A Randomized Trial Of Improving Partner Notification With Assisted Partner Notification Services Among HIV Positive MSM

Objective: MSM(men who have sex with men)population is one of the high-risk populations affected by the HIV epidemic.HIV prevalence has been increasing rapidly,and great changes have taken place in the AIDS epidemic of china now.At present,the HIV epidemic situation of MSM in China is severe.HIV prevalence and HIV incidence of MSM population is increasing rapidly.Facing of the severe HIV epidemic,we need more effective intervention measures to control the epidemic,and control the source of infection is an important link in the disease prevention.PN(partner notification)can control the transmission of HIV by controlling the source of infection,protecting the susceptible population and cutting off the transmission path.It is one of the effective measures to block the HIV second generation transmission.Although partner notification plays an important role in controlling the HIV transmission,relatively few cases have been successfully tracked in MSM population compared with other populations.The partner notification rate of HIV positive MSM population in China was between 30% and 50%,which was lower than that in USA,Australia,Spain and Peru.Several randomized controlled studies have been conducted abroad to promote sexual partners HIV counseling and testing for HIV infected people.According to the results of the study,the medically assisted measures increased the number of sexual partners who underwent HIV counseling and testing relatively.There is no specific RCT study on partner notification for HIV positive MSM in China,and it is still unknown whether the medical assisted promotion strategy can promote partner notification of HIV positive MSM in China.The purpose of this study was to explore the role of medical aids in improving peer notification and expanding the number of sex partners for HIV testing and counseling and provide scientific basis for controlling HIV transmission in MSM population in China.We have three aims in this study as the follows: 1.Assess the role of Medical Assistance Strategies in HIV positive MSM Informed male Sexual Partners of their HIV positive results;2.Clear the promoting effect of Medical Auxiliary Strategy on promoting the HIV detection of male sexual partner in HIV positive msm population;3.To explore the influencing factors of HIV positive results in HIV positive MSM population to inform male sexual partners,relatives and friends and influencing factors of HIV positive MSM population promoting HIV testing among male sexual partners.Methods: The subjects are HIV positive MSM was recruited from the VCT clinic and the AIDS treatment Clinic of the first affiliated Hospital of China Medical University in Shenyang,Liaoning Province from August 2017 to January 2019.The target population was randomly divided into intervention group and control group.The control group adopted the traditional patient notification promotion strategy(the subjects informed their partners of HIV positive results and promoted their partners to carry out HIV voluntary counseling and testing).On the basis of patient notification strategy,the intervention group applied medical assistant promotion strategy,that is,providing knowledge education to promote partner notification and increasing medical assistant promotion measures(Medical staff and subjects jointly promote partner testing for HIV or medical staff promote partner testing for HIV).Baseline data were collected to collect socio-demographic information on the characteristics of high-risk sexual behaviors associated with HIV.A prospective follow-up was conducted every 1 month,and the rate of partner notification and partner participation in HIV testing were obtained for 4 months in the intervention group and the control group.SPSS20.0 was used for statistical analysis.Chi-square test was used to compare the demographic and HIV-related high-risk sexual behaviors between the two groups.Chi-square test was used to analyze the difference in the rate of partner notification and the HIV detection rate of sexual partners between intervention group and control group.The difference in the number of partners tested for HIV between intervention group and control group was analyzed by generalized linear model.Multivariate logistic regression model was used to analyze the statistical correlation between predictive variables and HIV-positive MSM for male sexual partners,relatives/family members and friends to inform HIV-positive results and promote HIV testing among sexual partners after correcting confounding factors(age,household registration and educational level).Bilateral P < 0.05 was the test level with significant statistical difference.Results:1.Comparison of the basic characteristics of the two groups: in this study,198 HIV positive MSM patients were included in the study,including 104 in the intervention group(52.5%)and 94 in the control group(47.5%).The chi-square test showed that the proportion of having casual partners in the intervention group was higher than that in the control group,and the balance of social demographic information and sexual behavior information was comparable between the two groups.2.The influence of intervention on subjects informed their male sexual partners of the HIV positive results: At 1,2,3,4 months of follow-up,51.0%(53/104),51.9%(54/104),52.9%(55/104)and 53.8%(56/104)of subjects informed sexual partners of HIV positive results in the intervention group,respectively,compared with 51.1%(48/94),52.1%(49/94),52.1%(49/94)and 52.1%(49/94)respectively in the control group.Chi-square analysis showed that there was no significant difference in the informed proportion between the two groups at the same time after intervention(p > 0.05).3.Relevant factors analysis of HIV positive MSM informed male sexual partners of HIV positive results: Multivariate logistic regression found that non-single(vs.single,AOR=8.08,95%CI= 4.18-15.65,P< 0.001),monthly income was more than 5000(vs.Less than 3000,AOR= 2.23,95%CI= 1.05-4.72,P= 0.036),come out of the closet(vs.non come out of the closet,AOR= 2.71,95%CI= 1.29-5.72,P= 0.009),having regular partners(vs.non,AOR= 32.23,95%CI= 12.85-80.85,P< 0.001),non(vs.having casual partners,AOR= 2.20,95%CI= 1.15-4.20,P= 0.017),homosexuality(vs.non homosexuality,AOR= 1.94,95%CI= 1.02-3.69,P= 0.047),non(vs.via internet to seek partners,AOR= 3.32,95%CI= 1.59-6.52,P= 0.047)were the risk factors for HIV positive MSM to inform male sexual partners of the positive results.4.Effect of intervention on HIV testing behavior of sexual partners among subjects and HIV prevalence of sexual partners between the two groups: At 1,2,3,4 months of follow-up,18.3%(19/104),27.9%(29/104),28.8%(30/104)and 31.7%(33/104)of MSM in the intervention group promoted male sexual partners to carry out HIV tests,respectively,compared with 13.8%(13/94),14.9%(14/94),16.0%(15/94)and 17.0%(16 / 94)in the control group,respectively.Chi-square analysis showed that there was no significant increase in the propelling partners rate at one month's follow-up(p = 0.397),but at 2 months(p = 0.027),3 months(p = 0.031)and 4 months(p = 0.017),propelling partner rate was significantly higher than that in the control group.There was no significant difference in HIV positive rate between intervention group and control group(P = 1.000),which was 20.9%(10/48)and 26.3%(5/19)respectively.5.Relevant factors analysis of HIV positive MSM successfully promoting HIV testing in sexual partners: Multivariate logistic regression found that Medically assisted push strategy(vs.Patient driven strategy,AOR=2.35,95%CI= 1.18-4.70,P= 0.016),non-single(vs.single,AOR=8.08,95%CI= 4.18-15.65,P< 0.001),having regular partners(vs.non,AOR= 6.76,95%CI= 2.51-18.19,P< 0.001),first sexual intercourse year was more than 25 years old(vs.first sexual intercourse year under 25 years old,AOR= 3.05,95%CI= 1.04-8.94,P= 0.042)and non informed.(vs.inform male sexual partners of the positive results,AOR= 12.91,95%CI= 4.82-34.55,P< 0.001)were the risk factors for HIV positive MSM to promote sex partner to detect.Conclusion: Assisted partner notification services have limited effect on informing sexual partners of HIV positive results,but it can significantly promote partners HIV detection.HIV positive MSM who were not single,high income,out of the cabinet and not seek sexual partners through internet / same-sex social software were more willing to inform sexual partners of HIV positive results.HIV positive MSM who are not single,have regular sex partner and have sex partner are more willing to promote HIV detection of sex partner.