Partners of People Living with HIV: Health Care Delivery in a

1,2
1,2
2
1,2
Ana Vsquez, MD ; Renato A. Errea, MD ; Daniel Hoces, MD ; Elsa Gonzlez, MD ; Eduardo
Referral Hospital in
Lima-Peru
1,2,3

No.
397

Ana Luca Vsquez Choy, MD

Universidad Peruana Cayetano
Heredia
Email: ana.vasquez.c@upch.pe
Phone: +511 987 760 449
Address: Calle 27 N290 San Borja
3
,
Lima- Peru
Table 1. HIV concordant couples: Comparison
of clinical

Gotuzzo, MD

Contact

School of Medicine - Universidad Peruana Cayetano Heredia (UPCH), 2Instituto de Medicina Tropical Alexander von Humboldt UPCH Hospital
Cayetano
Heredia,
Lima
Fig 1. Initial and follow-up HIV testing among eligible partners
Abstract
Methods
characteristics between index cases and their partners enrolled in

Background: Given the recommendation of antiretroviral

therapy to people living with HIV (PLWH) in serodiscordant
couples, partners of PLWH concentrate major health needs. We
describe the frequency and circumstances for partners HIV
testing under the routine of a Peruvian referral hospital during a
ten-year period.
Methods: Secondary data analysis of five routine databases from
the study center. Index cases (ICs) were PLWH at least age 18
enrolled at the HIV program between 2005 and 2014 reporting a
unique partner not previously tested for HIV at the study center. If
ICs reported at entry that their partners HIV status was
Unknown or Negative, these partners were eligible for HIV
testing. The main outcome was the frequency of HIV tests among
eligible partners. Secondary outcomes were: (a) Circumstances
under which partners HIV testing occurred, (b) not occurred, and
(c) clinical differences among HIV concordant ICs and partners
enrolled in the HIV program.
Results: 3677 PLWHs were enrolled in the HIV program, 39%
reported a unique partner, 40% reported not knowing their
partners HIV status. Among partners eligible for HIV testing (n =
896), 10% had initial HIV testing; follow-up testing was 36%; and
51% of HIV tests were unrelated to preventive activities after IC
diagnosis. 42% of ICs had posterior visits at the study center that
did not result in partners testing. Partners that were timely
tested (within 3 months after entry of the IC), found to be HIVpositive and enrolled in the HIV program had less hospital
admissions and were less in HIV WHO stage IV compared to ICs
(p<0.05).

Background

Conclusion:
Under
this routine conditions,
there
are still
Given that HIV
transmission
is primarily
driven
by missed
sexual
opportunities for the timely provision of health services to
contact, the partners of people living with HIV (PLWH)
partners of PLWH. This situation
1-3 can preclude the successful
concentrate major health needs .
implementation of treatment as prevention for serodiscordant
couples.
Within the concept of Treatment as Prevention (TasP),
antiretroviral (ARV) therapy to PLWH in serodiscordant couples
is being progressively implemented 4-5, as recently occurred in
Peru6. However, partners identification and notification still
collide with ethical and legal aspects.

This study describes the results of health care delivery to

partners of PLWH, with special focus on frequency and
circumstances for partners HIV testing under routine
conditions in a Peruvian referral center during a ten-year
period.

