A high number of HIV-positive sex partners identified through assisted partner notification services in Namibia, most previously diagnosed HIV-positive


BACKGROUND: Trials evaluating assisted partner services (APS) have reported case-finding indices (# newly diagnosed partners/index cases) of 0.2 ' 0.4. Many nations are implementing large APS programs. We report program outcomes of intensified APS implementation in Namibia, a nation nearing HIV epidemic control.
DESCRIPTION: Healthcare workers (HCW) in four public clinics offered APS to HIV patients newly diagnosed and previously diagnosed with viral loads >1,000 copies/mL (HVL). Using a structured interview guide, HCWs elicited information on index cases' sex partners from the prior 24 months and offered HIV testing to partners who had not been previously HIV diagnosed and not tested HIV-negative within 30 days. We analyzed APS program data collected May 2019-May 2020.
LESSONS LEARNED: HCWs provided APS to 333 (70%) of 479 newly diagnosed index cases (Figure 1); they identified 461 sex partners, of whom 325 were eligible for HIV testing, 141 tested and 43 (30% of tested) were newly diagnosed HIV-positive. Ninety-nine HVL index cases received APS naming 121 partners, of whom 34 tested and 9 (26.5% of tested) were newly diagnosed HIV-positive. The case-finding index was higher among newly diagnosed compared to HVL index cases (0.13 vs. 0.09). A total of 170 index cases (39%) identified >1 HIV-positive partner, of whom 132 (72%) had been previously diagnosed and 122 (92%) were receiving HIV care. All 52 newly diagnosed HIV-positive individuals were linked to HIV care.

CONCLUSIONS: Although HIV positivity was high and almost half of index cases identified an HIV-positive partner, case-finding was lower than reported in APS trials and particularly low in HVL index cases. Further investigation is needed to determine if an HVL threshold exists above which HIV-positive partners are most likely to be identified for more targeted APS. Most HIV-positive partners were previously diagnosed, which may be expected from APS implementation in countries nearing HIV epidemic control.