The Centers for Disease Control and Prevention (CDC) strongly recommends that all persons with newly diagnosed or reported HIV infection receive partner services with active health department involvement . In 2008, the CDC published recommendations describing partner services as an array of services that not only includes partner notification, the identification and notification of HIV-exposed partners, but also active linkage to medical care for persons infected with HIV.
In New York City (NYC), which has the most new diagnoses annually of any city in the USA, the health department formed the Field Services Unit (FSU) in 2006 to expedite partner services. As part of the partner services interview, staff assessed patients’ understanding of the follow-up care plan made by providers and attempted to address any potential barriers to adherence to the plan, including facilitating appointment scheduling and providing transportation to appointments . In 2011, 38% of patients newly diagnosed with HIV in NYC were interviewed by FSU staff. We examined the contribution of our FSU HIV partner services program in improving timely linkage and retention in HIV medical care.
Data were analyzed from two sources: the NYC HIV Surveillance Registry (HSR) and the FSU database. The HSR is a population-based public health registry of all persons diagnosed with AIDS (since 1981) or HIV infection (since 2000) in NYC. All reportable HIV-related laboratory events, which since 2005 in New York State have included all viral load and CD4+ values, are incorporated into the HSR [3,4]. The FSU database contains information on FSU patients and their named partners. People living with HIV who appear in both datasets are linked by a unique person-based identifier.
Two mutually exclusive analytic populations were drawn from the population of all persons living in NYC at least 13 years old newly diagnosed with HIV infection between 2007 and 2011 and reported to the NYC Health Department by 31 March 2013: newly HIV-diagnosed persons interviewed for partner services by FSU staff (‘FSU patients’) and newly HIV-diagnosed persons at non-FSU-participating NYC facilities that offered ongoing HIV medical care (‘non-FSU patients’).
Differences between the two groups by sociodemographic characteristics and clinical status outcomes were analyzed using chi-square tests of association (for categorical variables) and t-tests or Wilcoxon rank sum tests (for continuous variables). Two clinical outcomes were examined: linkage to care within 91 days and established care among persons with a care visit. Linkage to care was evaluated using CD4+ and viral load reports to the HSR as a proxy for an HIV-related medical care visit, and considered timely if received within 91 days of HIV diagnosis, following a 7-day lag . Any CD4+ or viral load within 7 days of diagnosis was considered part of the diagnostic work-up and not a linkage to care event. HIV care was considered ‘established’ if at least two viral load or CD4+ tests, including the linkage to care laboratory, separated by at least 91 days, were received for those who had ever initiated care during the 12-month period after initial diagnosis . Prevalence ratios were calculated and adjusted for age, sex, race/ethnicity, and late diagnosis (AIDS diagnosis within 31 days of an HIV diagnosis). All statistical analyses were conducted using SAS, version 9.2 (Cary, North Carolina, USA).
Our population included 10 095 persons newly diagnosed with HIV from 2007 through 2011, including 4108 FSU patients and 5987 non-FSU patients. FSU patients were more likely to be black or Hispanic, foreign-born, have a late HIV diagnosis and less likely to be male, MSM, or live in the borough of Manhattan (Table 1).
Field Services Unit patients (79%) were more likely than non-FSU patients (66%) to initiate care within 3 months of diagnosis (P < 0.0001). In the multivariable model, FSU patients were slightly more likely to initiate care within 3 months of diagnosis [adjusted prevalence ratio (aPR) 1.10, 95% confidence interval (CI) 1.08–1.12]. Among those who ever initiated care, FSU patients were more likely than non-FSU patients to have established themselves in care (87 vs. 84%; P = 0.0001) and in the multivariable analysis were slightly more likely to have established care (aPR 1.04, 95% CI 1.02–1.06).
Our analysis of HIV partner services data from the NYC Health Department is among the first to evaluate outcomes related to the more comprehensive 2008 CDC recommendations for HIV partner services programs . Whereas most HIV partner service analyses focus on case finding and its cost-effectiveness, we evaluated linkage to and establishment in care as well. More FSU patients had a concurrent diagnosis because FSU-associated facilities were deliberately selected from neighborhoods with high HIV prevalence and mortality. HIV partner services include a broad array of services that can help prevent HIV transmission by not only identifying persons with previously undiagnosed HIV infection, but also assisting with timely linkage to HIV medical care for patients and their newly diagnosed partners.
The authors thank Kent Sepkowitz and Julie Myers for helpful comments on the manuscript and the members of the Field Services Unit who interviewed and assisted with linking patients to HIV medical care.
Authors’ contributions: A. Bocour conceived and led the writing of the manuscript, and conducted the data analysis. C. Udeagu led the program and contributed to the writing of the manuscript. T. Renaud and C. Shepard provided critical input and guidance in the writing of the manuscript.
Human participant protection: No institutional review board approval was necessary because this is a secondary analysis of data collected as part of the New York City Department of Health and Mental Hygiene routine case and partner services program.
Conflicts of interest
There are no conflicts of interest.
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