Study Design and Data Sources

Secondary data analysis of routine databases available at the study
center including the HIV program, laboratory, inpatient and
outpatient infectious diseases services.
At entry at the HIV program, PLWH are routinely asked about the
HIV status of their sexual partners.
In order to identify Index cases and partners, databases were linked
by a compound identifier formed with the initials, sex and year of
birth.
Definitions:
Index cases (ICs) were PLWH with at least age 18 enrolled at the
HIV program between Jan 2005 and Dec 2014 reporting a unique
partner not previously tested for HIV at the study center.
If ICs reported at time of entry that their partners HIV status was
Unknown or Negative, these partners were considered eligible
for HIV testing.
The first partners HIV test after entry of the IC was reported as
Initial. The subsequent test up to March 2015 were reported as
Follow-up.
Timely tested was a partners HIV test done up to 3mo after entry
of the IC.
Data Measurements:
Main outcome: Frequency of initial and follow-up HIV tests among
eligible partners.
Secondary outcomes: (a) Circumstances under which HIV testing
occurred, (b) encounters of the IC with the study center that did
NOT lead to partners HIV testing, and (c) clinical differences
Results
between IC and partners with
positive HIV status enrolled in the HIV
program
During the study period, 3677 PLWHs were enrolled in the HIV
program.
At entry, 39% reported a unique partner with 4 years
Ethical
aspects:
The
(IQR: study
1.6-9) protocol
as median
in thebyrelationship;
40%
was time
approved
the IRBs from
the(571)
two
reported not knowing
partners
HIV and
status.
institutions
involved.their
Match
of IC
partners was done
anonymously.
Among partners eligible for HIV testing, 10% (88/896) had initial
HIV testing; follow-up testing was 36% (8/25). (Fig. 1)
Among partners eligible for HIV testing, the frequency of initial HIV
tests did not increase throughout the ten year period.
Among eligible partners, 51% (45) of HIV tests were unrelated to
preventive activities after IC diagnosis; 42% (343) of ICs had
encounters with health services at the study center that did not
result in partners testing. (Fig. 2)
Compared to ICs, the subgroup of partners that were timely tested
with a resulting positive HIV test and posteriorly enrolled in the HIV
program had significantly less hospital admissions and were less
likely to be in HIVAcknowledgments
WHO stage IV. (Table 1)
We are grateful to all the staff from the HIV program at Hospital Cayetano
Heredia and at the HIV Research Unit of the Institute of Tropical Medicine
Alexander von Humboldt .
This study was supported by Fogarty International Center at the U.S. National
Institutes of Health (NIH) through the Program for Advanced Research
Capacities for AIDS in Peru (PARACAS) [grant number D43TW00976301].

the HIV program

Clinical
characteristic

Reason for HIV

testing
Signs and
symptoms of
HIV/AIDS infection
Seropositive
partner
Perceived risk
Pregnancy

Index
cases
(n=48)
N (%)

HIV-positive
partners
(n=48)
N (%)

19(40)

2(4)

0.36

0(0)

39(82)

0.82

7(15)

0(0)

0.15

7(15)

2(4)

0.11

3(6)

1(2)

0.04

12(24)

4(8)

0.16

Prevalence
difference

P [IC]

Others

<0.001
(0.21,0.51)
<0.001
(0.71,0.93)
0.005
(0.05,0.25)
0.06 (0.01,0.23)
0.3 (-0.04,0.12)

Unknown

0.03 (0.02,0.3)

WHO Clinical
Stage IV at
enrollment
Late tester

14 (30)

3 (7)

0.23

22 (46)

15 (32)

0.14

Indication of

30(63)

23 (49)

0.14

HAART
Linkage to care

30 (63)

23 (49)

0.14

Viral suppression

Fig 2. HIV testing and not testing among eligible partners:

Circumstances of HIV testing and encounters of index cases not
leading to partners HIV testing

26/34 (77)
Limitations

31/42 (74)

0.03

0.003
(0.09,0.38)
0.16 (0.05,0.33)
0.18 (0.06,0.33)
0.18 (0.06,033)
0.75 (-

0.19,0.14)
We did not have information of disclosure rates to partners
or
Hospital
23/139 (17) 8/184 (4)
0.12
<0.001
information
of
partners
that
might
receive
care
in other
admission
(0.05,0.19)
health
centers.
index
(personyear)
In spite of <%5 missing data, probably not every couple
Mortality
3(6)
0(0)
0.06
0.08 (0.01,0.13)
could be identified
and matched.
We excluded subjects with multiple partners and did not
consider sexual orientation, as such information was limited
in the original data sources.
Conclusions

In the setting described, we identified missed opportunities

for the timely provision of health services to partners of
PLWH. Furthermore, many of the HIV tests in partners may
not have been the result of prevention services, but of
posterior clinical needs of partners.
Under routine conditions, HIV programs might struggle to
timely deliver prevention services, which might be restricted
to the initial encounters and may not be aligned to PLWH
changing needs in time.
This situation can preclude the implementation of treatment
as prevention for serodiscordant couples, as currently
recommended.
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