Increasing public health partner services for human immunodeficiency virus: results of a second national survey.

BACKGROUND: Recent US national efforts taken to prevent human immunodeficiency virus (HIV) infection have emphasized HIV case-finding, including partner services (PS). METHODS: We collected data on HIV PS procedures and outcomes in 2006 from health departments in US metropolitan areas with the highest number of cases of acquired immunodeficiency syndrome, gonorrhea, chlamydial infection, and primary and secondary syphilis, and compared our results with the data collected through a similar study carried out in 2001. RESULTS: Of the 71 eligible jurisdictions, 51 (72%) participated in this study. In 2006, health departments interviewed 11,270 (43%) of the 26,185 persons with newly reported HIV, which was an increase from the 32% reported in 2001 (P < 0.01). Among 10,498 potentially exposed partners, 2228 (21%) had been previously diagnosed with HIV, 803 (8%) were newly HIV-diagnosed, 3337 (32%) tested HIV-negative, and 4130 (39%) were not successfully notified, were notified but refused HIV testing and denied previous diagnosis, or did not have an outcome recorded. Combining data from all jurisdictions, public health staff needed to interview 13.6 persons with HIV to identify one new case of infection; this number was unchanged from 2001 (13.8; P = 0.75). CONCLUSION: In the United States, the proportion of persons diagnosed with HIV receiving PS has increased since 2001, whereas HIV case-finding yields have remained stable. Despite this, most people newly diagnosed with HIV still do not receive PS.

We must rigorously follow basic infection control procedures to protect our healthcare workers from SARS-CoV-2.

Because severe acute respiratory coronavirus virus 2 (SARS-CoV-2) spreads easily and healthcare workers are at increased risk of both acquiring and transmitting infection, all healthcare facilities must rapidly and rigorously implement the full hierarchy of established infection controls: source control (removal or mitigation of infection sources), engineering and environmental controls, administrative controls, and personal protective equipment.

An evaluation of the reliability of HIV partner notification disposition coding by disease intervention specialists in the United States.

BACKGROUND: The reliability of CDC HIV partner notification (PN) disposition codes has not been evaluated. METHODS: Disease Intervention Specialists (DIS) working for health departments in high HIV/STD-morbidity metropolitan areas completed a questionnaire that presented vignettes describing PN interviews. Questionnaires asked DIS to indicate whether they would record a disposition and what codes they would assign to each partner. RESULTS: A total of 136 DIS from 28 of 29 eligible states participated. Partner 1: The index case says he will inform his partner of his HIV diagnosis and, at follow-up, reports that the partner has tested negative. Seventeen percent of DIS indicated they would record a partner disposition. DIS used 7 different codes to define the PN outcomes. Partner 2: The index case says she will inform her partner, who attends the clinic, indicates no history of testing, and tests HIV-negative. 93% of DIS reported they would record a disposition, 90% of whom used code 6, "Not Previously Tested, New Negative." Partner 3: The index case with partner 2 (above) agrees to have DIS notify her second partner. When contacted, the partner tells DIS that he had previously tested negative and will arrange to be tested himself. He subsequently reports testing HIV-negative, but DIS do not confirm this. Seventy-three percent of DIS recorded a disposition for the partner, of whom 84% used code J, "Located, Refused Counseling and Testing." CONCLUSIONS: CDC HIV PN disposition codes are reliable for simple scenarios with verified outcomes, but less reliable when DIS elicit partner-reported outcomes.

Return on public health investment: CDC's Expanded HIV Testing Initiative.

BACKGROUND: Over a 3-year period, the Centers for Disease Control and Prevention invested $102.3 million in a large-scale HIV testing program, the Expanded HIV Testing Initiative for populations disproportionally affected by HIV. Policy makers, who must optimize public health given a set budget, are interested in the financial return on investment (ROI) of large-scale HIV testing. METHODS: We conducted an ROI analysis using expenditure and outcome data from the program. A health system perspective was used that included all program expenditures including medical costs of treating newly diagnosed patients. We incorporated benefits of HIV transmissions averted from persons diagnosed of their infection through the Initiative compared with when, on average, those persons would have been diagnosed without the Initiative (3 years later in the base case). HIV transmissions were derived from a published mathematical model of HIV transmission. In sensitivity analysis, we tested the effect of 1-year to 5-year alternate testing intervals and differences in the prevalence of undiagnosed HIV infection. RESULTS: Under the Initiative, 2.7 million persons were tested for HIV, there was a newly diagnosed HIV positivity rate of 0.7%, and an estimated 3381 HIV infections were averted. It achieved a return of $1.95 for every dollar invested. ROI ranged from $1.46 to $2.01 for alternative testing intervals of 1-5 years and remained above $1 (positive return on investment) with a prevalence of undiagnosed HIV infection as low as 0.12%. CONCLUSIONS: The expanded testing Initiative yielded ROI values of >$1 under a broad range of sensitivity analyses and provides further support for large-scale HIV testing programs.

"The anticipation alone could kill you": past and potential clients' perspectives on HIV testing in non-health care settings.

HIV testing in non-health care settings is an effective strategy for increasing the proportion of persons aware of their infection. We conducted 21 focus groups with 186 past and potential clients in five U.S. cities to explore attitudes and experiences related to HIV counseling and testing in non-health care settings. Qualitative analysis yielded several key themes. HIV-related stigma and fear emerged as a main theme throughout the discussions. Knowing one's HIV status quickly and accurately was of primary importance; HIV prevention counseling was secondary. Participants prioritized a supportive, nonjudgmental environment with adequate privacy and confidentiality. Provision of immediate emotional support, medical information, and linkage services to HIV-infected clients were considered essential. Staff with HIV-specific skills to address clients' emotional and informational needs was considered a strength of non-health care testing programs. Frequently, however, participants compared non-health care settings unfavorably to health care settings regarding privacy, competency, confidentiality, and test accuracy. Recommendations for enhancing counseling and testing services in non-health care settings are discussed.