Quy Ton, MD, MPH
Nominated From: University of Washington
Research Site: Kenya
Project: Partner Notification & HIV Care Linkage
Primary Mentor: Carey Farquhar, M.D., M.P.H (University of Washington)
Research Project Background
Maximizing the individual and public health benefits of antiretroviral therapy (ART) requires investments in HIV testing and the entire continuum of HIV care and treatment, which encompasses 4 steps: 1) testing to enrollment; 2) enrollment to eligibility; 3) eligibility to initiation; and 4) initiation to lifelong ART. The majority of people living with HIV (PLHIV) in resource-limited settings are not aware of their status. Along the continuum of HIV care, patient attrition occurs at every step as many do not link to or remain in care after testing positive. Previously, retention strategies focused on the period after ART initiation. However, recent research indicates that the greatest attrition occurs prior to initiation of ART with data suggesting that less than one-third of those testing positive initiating ART, even in the US.
Notifying partners of newly diagnosed PLHIV has been a cornerstone of public health efforts to reduce transmission in the US. New data from Malawi and Cameroon have demonstrated acceptability, feasibility and efficacy of provider-initiated assisted partner notification services (aPS). With the strong support of the Kenya Ministry of Health (funded by NIH/NIAID-R01-A1099974-01), we plan to introduce aPS into 18 volunteer counseling and testing (VCT) facilities using a cluster randomized clinical trial design to determine its capacity to increase rates of HIV testing, case-finding of positives and initial HIV care linkage among partners of index cases. The intervention will be implemented by a new cadre of providers, health advisors, who will contact partners of index cases, notify them of HIV exposure, provide counseling and testing, and facilitate linkage to care. These data will provide the rationale and information needed to move forward with scale-up of aPS in Kenya.
Overall, there is a paucity of data on rates and reasons for attrition and a great need to develop and test interventions that can improve retention along the entire continuum of care. To date, no single study has prospectively determined rates of attrition at each step in the cascade of care. As a study nested within the larger aPS study, we propose to determine if aPS using health advisors can improve rates of HIV linkage to care, retention in pre-ART care and ART initiation among individuals newly diagnosed with HIV-1 (index cases). In the proposed study, health advisors will have an expanded role that will include contacting the index case by phone or in person to promote engagement in care. In the US, this is an accepted role of health advisors and expanding their role here could demonstrate the effectiveness of an intervention that could also be scaled up and potentially have a major impact on filling the gap between testing and treatment.