HIV partner notification (PN) is a process in which contacts of people with HIV are identified and offered HIV testing. This strategy provides considerable opportunities to reach those at highest risk of HIV and reduce onward transmission through approaches such as post-(PEP) and pre-exposure prophylaxis (PrEP), and well established antenatal interventions. Thus effective HIV PN confers benefits to individual health by facilitating earlier diagnosis and linkage to care, and benefits to public health by preventing the spread of infection. Achieving effective HIV PN can be challenging - less than 3% of the 4060 individuals newly diagnosed with HIV in a GUM clinic in 2013 are reported as being identified through PN. Around a fifth of new infections are recently acquired and these individuals have high levels of viraemia, conferring much greater risk of transmission. There is therefore a pressing need to develop and maintain robust clinical and public health practice for HIV PN across the UK.
The standards document (SEE BELOW) defines relevant outcomes and proposes standards for HIV PN. It does not describe the processes nor best clinical practice for PN; these are to be found in the BASHH Statement on Partner Notification for Sexually Transmissible Infections and the SSHA Manual for Sexual Health Advisers.
The definitions and standards were developed by a multidisciplinary group of clinical, public health and third sector experts for use by multiprofessional clinicians, services and commissioners to monitor their performance against agreed standards, with the overall aim of improving the delivery of HIV PN nationally, thereby increasing diagnoses of HIV and impacting on both individual and public health.
Terms and Definitions
* See standards document for fuller descriptions, or hover over the icons on the calculator
Index case: Person with HIV
Contacts: People who have had contact with the index case in a way which is associated with HIV transmission, and who may or may not have HIV infection themselves
Two main contact categories are used, based on whether or not the contact’s HIV status is known at the time of the initial PN discussion with the index case. This reflects how contacts are managed in routine clinical practice:
I. Contacts whose HIV status is known: Status-known contacts
II. Contacts whose HIV status is unknown: Status-unknown contacts
l. Status-known contacts: these include known HIV positive contacts (or “contacts whom we know are HIV positive”) and known HIV negative contacts (“contacts whom we know are HIV negative because they have had a negative result on a fourth generation HIV test performed 4 weeks or more post-exposure; which is highly likely to exclude HIV infection). For the purpose of audit, we also include deceased contacts in this category, whether or not their HIV status is known.
Index case report is sufficient to assign contact HIV status category for audits. However, for contacts reported as known HIV negative it may be clinically advisable to notify if there is any uncertainty as to whether the window period was adequately covered by their HIV negative test.
ll. Status-unknown contacts: these are divided into two groups based on whether or not we know enough about them for any PN to be feasible:
- Contactable: people for whom a means of contact is available or there is enough known about them to enable them to be “found” through past attendance at a sexual health or HIV service.
- Information provided by the index case may include working mobile number or email address, and suf cient demographic data to generate means of contact or identification - name and date of birth /address. Appropriate use of all information sources, with index case agreement, including social networking websites, should be considered in attempting to identify contacts.
These are the “contactable status-unknown contacts”
- Uncontactable: people for whom the index case (or HCP) has no means of contact. These are the “uncontactable status-unknown contacts”
Routes of exposure: Sexual, mother to child (MTC), injecting drug use (IDU), other (including blood/blood product transfusion, organ and skin transplantation, semen donation and needlestick and other injury). Mother to child transmission and testing of children is not covered in this document
The outcomes are as follows:
Measured at 3 months post-diagnosis of the index cases
Number of contacts* tested per index case.
(* status-known contacts + number of contactable status-unknown contacts)
0.6 HCP verified
0.8 Index reported or HCP verified (i.e those captured via either)
Measured at 3 months post-diagnosis of the index cases
Proportion (%) of contactable partners tested*
(*status-known contacts + contactable status-unknown contacts tested / total number of status-known contacts and contactable status-unknown contacts)
65% HCP verified
85% Index reported or HCP verified (i.e those captured via either)
Measured at 4 weeks post-diagnosis of the index cases
Proportion (%) of index cases with a documented PN plan within 4 weeks of diagnosis
Measured at time of HIV diagnosis (where diagnosis is made within your service)
Proportion (%) of index cases with PEP assessment: documented evidence of PN discussion at time of diagnosis to determine if any at risk contact has occurred within previous 72 hours to identify and refer partners potentially eligible for PEP.
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|Outcome Standards (Overall)|
The standards are rated using the RAG rating system below:
GREEN = Standard achieved
AMBER = Within 10% of achieving standard
RED = Failing standard by >10%