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Background: One in three early syphilis diagnoses in Milwaukee, Wisconsin during 2012-2014 had a prior HIV diagnosis; the majority of both infections occurred in young Black MSM. In order to reduce new infections, the state and city health departments conducted an investigation in 2015 and prioritized HIV and syphilis cases for follow-up by Disease Intervention Specialists (DIS).
Methods: Males aged <30 years diagnosed with HIV or early syphilis in Milwaukee County during 2012-2014 were identified through HIV and STD surveillance systems. Their sexual partners were analyzed through partner services data systems. The HIV surveillance system provided information on HIV care and viral load status in the 6 months prior to the investigation. LexisNexis® Accurint® was used to update locating information for cases and partners.
Results: The investigation identified 617 individuals. Nearly half (n=254, 46%) had a disease diagnosis during the period: HIV (n=152), PSEL syphilis (n=82), or both (n=47). The remaining 54% (n=336) were partners; the majority (n=257) tested HIV-negative or had no HIV test on record. Non-virally suppressed or out of care HIV-positive clients (n=102), and HIV-negative clients with an HIV-positive partner or a syphilis diagnosis and 3+ named partners, (n=159) were identified for follow-up. The majority was found to be out of jurisdiction or unable to locate. However 11 HIV-positive clients were found to be in care and 8 were re-linked to HIV care; 14 high-risk HIV-negative individuals were re-interviewed and offered HIV and syphilis testing and referral to HIV pre-exposure prophylaxis.
Conclusions: HIV and syphilis case report and partner data can enable individual-level follow-up to help avert new infections. Contacting those with current risk indicators would likely yield improved outcomes. The investigation led to generation of weekly lists of high-risk HIV and syphilis cases for timely follow-up by DIS.