Electronic Partner Notification for STIs: A Syndemic Approach to Improve HIV and STI Service Access in MA

About This Grant

Suffolk County, an Ending the HIV Epidemic (EHE) priority area in Massachusetts, has seen a dramatic increase in bacterial sexually transmitted infections (STIs). Although diagnosis of bacterial STIs is an indication to consider HIV pre-exposure prophylaxis (PrEP), uptake of PrEP remains inconsistent across patient populations, often not reaching those at greatest risk for HIV acquisition. To address the rising rate of STIs, the Massachusetts Department of Public Health (MDPH) is implementing a provider-initiated electronic partner notification (ePN) platform for STIs, through which index patients can anonymously alert their sexual partners about STI exposure and link them to care resources. The goals of this platform, which, to our knowledge, is the first state-sponsored, statewide ePN intervention in the US, include not only an increase in the number of people tested and treated for STIs, but also the promotion of HIV testing and PrEP. ePN has the potential to overcome barriers to STI/HIV services by increasing awareness and linking notified individuals to accessible, low-cost care. How best to design and implement ePN to promote integrated STI/HIV services that serve populations at increased risk for STIs and HIV in community settings is unknown. In collaboration with MDPH and three high-volume sexual health clinics in Suffolk County, we propose to leverage this statewide "natural experiment" through the following three specific aims: 1) To evaluate the impact of ePN implementation on number of partners notified and engaged in care statewide when: 1a) used by field epidemiologists as an adjunct for assisted partner notification services for people diagnosed with syphilis; and 1b) initiated by clinicians at STI clinics for people diagnosed with gonorrhea and chlamydia; 2) To identify determinants of ePN implementation for STIs via qualitative interviews with index patients, partners, field epidemiologists, and clinicians and use the ADAPT implementation process to develop enhancements that incorporate HIV services; and 3) To implement and evaluate the impact of ePN platform enhancements on PrEP uptake and HIV care re-engagement at three selected high-volume MDPH-funded STI clinics deploying ePN and statewide, including an assessment of reach into different patient populations. We hypothesize that ePN will increase the number of partners notified and engaged in sexual health care and that enhancements to ePN will increase PrEP uptake and HIV care re-engagement among notified individuals, thereby helping to address both the STI and HIV epidemics. This proposal is directly responsive to the NIH HIV/AIDS research priorities to improve uptake of multi-level HIV prevention interventions, develop prevention strategies for HIV-relevant coinfections, and address high HIV incidence populations. It is also responsive to the NIH Director's strategic priority to use implementation science to advance EHE efforts in the US. This work will shift the paradigm of HIV and STI care by reimagining partner notification for the digital age and expanding its reach to enable more effective linkage to HIV services.