WP 41 Using Sexually Transmitted Disease Partner Services to Promote Engagement in HIV Care Among Persons Living with HIV

Wednesday, September 21, 2016
Galleria Exhibit Hall
David Katz, PhD, MPH1, Matthew R. Golden, MD, MPH2, Teal Bell, MPH3, Roxanne Kerani, PhD4, Mark Aubin, BA5, Zandt Bryan, BS6, David Kern, BA7, David Heal, MSW6 and Julia Dombrowski, MD, MPH8, 1Department of Medicine, University of Washington, Seattle, WA, 2Department of Medicine, Division of Allergy and Infectious Disease, and Public Health - Seattle & King County HIV/STD Program, University of Washington, Seattle, WA, 3Infectious Disease Assessment Unit, Washington State Department of Health, Olympia, WA, 4HIV/STD Control Program, Public Health - Seattle and King County, Seattle, WA, 5STD Services Section, Washington State Department of Health, Olympia, WA, 6Washington State Department of Health, Olympia, WA, 7Chicago Department of Public Health, Chicago, IL, 8Div Infectious Diseases, Medicine, University of Washington, Seattle, WA

Background: Persons living with HIV (PLWH) are at elevated risk for other sexually transmitted diseases (STDs). STD partner services (PS) provide an opportunity to identify PWLH who are inadequately engaged in HIV care and link or relink them to care.

Methods: In May 2012, disease intervention specialists (DIS) in Washington State began routinely assessing HIV care and antiretroviral therapy (ART) status during PS interviews. DIS provide or refer PS recipients identified as inadequately engaged in care to re-linkage services. Among STD cases receiving PS, we identified the proportion of PLWH who reported inadequate engagement and who, of those, were virally suppressed within 6 months following interview. Inadequate engagement was defined by 3 hierarchical criteria based on self-report: 1) not having an HIV care provider, 2) no completed appointment in the prior six months and none scheduled in the next two months, or 3) not taking ART. We used HIV surveillance to assess viral suppression, defined as an HIV RNA <200 copies/mL. 

Results: From May 2012-June 2015, 1801 PLWH were diagnosed with a total of 3178 bacterial STDs in Washington State; 2143 (67%) of the total cases received PS. Among PS recipients, 400 (19%) reported inadequate engagement: 81 (3.8%) reported no provider, 92 (4.3%) no recent or upcoming provider visit, and 227 (11%) not taking ART. Thirteen percent of syphilis, 23% of gonorrhea, and 17% of chlamydia cases reported inadequate engagement (p<0.0001). Of 392 reporting inadequate engagement who matched to HIV surveillance, viral suppression increased from 26% in the year prior to interview to 44% in the subsequent 6 months (p<0.001).

Conclusions: Approximately 1 in 5 PLWH interviewed for STD PS reported inadequate engagement in HIV care. In this group, a moderate increase in viral suppression occurred following DIS relinkage efforts; however, the effectiveness of this approach is uncertain without comparison against a control group.