CRD summary

This review concluded that HIV partner counselling and referral services (PCRS) with partner notification by provider referral were effective in increasing the number of high-risk people tested for HIV. Given the lack of potentially relevant participant and study details, the unclear reporting of the review and the limited data synthesis, the authors' conclusions should be regarded with caution.

Authors' objectives

To assess the effectiveness of HIV partner counselling and referral services (PCRS) in increasing the number of high-risk people tested for HIV infection.

Searching

EMBASE, MEDLINE, PsycINFO, AIDSLine and SocioFile were searched to September 2004 for studies published in English between 1985 and 2004. In addition, internet searches were undertaken and reference lists and referrals from HIV specialists were checked.

Study selection

Studies conducted in countries with high-income economies were eligible for conclusion if the studies assessed partner notification and reported sufficient data for calculation of the proportion of individuals tested through partner notification who tested positive for HIV. Included studies were of participants from different ethnic backgrounds and sexual orientations and were either intravenous drug or non-drug users. The review reported secondary outcomes including behavioural changes such as sexual experience, condom use at last sexual episode, number of protected and unprotected sexual acts and acquisition of new sexual partners, as well as harm (including relationship dissolution and emotional and physical abuse).

No inclusion criteria were stated for study design.

The authors stated neither how the papers were selected for the review nor how many reviewers performed the selection.

Assessment of study quality

Validity was assessed using the Community Guide review process. Studies were classified as having good, fair or limited quality of execution. The authors did not state how the validity assessment was performed.

Data extraction

Data were extracted on the number of partners located and tested, to calculate the proportion (%) of individuals testing positive for HIV. The authors do not state how many reviewers performed the data extraction.

Methods of synthesis

Data were presented as a narrative synthesis and in tables.

Results of the review

One randomised controlled trial (RCT) comparing patient versus provider referral and eight intervention evaluation studies were included in the review (n=3,437 cases; n=11,717 elicited partners). Sample sizes ranged between 42 and 1,379 for cases and between 135 and 8,633 for elicited partners.

Six studies reported a mean of 20 per cent of individuals (range 14 to 26 per cent) as newly diagnosed with HIV. This translated into a one to eight per cent proportion of all partners identified by cases.

Eight studies reported that a mean of 76 per cent (range 44 to 89 per cent) of partners were notified. Six studies reported that 63 per cent (range 42 to 97%) of notified individuals were tested.

Two direct comparison studies reported substantial differences in notification rates for contract referral (34 and 85 per cent) and reported patient referral as seven to 57 per cent notified.

Secondary outcomes were reported in the review, but only by studies that did not meet the inclusion criteria.

Authors' conclusions

Partner counselling and referral services with partner notification by a public health professional (provider referral) were effective in increasing the number of people from high-risk populations tested for HIV. The evidence was insufficient to determine the effectiveness of patient referral, impact of partner counselling and referral services with partner notification on behaviour modification or HIV transmission reduction and the potential harms of each intervention.

CRD commentary

The review question was clear, but supporting inclusion criteria were somewhat limited and not always clearly defined. A comprehensive literature search using five electronic databases and several other sources was conducted. Searches were restricted to the English language, which meant that potential language bias cannot be ruled out. This, together with an apparent lack of a search for unpublished material, made it possible that relevant papers were missed. Validity assessment appeared limited, the quality of the included studies was not reported and details on each stage of the reviewing process were not provided, so that potential for reviewer error and bias cannot be ruled out. Potentially relevant details on participant characteristics and study details (such as partner counselling and referral services duration and intensity, and follow-up duration) were not reported. Data synthesis was limited, particularly as two of the included studies did not report on the primary outcome. Given the above considerations, the authors' conclusions should be regarded with caution.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that larger studies were needed to compare the effectiveness of patient, contract and dual referral with provider referral partner counselling and referral services (partner counselling and referral services) interventions. Further evaluation of the acceptability of partner counselling and referral services to patients and their partners was warranted. Further research was also required to assess the effects of partner counselling and referral services on certain outcomes (in particular, behaviour change and possible harm) and the effect that laws on disclosure of HIV status had on partner notification participation. Furthermore, the impact that partner counselling and referral services had on research and public health agency efforts to tackle HIV should be evaluated.

Funding

No financial conflicts of interest were reported.

Bibliographic details

Hogben M, McNally T, McPheeters M, Hutchinson A B. The effectiveness of HIV partner counseling and referral services in increasing identification of HIV-positive individuals: a systematic review. American Journal of Preventive Medicine 2007; 33(2 Supplement): S89-S100. [PubMed: 17675019]

Original Paper URL

http://www.ajpm-online.net/article/S0749-3797(07)00240-1/abstract

Indexing Status

Subject indexing assigned by NLM

MeSH

Contact Tracing; Directive Counseling; HIV Infections /diagnosis /prevention & control /psychology; Health Knowledge, Attitudes, Practice; Humans; Patient Education as Topic; Preventive Medicine; Referral and Consultation; Risk Factors; Spouses; United States

AccessionNumber

12007002632

Database entry date

05/08/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.