式。男性伴侣将被告知其 HIV 暴露的潜在风险，并可选择社区或机构 HIV 检测服务（HTS）。女性索引客户和 HIV 阳性的男性伴侣在登记后 6 周、6 个月和 12 个月进行随访，以评估其与抗逆转录病毒治疗的关联。在 12 个月时评估病毒载量。
2018 年 5 月 1 日至 2020 年 3 月 31 日期间，32722 名女性接受了 HTS；1910 人（6%）HIV 检测呈阳性，其中 1724 人（90%）接受了 APS。女性索引客户共提名了 5137 名男性伴侣（中位数为每个索引客户 3 名[IQR 2-4]），其中 4422 名（86%）男性伴侣收到了暴露通知和 HTS。452 名（12%）接受检测的男性伴侣新诊断出 HIV 阳性，1292 名（29%）报告曾有 HIV 诊断。在 12 个月的随访中，1512 名（88%）HIV 阳性的女性索引客户和 1621 名（89%）男性伴侣正在接受 ART 治疗，几乎没有不良事件：25 名（2%）女性索引客户和 7 名（<1%）男性伴侣报告了亲密伴侣暴力，60 名（3%）女性索引客户和 10 名（<1%）男性伴侣报告了关系破裂。
这项真实世界 APS 扩大规模项目的证据表明，APS 是一种安全、可接受且有效的策略，可以识别 HIV 阳性男性，并将其保留在护理中。
美国国立卫生研究院。
