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Provider assisted HIV partner notification is feasible in Malawi
G. Kamanga1, L. Brown1,2, D. Chiwanda1, P. Jawati1, A. Pettifor2, F. Martinson1, I. Hoffman2
1UNC Project, Lilongwe, Malawi, 2University of North Carolina, Chapel Hill, United States
Background: The partner notification return rate for HIV testing and counseling and testing (HTC) is very minimal in Malawi. Passive referral, the standard of care, relies on index patients to notify their partners themselves. Under contract referral, an index is given a period of time to notify their sexual partners, after which a health care provider contacts partners who have not reported for HTC. Under provider referral a health care provider contacts partners directly.
Methods: As part of an ongoing study to determine the most effective method of HIV partner notification, newly diagnosed HIV cases were randomized to one of three methods of partner notification: passive, contract, and provider referral. We performed in-depth interviews with HIV positive index participants and their sexual partners after partner notification.
Results: 17 in-depth interviews were completed with index participants: 9 females; 6 males; 7 passive referral; 5 contract referral; and 5 provider referral. 12 in-depth interviews were completed with partners: 6 females; 6 males; 3 passive referral; 2 contract referral; and 7 provider referral. Although most index participants and partners expressed a preference for patient referral, both indexes and partners articulated benefits to provider notification. Two partners from the provider referral arm described provider referral as the best notification method. Several mentioned couple counseling as a way to diffuse tension and get accurate information. Both index participants and partners support the right for sexual partners to know the HIV testing status of their partner. All mentioned benefits to HIV testing, including the ability to access antiretroviral drugs and change behavior. No social harms were reported associated with any of the notification procedures.
Conclusions: Provider assisted partner notification was acceptable and was not associated with social harms in this population. While self-disclosure should be encouraged, provider notification is feasible and beneficial. Couples counseling should be encouraged.
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