Maximizing HIV partner notification opportunities for index patients and their sexual partners in Malawi|
Kamanga, G.; Brown, L.; Jawati, P.; Chiwanda, D. & Nyirenda, N.
HIV testing and counselling (HTC) is important to effect positive
sexual behaviour change and is an entry point to treatment, care, and
psychosocial support. One of the most practical initiatives to increase
HTC is to encourage sexual partners of HIV-infected persons to test
for HIV. However, partner notification strategies must be feasible in the
healthcare setting and acceptable to the population.
We conducted a qualitative study during the pilot phase of an HIV
partner notification trial to complement its assessment of feasibility and
acceptability of methods of partner notification. We performed in-depth
interviews with 16 consecutive HIV-positive index participants who
consented and their 12 identifiable sexual partners. We also conducted
two focus group discussions with healthcare workers to supplement the
In the main study, newly diagnosed HIV cases (index cases) were
randomized to one of three methods of partner notification: passive,
contract, and provider referral. Clients in the passive referral group were
responsible for notifying their sexual partners themselves. Individuals in
the contract referral group were given seven days to notify their partners,
after which a healthcare provider contacted partners who had not reported
for counselling and testing. In the provider group, a healthcare provider
notified partners directly.
Although most index participants and partners expressed a preference for
passive notification, they also highlighted benefits for provider-assisted
notification and the universal right for all HIV-exposed persons to know
their HIV exposure and benefit from HIV testing and access antiretroviral
treatment. Several participants mentioned couples counselling as a way to
diffuse tension and get accurate information. All mentioned benefits to
HIV testing, including the opportunity to change behaviour.
Provider-assisted partner notification is not preferred, but it is acceptable
and may complement the passive method of notification. Couples
counselling should also be encouraged.