Background Because of increased transmission potential, the US Centres for Disease Control and Prevention (CDC) recommends prioritising high HIV viral load (≥50,000 copies/mL, HVL) individuals for routine follow-up services, including linkage-to-care and partner services. However, little guidance exists on operationalizing this recommendation. In June 2014, the Baltimore City Health Department developed and implemented a pilot program to prioritise HVL individuals for follow-up services. The objective of this analysis is to describe the pilot program and evaluate process outcomes for follow-up services pre- and post-pilot program implementation.
Methods This pilot program was modelled after a protocol for responding to congenital syphilis. Disease Intervention Specialists (DIS) were trained to locate, administer partner services interviews and link-to-care HVL individuals with increased urgency and effort compared to other HIV cases. A DIS supervisor reviewed each HVL case before closing to ensure adequate response and documentation. We used a pre-post design to evaluate the pilot and compared linkage-to-care and contact tracing outcomes for HVL individuals post pilot implementation (post-pilot, June 2014–January 2015) to a similar time period prior to implementation (pre-pilot, June 2013–January 2014).
Results There were 23 pre-pilot and 17 post-pilot HVL cases (n = 40). DIS were more likely to link HVL individuals to care (59% pre-pilot vs. 65% post-pilot), and complete partner services interviews (39% pre-pilot vs. 59% post-pilot). Among HVL individuals who completed interviews, DIS were more likely to obtain sex partner meeting place information (33% pre-pilot vs. 40% post-pilot) and locating information for disclosed sex partners (16% pre-pilot vs. 39% post-pilot) in the post-pilot period compared to the pre-pilot period.
Conclusion This pilot program demonstrates one successful method to operationalize CDC guidelines regarding prioritisation of HVL individuals. Future work will evaluate additional outcomes of this program, including HIV testing among sex partners and at sex partner meeting places disclosed by HVL individuals.
Disclosure of interest statement The authors have no conflicts of interest to disclose.
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