HIV Partner Notification Is Effective and Feasible in Sub-Saharan Africa: Opportunities for HIV Treatment and Prevention

Many African countries lack standardized HIV partner notification procedures, and the efficacy of PN has not been evaluated in developing countries, the authors of the current study noted. Brown and colleagues conducted a prospective trial of HIV PN in Malawi among newly diagnosed patients presenting to two hospital-based outpatient STD clinics in Lilongwe.

Index patients were randomized to one of three PN methods: passive or "self-referral," where index patients notify their own partners; contract referral, where the patient is given 10 days to notify partners, after which a health care provider contacts partners who have not presented for counseling and testing; and provider referral, wherein the provider notifies partners directly.

The 245 index patients identified 302 sex partners and locating information for 252, among whom 107 returned for HIV testing and counseling. For passive referral, 20 of 82 partners presented to the clinics (24 percent; 95 percent confidence interval: 15 percent to 34 percent), compared with 45 of 88 (51 percent; 95 CI: 41 percent to 62 percent) for contract PN and 42 of 82 (51 percent; 95 percent CI: 40 percent to 62 percent) in the provider referral arm (P<0.001).

Among the 107 returning partners, 67 were HIV-infected (64 percent), including 54 newly diagnosed (81 percent).

"This study provides the first evidence of the effectiveness of partner notification in sub-Saharan Africa," Brown and colleagues wrote. "Active partner notification was feasible, acceptable and effective among sexually transmitted infections clinic patients. Partner notification will increase early referral to care and facilitate risk reduction among high-risk uninfected partners."

This trial enrolled 90 percent of eligible patients, and most index cases were women, married and only named a single sex partner, independent consultant John J. Potterat observed in an accompanying editorial, "Puzzling Observations in a Trial of HIV Partner Notifications in Sub-Saharan Africa" (2011;56(5):381-383). Of 302 partners identified (1.25 per index), nearly three-quarters were main partners, he wrote. Index patients reported they intended to continue sexual relations with nearly three-quarters of partners identified. Almost all successful referrals were main partners, and 45 percent of all those tested were serodiscordant, Potterat wrote.

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