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Background: The Centers for Disease Control and Prevention recommends all HIV+ persons newly diagnosed with gonorrhea or chlamydia infection receive partner services due to the potential for HIV transmission. There are no published evaluations of these investigations’ effectiveness in identifying undiagnosed HIV infections among named contacts.
Methods: The study population included males ≥13 years diagnosed with chlamydia (CT) or gonorrhea (GC) infection in Texas between January 1, 2005 and December 31, 2014 with an HIV diagnosis date ≥30 days prior and were reported to Texas’ HIV and STD surveillance systems. Males with a concurrent diagnosis of syphilis were excluded. The primary outcome evaluated was the Number Needed to Treat (NNT), defined as the number of disease investigations initiated per new HIV diagnosis among named contacts. The NNT was compared across demographic groups and diagnosis years.
Results: Over the study period, 971 of 10,829 (9%) HIV+ men diagnosed with CT (32%) GC (63%) or dual CT/GC infection (5%) were initiated for partner services, and a total of 25 new HIV cases were diagnosed among their named contacts (overall NNT=39). The NNT was lowest in heterosexual males (NNT=18), males living with HIV >8 years (NNT=22) and white males (NNT=24), and highest in males diagnosed with HIV <1 year prior (NNT=108). The proportion of CT/GC diagnoses in HIV+ males initiated for partner services increased from 5% (n=15) in 2005 to 14% (n=285) in 2014, and the NNT increased from 2 to 285 over the same time period. In over half (55%) of the initiated investigations, partner services did not obtain any contacts from the patient.
Conclusions: The current protocol for investigating CT/GC diagnoses in HIV+ males may not be an effective intervention for identification of undiagnosed HIV infections. Reducing the scope of initiated cases by targeting demographic groups with high NNTs may increase the case yield.