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An effective strategy to diagnose HIV infection: findings from a national audit of HIV partner notification outcomes in sexual health and infectious disease clinics in the UK
  1. Michael Rayment1,
  2. Hilary Curtis2,
  3. Chris Carne3,
  4. Hugo McClean4,
  5. Gill Bell5,
  6. Claudia Estcourt6,
  7. Jonathon Roberts7,
  8. Ed Wilkins8,
  9. Steven Estreich9,
  10. Georgina Morris10,
  11. Jara Phattey11,
  12. Ann K Sullivan1
  13. on behalf of the members of the British Society for Sexual Health and HIV National Audit Group, and the British HIV Association Audit and Standards Subcommittee
    1. 1Directorate of HIV/GU Medicine, Chelsea and Westminster NHS Foundation Trust, London, UK
    2. 2Audit and Standards Sub-committee, British HIV Association, London, UK
    3. 3Genitourinary Medicine, Cambridge Community Services, Cambridge, UK
    4. 4City Health Care Partnership, Hull, Kingston Upon Hull, UK
    5. 5Department of GU Medicine, Royal Hallamshire Hospital, Sheffield, UK
    6. 6Reader in Sexual Health and HIV, Barts and the London School of Medicine and Dentistry, Centre for Immunology and Infectious Disease, London, UK
    7. 7Brighton and Sussex University Hospital NHS Trust, Brighton, East Sussex, UK
    8. 8Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK
    9. 9Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
    10. 10Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
    11. 11Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
    1. Correspondence to Dr Michael Rayment, Consultant Physician, St Stephen's Centre, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK; michaelrayment{at}nhs.net

    Abstract

    Objectives Partner notification (PN) is a key public health intervention in the control of STIs. Data regarding its clinical effectiveness in the context of HIV are lacking. We sought to audit HIV PN outcomes across the UK.

    Methods All UK sexual health and HIV services were invited to participate. Clinical audit consisted of retrospective case-note review for up to 40 individuals diagnosed with HIV per site during 2011 (index cases) and a review of PN outcomes for up to five contacts elicited by PN per index case.

    Results 169/221 (76%) clinical services participated (93% sexual health/HIV services, 7% infectious diseases/HIV units). Most (97%) delivered PN for HIV. Data were received regarding 2964 index cases (67% male; 50% heterosexual, 52% white). PN was attempted for 88% of index cases, and outcomes for 3211 contacts were audited (from an estimated total of 6400): 519 (16%) were found not to be at risk of undiagnosed HIV infection, 1399 (44%) were informed of their risk and had an HIV test, 310 (10%) were informed of the risk but not known to have tested and 983 (30%) were not informed of their risk of HIV infection. Of 1399 contacts tested through PN, 293 (21%) were newly diagnosed with HIV infection. Regular partners were most likely to test positive (p<0.001).

    Conclusions HIV PN is a highly effective diagnostic strategy. Non-completion of PN thus represents a missed opportunity to diagnose HIV in at-risk populations. Vigorous efforts should be made to pursue PN to identify people living with, and at risk of, HIV infection.

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    Footnotes

    • Handling editor Jackie A Cassell

    • Twitter Follow Michael Rayment at @mikeyrayment

    • Collaborators Members of BASHH National Audit Group: Ann Sullivan, Hugo McClean, Chris Carne, Vanessa Apea, Anatole Menon-Johansson, Meena Gupta, Liz Anderson, Huw Price, Andy Williams, Sarup Tayal, Say Quah, Cara Saxon, Gill Wildman, Ciara Cunningham, Amelia Hughes, Andrew DeBurgh-Thomas, Steven Ostrich, Manjula Pammi, Meena Sethupathi, Sara Scofield, Sumit Bhaduri, Maneh Farazmand, Emma Street, Sophie Brady, Michael Rayment, David Daniels, Helen Wiggins, Erna Buitendam, John Saunders, Helen Ward, Jamie Hardie. Members of the BHIVA Audit and Standards Sub-committee: Andrew Freedman, Ann Sullivan, Brian Angus, David Asboe, Garry Brough, Fiona Burns, David Chadwick, Duncan Churchill, Valerie Delpech, Katja Doerholt, Yvonne Gillette, Aoife Molloy, Chinyere Okoli, Ed Ong, Alison Rodger, Caroline Sabin, Julie Musonda, Sonia Raffe, Michael Rayment.

    • Contributors All authors designed the audit, coordinated data collection and reviewed and analysed the data. MR drafted the article and all authors reviewed it. Members of the BASHH National Audit Group and BHIVA Audit and Standards Subcommittee contributed to the design, conduct and analysis of the audit.

    • Funding This audit was funded by the National Audit Group of the British Association of Sexual Health and HIV, and by the Audit and Standards Subcommittee of the British HIV Association.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All original and unpublished data are available on request. Please direct enquiries to Hilary Curtis at: hilary@regordane.net.

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