Integrated Partner Services: From Recommendations to Practice

Background: In Houston, 1,191 new HIV diagnoses and 1,834 syphilis diagnoses were reported in 2007.  The integrated Houston HIV/STD partner services program serves Harris County, Texas; the third most populous county in the US spanning 1,700 square miles with 3.7 million residents. 

Objectives: The Houston program has been integrated over 20 years.  Since name-based HIV reporting began in Texas in 1999, Disease Intervention Specialists (DIS) investigate both HIV and syphilis field records initiated directly from the HIV/STD surveillance program.

Methods: To enhance utilization of partner services by high volume medical providers, both public and private, DIS liaisons are assigned to conduct partner services within the medical providers’ office.  The internet is also used to engage hard-to-reach populations, particularly men who have sex with men (MSM), in partner services.  A web-based self-interview has been developed for clients to submit interview data online, and an Internet Partner Services DIS maintains profiles on several “hook-up” sites and conducts partner notification online through these sites.  Monitoring and evaluation of the partner services program is conducted through an intensive quality improvement process consisting of 23 quality indicators.

Results: In 2007, the HIV/STD surveillance program received 11,190 positive syphilis reports and over 54,000 positive HIV reports (including EIA, Western Blot, Viral Load, and CD4).  Of these, over 4,500 field records (3,875 syphilis and 674 HIV) were initiated to DIS.  Thirty-seven percent of the primary and secondary syphilis cases were co-infected with HIV, and one DIS was able to interview these clients regarding both infections.  The majority of the partner services quality indicators were met in 2007.

Conclusions: Traditional partner services techniques in conjunction with innovative strategies such as DIS liaisons and internet partner services create opportunities for success while an intensive quality improvement process ensures that success is achieved.

Implications for Programs, Policy, and/or Research: Although controversial, using surveillance data to initiate partner services in an integrated HIV/STD program is effective and efficient.