Interventions to Identify HIV-Positive People Through Partner Counseling and Referral Services

Partner counseling and referral services (PCRS) are part of the spectrum of care for HIV-positive people and their sexual or needle-sharing partners. Referral involves notifying partners of exposure, after which they are (ideally) tested and receive prevention or risk reduction counseling or enter into care (if they test positive).

Methods of PCRS include:

• Provider referral:
  • The HIV-positive patient voluntarily discloses information about partners
  • Provider or other public health professional notifies partner(s)
• Patient referral:
  • The HIV-positive patient notifies partner(s)
• Contact referral:
  • The HIV-positive patient voluntarily discloses information about partners
  • The patient agrees to notify partners within a certain time period
  • If all partners are not contacted and notified, the provider can complete the process

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force recommends provider referral partner notification based on sufficient evidence of effectiveness in increasing HIV testing and identification of previously undiagnosed HIV-positive individuals.

The Task Force finds insufficient evidence to determine the effectiveness of partner notification using either patient or contact referral because too few studies qualified for review.

Task Force Finding

Results from the Systematic Reviews

Nine studies assessing provider referral qualified for the review and examined a series of related outcomes.

• Number of partners located and notified: 67% (8 studies)
• Number of notified partners (with unknown HIV status) who were tested: 63% (6 studies)
• Number of tested partners who were HIV-positive: 20% (7 studies)
• There was little difference among the three partner-notification methods evaluated (provider, patient, and contact referral) in terms of the mean number of infected individuals identified (although very few studies tested patient or contact referral).
• Behavioral changes after partner notification:
  • There were changes in the direction of safer sexual behavior with HIV partner notification.
  • Small number of studies and diversity of comparisons and outcomes precludes firm conclusions.
• Data do not suggest substantial harms to the person who is screened and found to be HIV positive resulting from partner notification services (two studies).
• The studies in this review were conducted among a variety of populations (black and white men and women; gay, bisexual, and straight; intravenous drug users or not), in a variety of settings in the United States (statewide in seven states and locally in several cities), over a 20-year period.

Economic Review

An economic review and cost-effectiveness analysis, using the same data set as this review and comparing the three methods of referral (provider, patient, and mixed [dual]), found that provider referral is the most cost effective from both provider and societal perspectives.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related prevention of HIV and AIDS.

Supporting Materials

• Analytic framework [PDF - 333KB] - See Figure 2 on page S92
• Research gaps
• Summary evidence tables [PDF - 25KB]
• Included studies
• Search strategy

Publications

Hogben M, McNally T, McPheeters M, et al. The effectiveness of HIV partner counseling and referral services in increasing identification of HIV positive individuals: a systematic review. [PDF - 333KB] Am J Prev Med 2007;33(2S):S89–S100.

Task Force on Community Preventive Services. Recommendations to increase testing and identification of HIV-positive individuals through partner counseling and referral services. [PDF - 36KB] Am J Prev Med 2007;33(2S):S88.

More Community Guide publications about Prevention of HIV/AIDS, other STIs and Pregnancy

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Interventions to identify HIV-positive people through partner counseling and referral services. www.thecommunityguide.org/hiv/partnercounseling.html. Last updated: MM/DD/YYYY.

Review completed: February 2005