Munthali Tapiwa, Masano Angella, Chen Jane S, Kumwenda Wiza, Pedersen Claire, Chinthenga Kenneth, Jere Edward, Mathiya Esther, Ndalama Beatrice, Nyirenda Naomi, Bonongwe Naomi, Chagomerana Maganizo B, Hosseinipour Mina C, Hoffman Irving F, Matoga Mitch, Rutstein Sarah E
UNC Project Malawi, P/Bag A104, 100 Mzimba Road, Tidziwe Center, Lilongwe, Malawi.
Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
BMC Health Serv Res. 2025 Jul 2;25(1):890. doi: 10.1186/s12913-025-13038-4.
Pre-exposure prophylaxis (PrEP) prevents HIV acquisition but strategies are needed to improve uptake among high-risk groups. Assisted partner notification (aPN), proven for HIV case-finding, may expand PrEP services to sexual partners of sexually transmitted infection (STI) patients. While passive (index-led) partner notification for STI treatment receipt is standard, offering an assisted strategy may increase linkage to PrEP for HIV vulnerable partners who may otherwise be missed. This study explored the feasibility and outcomes of integrating aPN into PrEP programs at an STI clinic in Malawi.
Between March 2022 and January 2023, this prospective cohort study enrolled men and women presenting for STI services who were initiating PrEP (index PrEP user) and their referred sexual partners. Using World Health Organization-recommended aPN methods, recent (within last 6 months) sexual partners named by index participants were traced via phone or in-person. We assessed demographic characteristics of index participants and referred partners, tracing outcomes, and PrEP initiation among partners.
174 index PrEP user participants were enrolled, most were male (109/174; 63%) with median age of 27 years (IQR 22, 32). The 174 index participants were asked to provide contact information for their partners, 69 of whom did. These 69 participants named 101 sexual partners (57% female). Partners were named as primary partners (53%), casual partners (41%), or sex workers (6%). Tracing efforts were employed for 52 partners with phone tracing yielding a 57% contact success and physical tracing yielding a 10% contact success. 58 partners (including those not traced) presented at the clinic for screening. Most presenting partners were female (39/58; 67%) and the median age was 28 years (IQR 23, 31). Among the presenting partners, 34/58 were eligible for PrEP, and 31/34 (91%) initiated PrEP. 20 of 55 named partners who agreed to testing were HIV positive, with 20% of these newly diagnosed during PrEP screening.
aPN, including passive notification, effectively identifies and links at-risk partners of persons initiating PrEP to HIV prevention services, achieving high rates of PrEP uptake among eligible presenting partners, though less than half of index PrEP users named partners for tracing. Notably, phone tracing was more effective than physical tracing, but phone number availability was limited. This study highlights the potential of aPN in expanding PrEP access and strengthening HIV prevention efforts among persons seeking STI services.
This trial is registered on 5 October, 2023 at ClinicalTrials.gov NCT05307991 .
暴露前预防（PrEP）可预防艾滋病毒感染，但需要采取策略以提高高危人群的接受率。辅助性伴侣通知（aPN）已被证明可用于艾滋病毒病例发现，可能会将PrEP服务扩展到性传播感染（STI）患者的性伴侣。虽然被动（由感染者主导）性伴侣通知以接受STI治疗是标准做法，但提供辅助策略可能会增加与艾滋病毒易感伴侣的PrEP联系，否则这些伴侣可能会被遗漏。本研究探讨了在马拉维一家STI诊所将aPN纳入PrEP项目的可行性和结果。
在2022年3月至2023年1月期间，这项前瞻性队列研究招募了前来接受STI服务并开始使用PrEP的男性和女性（PrEP使用者）及其被推荐的性伴侣。使用世界卫生组织推荐的aPN方法，通过电话或亲自追踪PrEP使用者最近（过去6个月内）提及的性伴侣。我们评估了PrEP使用者及其被推荐伴侣的人口统计学特征、追踪结果以及伴侣中PrEP的启动情况。
共招募了174名PrEP使用者，大多数为男性（109/174；63%），中位年龄为27岁（四分位间距22，32）。要求这174名PrEP使用者提供其伴侣的联系信息，其中69人提供了。这69名参与者提及了101名性伴侣（57%为女性）。伴侣被列为主要伴侣（53%）、临时伴侣（41%）或性工作者（6%）。对52名伴侣进行了追踪，电话追踪的联系成功率为57%，亲自追踪的联系成功率为10%。58名伴侣（包括未被追踪到的）到诊所进行筛查。大多数前来筛查的伴侣为女性（39/58；67%），中位年龄为28岁（四分位间距23，31）。在前来筛查的伴侣中，34/58符合PrEP条件，31/34（91%）开始使用PrEP。在55名同意检测的被提及伴侣中，20人艾滋病毒呈阳性，其中20%是在PrEP筛查期间新诊断出的。
aPN，包括被动通知，有效地识别并将开始使用PrEP者的高危伴侣与艾滋病毒预防服务联系起来，使符合条件的前来筛查的伴侣中PrEP接受率很高，尽管不到一半的PrEP使用者提及伴侣以便追踪。值得注意的是，电话追踪比亲自追踪更有效，但电话号码的可得性有限。本研究突出了aPN在扩大PrEP可及性和加强寻求STI服务者中的艾滋病毒预防工作方面的潜力。
本试验于2023年10月5日在ClinicalTrials.gov上注册，注册号为NCT05307991 。
