WHAT A Cluster!

Background:  Clustering is a very effective practice of identifying and locating social contacts of individuals associated with syphilis; but can clustering of individuals associated with HIV portend an effective practice for finding new disease? Wichita had a cluster of disease in the first half of 2009 that helps resolve this question.

Objectives:   Promote field education and testing in at risk populations that otherwise may be missed by health care resources.  Ensure disease intervention occurs within a social context.

Methods:  Conducted thorough clustering and partner elicitation of HIV cases according to program instruction and field training to elicit the maximum number of individuals that are potentially exposed and associated socially.  All sexual partners and clusters receive, thorough clustering and partner elicitation according to programmed instruction and field training, interviews to elicit the maximum number of those potentially exposed and associated socially.

Results:   Thorough clustering and partner elicitation from a single new HIV case resulted in 13 sexual contacts.  Clustering these sexual contacts resulted in 36 individuals receiving testing and two new HIV cases and one new syphilis case.  Clustering the clusters resulted in 67 additional individuals tested with two new syphilis infections.  Three HIV infections, 1 early latent syphilis case and 2 primary syphilis cases were identified through thorough clustering of one individual HIV case. 

Conclusions:  When new HIV cases have engaged in casual and anonymous sex, clustering appears to be an effective way to reach into social networks for individuals who may not seek routine medical evaluation because of lack of information and knowledge. 

Implications for Programs, Policy, and/or Research:   Aggressive clustering of individuals with HIV increases the effectiveness of disease intervention for high risk individuals.