National Online HIV/STI Partner Notification Service

1. National Online HIV/STI Partner Notification Service Presented by Dónal Heath – Project Manager, GMFA

2. Presentation Outline • Project background • Project aims • Proof of concept • How the new service will work • The current schedule

3. Project background Where we began… • GMFA always looking for ways to improve the usefulness of its websites • In 2008 we began to think about developing an online Partner Notification service with a small feasibility study

4. Project background Where we began… • Feasibility study findings • An new online service would have value, but a non-clinical PN service, such as www.inspot.org is flawed, with a high proportion of erroneous / spoof notifications. To be really effective a new PN service would need to be presented at the point of diagnosis.

5. Project background Where we began… • January 2009, GMFA wrote a proposal for an online service exclusively accessible to patients with a clinical diagnosis. • September 2009, GMFA obtained funding from the Elton John AIDS Foundation (EJAF) to develop a new online PN service.

6. Partner Notification – a definition “…the process of contacting the sexual partners of an individual with a sexually transmitted infection including HIV, and advising them that they have been exposed to infection.” AIM: To reduce undiagnosed infection.

7. Project aim This project aims to assist gay men in the UK who have been diagnosed with HIV (or another STI) in reaching their recent sexual partners with notifications via text message, email and dating site website message.

8. HIV / STI prevention aims • To reduce undiagnosed HIV and other STI infections amongst men who have sex with men. • To develop a new service that, if successful, can be replicated for other target groups.

9. Proof of concept 1999 – the first reported use of the Internet to carry out contact tracing. Health professionals notified and evaluated ‘more than 40% of named partners… Previous studies among similar populations reported a substantially smaller number of partners per index case undergoing medical evaluation’ [1] [1] Tracing a Syphilis Outbreak Through Cyberspace

10. Proof of concept - Dating sites

11. Proof of concept – survey results 2010 - GMFA surveyed 3000 men on 3 gay dating websites. Of those who were diagnosed with HIV or an STI in the last five years: • 19% say they were not advised by the clinic to notify their partners. • 22% did not notify their partners, and a quarter of these men said it was because they were ‘too embarrassed’.

12. Proof of concept – survey results • Of 923 men in the survey who notified their partners, only 65% notified all their partners. • 97.5% of men say they would like to be informed if a recent partner is diagnosed. • 96% of men say they would be willing to inform their partners.

13. Proof of concept – current practise • Dating site PN is being successfully carried out in the US in some states by health professionals who have special accounts set up to deliver PN on Manhunt. • Dating site PN is carried out by a handful of clinics in the UK on Gaydar with varying degrees of success. • Most clinics have limited by time / freedom to set up profiles on gay dating sites. Our system will provide one interface that allows delivery of notifications to profiles on multiple dating sites, mobile numbers and email addresses.

14. How the new service will work

15. John is diagnosed John is tested and receives a positive result. The clinic presents him with partner notification options. One of the options is to notify partners in a dating site message, text message or email using GMFA’s PN website.

16. John is given a PN card The clinic writes down on a small card (the PN card) John’s clinic number and a restricted access key for the PN website. John (leaves the clinic) takes the card to a computer and signs on to the PN website.

17. John sends notifications John chooses which partners he wants to notify and how (dating site, SMS, email). He enters the relevant details and sends the notifications. If his clinic has the resources to offer him assistance or Provider Referral, John is given the details he needs to request their help at this stage.

18. John’s partners receive notifications The notifications include: • A PN Reference Number • Links to information about clinics and any STI’s named in the notification at www.gmfa.org.uk • Assurances about the intention of the notification, that mistakes and mischief are unlikely but possible and that every effort is made to reduce this happening. • The National Sexual Health Helpline number

19. Happylad’s response One of John’s partners (profile name: Happylad) takes his PN number with him to a clinic. The clinic staff type the PN number into the system and it records that he has visited. If no clinic visit from Happylad is recorded, an automatic follow-up will be sent to ask him if he has been for a check-up and if he has would he let us know.

20. Provider referrals Clinics can • use the PN website in the same way John does to deliver Provider Referrals via dating sites, text messages and email. • use the PN website to monitor delivery status of and responses to Provider Referrals. • generate reports on performance (in due course)

21. Measuring outcomes • System will record • Notifications sent, received / not received, responded to and acted on (with details) • Feedback from users • The PN website will record the number of notification recipients who refer to it • The GMFA website will record visitors to its sexual health information pages that come from the PN site • Further surveys of the target group may be carried out

22. The current schedule • Six month pilot to launch early 2011 • First phase roll-out to follow during second half of 2011 • Final phase roll-out to all clinics in England to follow from January to October 2012.