HIV partner notification: possible and essential.

摘要: Partner notification has been a long-standing well-accepted public health strategy for the control of sexually transmitted diseases. However, despite also being disease, HIV treated as an exception and partner strategies have lagged behind. In resource-limited settings, where its highest prevalence greatest impact on population, few countries adopted any evidence that it is acceptable1 cost-effective2 in some settings. this issue, Henley colleagues3 report findings from first large-scale implementation services developing country. Like with other STD programs, 3 were offered to infected individuals: patient referral (patient contacts by themselves), provider (partner notified care worker), contract agrees inform partner, but if not done within particular time frame, will notify partner). Overwhelmingly, was chosen participants (59.5%), followed smaller proportions (19.7%) (14.2%). This suggests patients wanted clinic-level support notification. Partner can play important role “test treat.”4 The test-and-treat paradigm postulates epidemics would be curbed all HIV-infected persons tested routinely, identified early, immediately placed lifelong antiretroviral therapy (ART).4 Because landmark HPTN 052 study demonstrated effectiveness early initiation ART prevention strategy,5 approaches increasingly proposed. skeptics argue impossible real-world settings because hinges cascade seeking: uptake counseling testing, linkage pre-ART care, ART, retention care.6 Partner potential improve seeking along several steps cascade. Although article et al.,3 authors do state how many needed approached get one index participate, we know once participated program, yield high. showed only took 1.6 1 person tested, 3.2 identify new positive, 3.8 HIV-positive linked care. current non–test-and-treat environment, these increase likelihood earlier treatment uptake. help initiate likely onward transmission non–index partners. theory, could applied later cascade—asking find partners who already their status linking them care. Partner identifying HIV-uninfected engaged HIV-discordant partnerships goal couple. Persons aware they are relationships display very high consistent condom use. addition, both prevention5 preexposure prophylaxis (PrEP)7 shown effective additional benefit couples. It yet determined whether mutual awareness discordance increases adherence Partners PrEP study, mutually aware, quite high.5,7 Test-and-treat require levels success; possible rates mimic those seen clinical trials5,7 or challenging varies according CD4 status.8 Such may enhanced notification. Although such home-based testing (HCT) resulted offer more efficient, targeted approach. reach fewer total people than HCT campaigns, reaches HIV-related needs. With notification, couples either concordant positive needs discordant most uninfected, negative, especially subsequent campaign rounds.9 incorporate components community based facility HCT, primary emphasis includes facilities approach essentially addresses 2 (testing care) at once. In 2012, World Health Organization issued guidance encouraging couple-based address range context test-and-treat.4,6 described broad areas research. area assess recruiting second research understand programs. This work presented al. aspect area—assessing raises operational questions. conducted antenatal clinics, voluntary counseling, centers inpatient facilities. Understanding different preferred options question. Similarly, had diagnostic yields. did highlight service outcomes differed initial location, women bring suggesting highly successful setting predominate. Strategies targeting location engage men potentially Prevention Mother Child Transmission, maternal adherence, family benefits. Replication warranted determine similar feasible acceptable yields. The still addressed— understanding partner-based program test-and-treat. We speculate result infected, true known without further follow-up. expect couples, seroconversion less occur does need hide pill taking receive social support. well-designed longitudinal long-term impact. There considerable hesitation about strategies: expensive unsustainable harms. criticisms leveraged against sub-Saharan Africa—the introduction use ART. each concerns addressed resource commitments careful resulting significant gains improving outcomes. What clear individuals efficient manner. much remains unanswered regarding optimized ensure engagement overall outcomes, particularly setting. Successful programs essential step realizing full paradigm.