July 23, 2019

1. July 23, 2019 • Dr. Kimberly Green • Global Director, HIV & TB • Partner notification services - 101 • The power of partners! Positively engaging networks of people with HIV in testing, treatment, and prevention

2. What are partner notificationservices? • Partner notification services (PNS) is defined as a voluntary process whereby a trained provider asks people diagnosed with HIV about their sexual partners and/or drug injecting partners and then, if the HIV-positive client agrees, offers these partners HIV testing services. • Partner notification is provided using passive or assisted approaches. Assisted partner notification services couple counseling at G-link clinic. PATH Source: WHO, Guidelines on HIV Self-Testing and Partner Notification: Supplement to Consolidated Guidelines on HIV Testing Services. 2016

3. Why partner notificationservices? • Longstanding component of infectious diseasemanagementto identify those who have been exposed to infections & to enable more rapid access to treatment • Including for sexually transmitted infections (STI) and tuberculosis • Until last decade, HIV PNS limited to some high incomecountries • Increasing evidence of safety & effectiveness global scale-up • Sexual and drug injecting partners of PLHIV haveincreasedlikelihood ofbeing… • HIV-positiveOR • At high risk for future HIVacquisition • Opportunityfor: • High yield HIVcase-finding • Linking partners to HIV prevention andtreatment • Accelerates epidemic control – decreasingHIV transmission & morbidity

4. What is partner notification versus index testing services? Content from: C. Johnson. Understanding and ImplementingAssisted Partner Notification to increase HIV Diagnosis in theCaribbean, Dec 2018

5. Options for notifyingpartners Provider Referral = Health care provider contactspartner(s) to notify them of exposure and offertesting AssistedApproaches Contract Referral = Client agrees to notify partner(s) within specific time period after which the provider will contact the partner(s) with the client’s permission Dual referral = Client and provider notifypartners together Passive Client Referral = Index client tells partner(s)about HIV risk and encourages them to gettested

6. Evidence base –summary

7. WHO guidance: assisted partner notification services(APN) WHOrecommendation: Voluntary assisted partner notification servicesshould be offered as part of a comprehensive packageof testing and care offered to people withHIV (strong recommendation, moderate qualityevidence) Source: WHO2016 (Slide from: C. Johnson. Understanding and ImplementingAssisted Partner Notification to increase HIV Diagnosis in theCaribbean, Dec 2018)

8. Principles of PNS and index testing Client centered and focused Voluntary and non-coercive Confidential Culturally and linguistically appropriate Non - judgmental Comprehensive and integrative Accessible and available to all Free

9. Partner notification services If client consents, provider elicits sexual and drug- injectingpartners Person with HIV is newly or previously diagnosed (community, HIVST, facility) Trained provider introduces PNS to client & seeks client’sconsent Providerand/or client notifies partner(s)of HIV exposure Partner(s)offeredHIVtesting and linkage to prevention or treatment Client and provider select notification method forpartner(s) Results in increased partner testing, diagnosis, andlinkage to prevention and treatment

10. Potential methods for contactingpartners • No one size fits all; differentiate by PN preferences since they differ by population, age, geography,and partnertype (primary ornon-primary) • Assisted partner notificationmethods caninclude: • Face-to-face conversations withpartners • Phonecalls • Textmessages • Emails • Video and Internet-based messagingsystems • Care is needed whenusing phone calls and text messaging to ensure that the correct person receives the message and that the anonymity of both the HIV-positive client and notified partner ismaintained.

11. Example of differentiated partner notification services…

12. VIETNAM: PNS cascade, June 2017—March 2019 (PEPFAR/USAID/PATH Healthy Markets) KENYA: PNS cascade, October 2018—March 2019(PEPFAR/USAID/PATH AfyaZiwani) DRC: PNS cascade, October 2018—March 2019(PEPFAR/USAID/PATH IHAP-HK/L) 4 countries+ 4 epidemics = 4 differentiated approaches UKRAINE: PNS cascade, February—March 2019 (PEPFAR/USAID/PATHServing Life)

13. Key considerations and takeaways • Do no harm and implement based on the 5Cs; voluntariness and confidentiality are essential • Laws/policies that criminalize populations complicate aPNS delivery and uptake • Enable strong community leadership and engagement (and aPNS service delivery) • Differentiate aPNS based on population preferences (community, facility, HIVST – online engagement…) • Offer periodically – PNS is a process and acceptability or need may change over time • Time intensive and requires well-trained providers • Integrate as part of HIV testing, prevention, and treatment; and link to other needs and services (e.g. STIs, mental health)

14. Key resources • WHO Guidelines:https://bit.ly/2IeVwV8 • WHO Policy Brief:https://bit.ly/2IJX7C5 • WHO PN slide set:https://bit.ly/2IJXc8R • WHO Index testing slide set:https://bit.ly/2jYsJFW • PATH differentiated PN Brief: https://bit.ly/2Y1Vms7 • PATH PNS web articles:https://bit.ly/2JSQVpy • AIDSfreeTools on PN:https://bit.ly/32Jlkzj

15. Acknowledgements • Cheryl Johnson, WHO • Rachel Baggaley, WHO • David Katz, University of Washington • Davina Canagasabey, PATH • Bao Vu Ngoc, USAID/PATH Healthy Markets, Vietnam • Didier Kamerhe, USAID/PATH IHAP-HK/L, DRC • SvitlanaLeontyeva, PATH, Ukraine • Asha Hegde, PATH, India