Integrating HIV Testing into Syphilis Partner Services: A Collaborative Evaluation Study

1. February 11, 2019

2. Logistics

3. Agenda • Introduction of presenters • Article background, methods, and results • Discussion • Q&A

4. Integrating HIV testing into syphilis partner services Tigran Avoundjian, David Peyton, Kendra Johnson, Sara N. Glick, Matthew R. Golden University of Washington, Public Health Seattle & King County HIV/STD Program, and Mississippi State Department of Health

5. HIV and STDs in the Southeastern US Rates of HIV diagnosis, among adults and adolescents, 2016 Rates of reported primary and secondary syphilis cases, 2016

6. HIV/AIDS in Jackson, MS Rates of HIV Diagnoses, 2015 Rates of Stage 3 (AIDS) Diagnoses, 2015

7. Syphilis Partner Services • Syphilis is a known risk factor for HIV acquisition • High rates of syphilis and HIV co-infection in the US, particularly among MSM • As part of syphilis partner services activities, DIS already contacting partners of early syphilis cases

8. Objective Mississippi State Department of Health (MSDH) and University of Washington (UW) collaboration to evaluate the integration of new HIV-related activities into the MSDH STD Partner Services (PS) program • Aim 1: To evaluate the utility of STD PS as a means to increase HIV testing and case-finding • Aim 2: To assess the utility of STD PS to reengage persons with HIV to care and promote effective antiretroviral therapy • Aim 3: To assess the utility of STD PS for syphilis and gonorrhea as a means to increase HIV testing in high-risk MSM and to link MSM to pre-exposure prophylaxis (PrEP)

9. Syphilis PS Workflow New syphilis diagnosis/positive serological test reported to MSDH DIS contact index cases and conduct interview As of 2014: PRISM DIS contact named partners to test for syphilis, and collect demographic information DIS refer partners to STD clinic for rapid HIV testing OR offer blood draw in the field DIS offer all partners treatment for syphilis at time of syphilis testing (epi treatment) For partners with new early syphilis infection, DIS conduct full partner services interview Case record assigned to DIS for investigation

10. Study Population • Identified all early syphilis cases and their partners from July 2014 through December 2016 • Index case: case record in PRISM with diagnosis code for primary, secondary, or early latent syphilis (710, 720, 730) • Excluded index cases newly diagnosed with HIV within 30 days of early syphilis infection

11. Outcomes: Syphilis case finding • Syphilis testing: evidence of a syphilis serological test in PRISM after being named as a partner • New syphilis case: partner had diagnosis code for primary, secondary, or early latent syphilis after being named as a partner

12. Outcomes: HIV case finding • HIV testing: HIV test reported within 30 days after being named as a partner • New HIV case: partner had HIV diagnosis within 30 days after being named as a partner AND no evidence of previous HIV diagnosis

13. Partner Services Metrics • Partners named/contacted • Partners epidemiologically treated: number of partners who did not test positive for syphilis but received preventative treatment after DIS contact • Partners brought to treatment: partners tested positive for syphilis and received treatment after DIS contact • Number needed to Interview (NNTI): number of index cases needed to interview to identify one new case of HIV or syphilis among partners • Test positivity: number of partners testing positive for syphilis or HIV divided by the number of partners tested

14. Index Case Characteristics Race Gender/ gender of sex partners HIV Status 53% of MSM previous HIV+ (vs. 5% of MSW/women)

15. Partner Services Indices1 1Index: outcome divided by total number of index cases(n = 1619)

16. Syphilis/HIV Case Finding NNTI: 64 NNTI: 2.21

17. HIV case finding by index case characteristics

18. HIV Test Positivity

19. Summary of Findings • Syphilis PS yielded substantial number of new syphilis and HIV cases • HIV case finding was highest among partners of black MSM and index cases who were previously HIV+ • High HIV test positivity among these groups • Improving HIV testing rates could result in increased HIV case finding as a result of syphilis partner services

20. Discussion • Low syphilis NNTI in MS compared to other jurisdictions • HIV outcomes not as good as other jurisdictions • Only 50% of partners received HIV testing

21. Syphilis PS as HIV prevention opportunity • Setting to reduce disparities among MSM • Integration of other high impact HIV prevention activities into syphilis PS • PrEP uptake • Relinkage to HIV care

22. Implications for STD Programs • Integrating HIV testing into syphilis PS is an effective strategy for identifying people newly infected with HIV • Syphilis PS can be leveraged to improve PrEP uptake and HIV care delivery • Standard outcomes/framework for evaluating STD partner services programs

23. Future Directions • Facilitators/barriers to integrating HIV testing into syphilis PS • Evaluating impact of integrating PrEP referrals/HIV relinkage activities into syphilis PS

24. Acknowledgements • Co-authors • Christine Khosropour • Christie Lewis • James Stewart • MSDH DIS

25. Group Discussion • What strategies has your health department employed with DIS in the integration of HIV testing into syphilis partner services? • What challenges has your health department faced in integrating HIV testing into syphilis partner services? • What successes has your health department seen in integrating HIV testing into syphilis partner services?

26. Questions?

27. Additional questions? Tigran Avoundjian tavoun@uw.edu David Peyton david.peyton@rocketmail.com Kendra Johnson Kendra.Johnson@msdh.ms.gov Matthew R. Golden golden@uw.edu Christine M. Khosropour ckhosro@uw.edu Leandra Lacy llacy@ncsddc.org