Case finding among sexual partners to HIV positive individuals in Cameroon.

Thesis (Master's)--University of Washington, 2017-08Background: Heterosexual transmission of HIV accounts for a significant proportion of new HIV infections in sub-Saharan Africa with individuals unaware of HIV status at risk of transmitting the virus to their sexual partners. Partner services (PS) have been in use at the Cameroon Baptist Convention Heath Services (CBCHS) program to promote partner notification, early HIV testing, diagnosis and initiation to treatment for sexual partners to newly diagnosed HIV positive individuals (index persons). The goal of this study is to define the scalability, effectiveness and safety of partner services within the CBCHS PS program. Methods: We conducted a secondary analysis of CBCHS program data from 2007 to 2015 to evaluate the overall scale and partner notification outcomes; using data from 2014-2015, we determined index person (IP) and program factors associated with HIV case-finding; as well as adverse outcomes including partnership dissolution, loss of financial support and physical intimate partner violence (IPV). Descriptive analyses were used to define the overall scale of the program; and adverse outcomes at enrolment and follow-up, overall and stratified by gender. Logistic regression with clustering on the IP was used to describe factors associated with HIV case finding. Results: Overall, the CBCHS program interviewed 18,730 IPs who mentioned 21,057 sexual partners (index: partner ratio = 1:1.08) with a 10-fold increase in number of individuals that occurred mainly from 2007- 2010 before slowing down from 2011 - 2015. Between 2014 and 2015, 1261 IPs and 1357 sexual partners were mentioned. IPs were mainly female (63.8%), median age: 36 years (Interquartile Range [IQR]: 30, 43), married monogamous: 47.9% and seen at rural facilities (70.1%). Sexual partners were male (61.3%), median age 36 years (IQR: 30, 42), and married (57.0%). Ninety percent (n=1224) of the 1357 sexual partners, were notified in-person either by the IP or the health advisor and were offered HIV testing services. HIV prevalence among the 1224 notified sexual partners was 27.2% [previously diagnosed: 170/1224, 13.9%; newly diagnosed HIV positive: 163/1224, 13.3%]. HIV case finding was less likely to be associated with health advisor notification compared to IP notification [adjusted odds ratio [aOR] = 0.66, 95% confidence interval [CI]: 0.47, 0.93]. 19.7% of the IPs reported a history of IPV at enrolment to the PS program (female: 24.2%, male: 15.8%). On IP follow-up after receipt of PS, 61 (6.3%) had partnership dissolution, 15 (1.5%) had lost financial support while 11 (1.1%) sustained physical IPV. Three clients of the eleven reporting physical IPV after receiving PS (27.3%) attributed it to the intervention. Discussion: The CBCHS PS program was scalable, safe and had high HIV case finding compared with other HIV testing methods. IPV was relatively common in Cameroon. However, very few IPs receiving PS reported adverse outcomes following receipt of partner services. Partner services can be a useful component of routine HIV services to augment HIV testing to individuals at risk of HIV acquisition in sub-Saharan Africa countries