Assisted partner services for people with HIV who inject drugs
Authors: Tapiwa A Tembo, Saeed Ahmed, Nora E Rosenberg
Journal: The Lancet Global Health (2024)

In The Lancet Global Health, Aliza Monroe-Wise and colleagues examine the effectiveness of assisted partner services for people who inject drugs (PWID) living with HIV at eight harm-reduction sites in two Kenyan regions from 2018 to 2022.1Monroe-Wise A Mbogo L Sambai B et al.Efficacy of assisted partner services for people who inject drugs in Kenya to identify partners living with HIV and hepatitis C virus infection: a prospective cohort study.Lancet Glob Health. 2024; 12: e859-e867Google Scholar PWID living with HIV (index participants) were asked to list their sexual and injection partners, who were traced via phone or in person by community-based peer educators (people who formerly injected drugs trained to offer outreach and harm-reduction services) and encouraged to undergo testing for HIV and hepatitis C virus (HCV). Index and partner participants with HIV or HCV were then followed up for 6 months, and engagement in HIV and HCV care and viral suppression were assessed. The baseline HIV case-finding outcomes were remarkable. The 989 index clients each named an average of 4·76 partners, an elicitation rate nearly three times higher than that in studies of assisted partner services done in general (ie, not exclusively injection drug-using) populations with HIV.2Cherutich P Golden MR Wamuti B et al.Assisted partner services for HIV in Kenya: a cluster randomised controlled trial.Lancet HIV. 2017; 4: e74-e82Summary Full Text Full Text PDF PubMed Google Scholar 4588 (98%) of the 4705 elicited partners were found and tested for both HIV and HCV. Overall, 597 partners had HIV. The number needed to interview to identify one partner participant who was either newly diagnosed with HIV, not on antiretroviral therapy (ART), or not virally suppressed (ie, who was in need of HIV services) was 4·24 (95% CI 3·75–4·85). The high case-finding rate in Monroe-Wise and colleagues' study complements the findings of studies in general populations,3Dalal S Johnson C Fonner V et al.Improving HIV test uptake and case finding with assisted partner notification services.AIDS. 2017; 31: 1867-1876Crossref PubMed Scopus (102) Google Scholar, 4Sharma M Naughton B Lagat H et al.Real-world impact of integrating HIV assisted partner services into 31 facilities in Kenya: a single-arm, hybrid type 2 implementation-effectiveness study.Lancet Glob Health. 2023; 11: e749-e758Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar suggesting that assisted partner services are appropriate and efficacious in injection drug-using populations. The 6-month follow-up data were also impressive. Of the 142 partner participants who were not on ART at enrolment, 102 (72%) reported taking ART at 6 months, suggesting that assisted partner services not only identified people with HIV but also supported linkage to treatment. Although assisted partner services are typically characterised as an HIV testing intervention, this study reinforces their role in linkage to care. The inclusion of HCV testing and treatment is an important feature of the programme design, given that the prevalence of HCV is high among PWID and their networks.5Degenhardt L Peacock A Colledge S et al.Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review.Lancet Glob Health. 2017; 5: e1192-e1207Summary Full Text Full Text PDF PubMed Scopus (968) Google Scholar The HCV case-finding yield was also high, with 393 infections identified. The number of index clients who needed to be interviewed to identify one partner participant positive for HCV antibodies was 2·52 (95% CI 2·28–2·80). Nearly three-quarters of the 393 partner participants positive for HCV had been unaware of their status, and only four of the 393 partner participants had previously received treatment. These findings highlight the possibility to leverage assisted partner services to address multiple health conditions simultaneously. Although social harms were carefully monitored by the investigators, no violence or other social harms were recorded as a direct result of the assisted partner services programme, suggesting that these services can be safely implemented among PWID by peer educators who are committed to principles of consent and confidentiality within the context of harm-reduction programmes. This finding is important because in Kenya, and in other similar contexts, the HIV prevalence is many times higher6Oguya FO Kenya PR Ongecha F et al.Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey.BMC Public Health. 2021; 211549 Crossref Scopus (5) Google Scholar among PWID than in non-injecting populations and HIV care indicators (ie, the numbers of people aware of their status, on ART, and virally suppressed) are lower,7Githuka G Hladik W Mwalili S et al.Populations at increased risk for HIV infection in Kenya: results from a national population-based household survey, 2012.J Acquir Immune Defic Syndr. 2014; 66: S46-S56Crossref PubMed Scopus (27) Google Scholar and thus evidence-based solutions that can be implemented safely among PWID are urgently needed. An important next step is to take the lessons learned from this successful programme to scale in Kenya and beyond. A deeper understanding of the programme design and implementation strategies are needed to better understand how to replicate this work in other settings. A specific focus on the training, supervision, and procedures could help other programmes to achieve similar outcomes. Detailing the costs of the programme would also be of great benefit to implementers in other contexts. Overall, the novel results reported by Monroe-Wise and colleagues highlight the important role that assisted partner services can play in closing the gaps in HIV and HCV testing and treatment among PWID in sub-Saharan Africa. Engaging harm-reduction sites in assisted partner approaches could help to overcome barriers to reaching PWID in need of HIV testing and treatment and contribute to attainment of the UNAIDS 95-95-95 goals. We declare no competing interests. TAT, SA, and NER are supported through the US National Institutes of Health (grant numbers D43 TW010060, 5UG1MD019436-02, R01 MH124526, R21 MH125705, and R21 MH134750). Efficacy of assisted partner services for people who inject drugs in Kenya to identify partners living with HIV and hepatitis C virus infection: a prospective cohort studyUse of assisted partner services among people with HIV who inject drugs was safe and identified partners with HIV and HCV infections. Assisted partner services was associated with increased uptake of ART for both index participants and partners. Full-Text PDF Open Access