February 11, 2019 Logistics 2 Agenda Introduction of presenters - PowerPoint Presentation

February 11, 2019

Logistics 2

Agenda Introduction of presenters Article background, methods, and results DiscussionQ&A 3

Tigran Avoundjian, David Peyton, Kendra Johnson, Sara N. Glick, Matthew R. Golden University of Washington, Public Health Seattle & King County HIV/STD Program, and Mississippi State Department of Health Integrating HIV testing into syphilis partner services

HIV and STDs in the Southeastern US 5 Rates of HIV diagnosis, among adults and adolescents, 2016 Rates of reported primary and secondary syphilis cases, 2016

HIV/AIDS in Jackson, MS 6 Rates of HIV Diagnoses, 2015 Area of residence Rate 1 Miami–Fort Lauderdale–West Palm Beach, FL 38.7 New Orleans–Metairie, LA 33.3 Baton Rouge, LA 30.2 Atlanta–Sandy Springs–Roswell, GA 29.4 Orlando–Kissimmee–Sanford, FL 27.4 Jackson, MS 25.0 Memphis, TN–MS–AR 22.9 Jacksonville, FL 22.9 Las Vegas–Henderson–Paradise, NV 21.8 Houston–The Woodlands–Sugar Land, TX 21.8 Rates of Stage 3 (AIDS) Diagnoses, 2015 Area of Residence Rate 1Jackson, MS16.8Baton Rouge, LA16Miami–Fort Lauderdale–West Palm Beach, FL15.9New Orleans–Metairie, LA14.9Columbia, SC13.0Jacksonville, FL12.8Baltimore–Columbia–Towson, MD12.7Durham–Chapel Hill, NC12.3Atlanta–Sandy Springs–Roswell, GA12.1Winston–Salem, NC11.8

Syphilis Partner Services Syphilis is a known risk factor for HIV acquisition High rates of syphilis and HIV co-infection in the US, particularly among MSM As part of syphilis partner services activities, DIS already contacting partners of early syphilis cases 7

Objective Mississippi State Department of Health (MSDH) and University of Washington (UW) collaboration to evaluate the integration of new HIV-related activities into the MSDH STD Partner Services (PS) program Aim 1: To evaluate the utility of STD PS as a means to increase HIV testing and case-finding Aim 2: To assess the utility of STD PS to reengage persons with HIV to care and promote effective antiretroviral therapy Aim 3: To assess the utility of STD PS for syphilis and gonorrhea as a means to increase HIV testing in high-risk MSM and to link MSM to pre-exposure prophylaxis (PrEP) 8

Syphilis PS Workflow 9 New syphilis diagnosis/positive serological test reported to MSDH DIS contact index cases and conduct interview PRISM DIS contact named partners to test for syphilis, and collect demographic information For partners with new early syphilis infection, DIS conduct full partner services interview DIS offer all partners treatment for syphilis at time of syphilis testing (epi treatment) Case record assigned to DIS for investigation DIS refer partners to STD clinic for rapid HIV testing OR offer blood draw in the field As of 2014:

Study Population Identified all early syphilis cases and their partners from July 2014 through December 2016 Index case: case record in PRISM with diagnosis code for primary, secondary, or early latent syphilis (710, 720, 730)Excluded index cases newly diagnosed with HIV within 30 days of early syphilis infection 10

Outcomes: Syphilis case finding Syphilis testing: evidence of a syphilis serological test in PRISM after being named as a partner New syphilis case: partner had diagnosis code for primary, secondary, or early latent syphilis after being named as a partner 11

Outcomes: HIV case finding HIV testing: HIV test reported within 30 days after being named as a partner New HIV case: partner had HIV diagnosis within 30 days after being named as a partner AND no evidence of previous HIV diagnosis 12

Partner Services Metrics 13 Partners named/contacted Partners epidemiologically treated: number of partners who did not test positive for syphilis but received preventative treatment after DIS contactPartners brought to treatment: partners tested positive for syphilis and received treatment after DIS contactNumber needed to Interview (NNTI): number of index cases needed to interview to identify one new case of HIV or syphilis among partners Test positivity: number of partners testing positive for syphilis or HIV divided by the number of partners tested

Index Case Characteristics 14 53% of MSM previous HIV+ (vs. 5% of MSW/women) Gender/ gender of sex partners HIV Status Race

Partner Services Indices 1 15 1 Index: outcome divided by total number of index cases(n = 1619)

Syphilis/HIV Case Finding 16 NNTI: 2.21 NNTI: 64

HIV case finding by index case characteristics 17

HIV Test Positivity 18

Summary of Findings Syphilis PS yielded substantial number of new syphilis and HIV cases HIV case finding was highest among partners of black MSM and index cases who were previously HIV+ High HIV test positivity among these groups Improving HIV testing rates could result in increased HIV case finding as a result of syphilis partner services 19

Discussion Low syphilis NNTI in MS compared to other jurisdictions HIV outcomes not as good as other jurisdictions Only 50% of partners received HIV testing 20

Syphilis PS as HIV prevention opportunity Setting to reduce disparities among MSM Integration of other high impact HIV prevention activities into syphilis PS PrEP uptakeRelinkage to HIV care 21

Implications for STD Programs Integrating HIV testing into syphilis PS is an effective strategy for identifying people newly infected with HIV Syphilis PS can be leveraged to improve PrEP uptake and HIV care delivery Standard outcomes/framework for evaluating STD partner services programs22

Future Directions Facilitators/barriers to integrating HIV testing into syphilis PS Evaluating impact of integrating PrEP referrals/HIV relinkage activities into syphilis PS 23

Acknowledgements Co-authors Christine KhosropourChristie LewisJames StewartMSDH DIS 24

Group Discussion What strategies has your health department employed with DIS in the integration of HIV testing into syphilis partner services? What challenges has your health department faced in integrating HIV testing into syphilis partner services? What successes has your health department seen in integrating HIV testing into syphilis partner services?25

Questions? 26

Additional questions? Tigran Avoundjian tavoun@uw.edu David Peyton david.peyton@rocketmail.comKendra JohnsonKendra.Johnson@msdh.ms.govMatthew R. Goldengolden@uw.edu Christine M. Khosropour ckhosro@uw.edu Leandra Lacy llacy@ncsddc.org 27