Interrupting transmission of HIV and other sexually transmitted infections in Rhode Island.

Volume 95 No. 8 August 2012 trAnsmIssIon of humAn ImmunodefICIenCy virus (HIV) and other sexually transmitted infections (STI) in Rhode Island, a central New England location for many gay sex club venues, continues to be a public health challenge despite close collaboration between health care providers, community-based agencies, and the RI Department of Health (HEALTH). In December 2010, HEALTH requested assistance from the Centers for Disease Control and Prevention (CDC) to further understand a recent increase in syphilis and HIV infections among men who have sex with men (MSM) in RI. MSM comprise the majority of persons diagnosed with both syphilis and HIV infection in RI; increasing from 79% (27/34) in 2009 to 89% (54/61) in 2010 among new syphilis cases, and increasing from 47% (59/125) in 2009 to 51% (54/106) in 2010 among newly diagnosed HIV infections. The CDC evaluation highlighted HIV testing deficits among MSM and the need to increase HIV and STI testing, as well as early diagnosis. Many MSM in RI were not routinely tested for HIV and other STI, nor were they linked to appropriate care upon diagnosis, regardless of having a primary care provider. A key to effectively reducing HIV and other STI transmission in RI is understanding the epidemiology of those infections and their transmission from index cases to their sexual partners, which depend on routine testing, timely case reporting, and appropriate treatment. In identifies potential sexual partners of index cases and notifies these partners of their potential exposure to gonorrhea, syphilis, and HIV (i.e. contact tracing or partner notification). Sexual partners of chlamydia cases are not notified due to the high case volume, except with prioritized cases or upon provider request. Five methods of partner notification are employed with varying levels of effectiveness. (1) Provider referral: a specifically-trained health department employee, often referred to as a partner notification specialist or disease intervention specialist (PNS/DIS), interviews the index case, obtains their possible sexual partners and notifies them; (2) Third party referral: professionals other than HEALTH staff members carry out partner notification (e.g., HIV counselors or clinicians); (3) Self-referral: index cases choose to notify their sexual partners on their own; (4) Contract referral: the index case agrees to notify partners and if not successful or completed, the provider then intervenes and follows-up; and (5) Dual referral: both the index case and the provider notify partners of potential sexual exposures. Provider referral has been shown to be the most effective single method for partner notification, while self-referral is the least effective. Given that more partners are treated through partner notification services rather than through other strategies, treatment of sexual partners is valuable for control of infection and cost-effective for averting interrupting transmission of HiV and other sexually transmitted infections in Rhode island