Expanding Assisted Partner Services (APS) to Partners of Index Partners in Western Kenya.

Abstract

Objectives: To investigate the uptake, characteristics and outcomes of Assisted Partner Services (APS) when expanded to identify, test and treat female sexual partners of male partners identified through the APS scale up program. Design: Longitudinal study nested in the APS Scale-up Implementation Study (R01AI134130) Materials and Methods: We utilized data from 31 health facilities offering APS in Homa Bay and Kisumu Counties in Kenya from November 2018 – March 2020. Male sexual partners of female index participants were traced and tested for HIV. Male partners who tested HIV-positive were provided APS and, asked to provide contact information for their female sexual partners so that they could be offered HIV testing and linkage to care if positive. Based on the outcome of their HIV test, these female partners of male partners (FPP) were categorized as Known Positive (previously aware of their HIV positive status before APS), New Positive (new HIV diagnosis), or Negative. We evaluated socio-demographic characteristics of FPP by HIV status using chi-squared and fisher’s exact tests. We further compared New Positive FPP with index females (enrolled females who tested positive for HIV in the facility and provided contact information for their male sexual partners) in terms of socio-demographic characteristics, linkage to care at 6 weeks, viral suppression outcomes at 12 months, and intimate partner violence (IPV). Univariable and multivariable logistic regression was used to evaluate associations between FPP demographics and new HIV positivity. Results: Overall 4951 FPP were identified and enrolled. Among these, 291 (5.9%) were new positives, 1745 (35.2%) were known positive, and 2915 (58.9%) were negative. FPP and female index clients were similar in terms of age, marital status and income. FPP had a 1.72 (1.38-2.14) higher likelihood of having completed secondary school and nearly 6-fold increased likelihood of being self-employed (5.87 (4.20-8.21) compared to female index clients. Similar proportions of FPP living with HIV were in care at 12 months compared to index females (90% vs 89%). Follow-up and HIV viral load outcomes, including report of IPV, were also similar for both populations. No IPV experience was reported in either group. Conclusion: One in twenty female partners of male partners identified through expanded APS were newly diagnosed with HIV. FPP with HIV had high rates of linkage to HIV care and low IPV outcomes. Expanded APS also identified a large number of negative FPP at risk of HIV infection and link them to prevention interventions.