RESULTS OF A RANDOMIZED TRIAL OF PARTNER NOTIFICATION IN CASES OF HIV-INFECTION IN NORTH-CAROLINA
RESULTS OF A RANDOMIZED TRIAL OF PARTNER NOTIFICATION IN CASES OF HIV-INFECTION IN NORTH-CAROLINA
复制标题
DOI：
10.1056/nejm199201093260205
复制
发表时间：
1992-01-09
影响因子：
158.5
通讯作者：
KOCH, GG
中科院分区：
文献类型：
--
作者：
LANDIS, SE;SCHOENBACH, VJ;KOCH, GG
背景。我们试图比较两种通知性伴侣感染人类免疫缺陷病毒（HIV）或与他们共用针头的人（共用针头的伴侣）的方法：“患者转诊”，其中通知性伴侣的责任留给患者，“提供者转诊”，其中提供者试图通知性伴侣。性伴侣和共用针头伴侣的姓名以及如何找到他们的信息是从北卡罗莱纳州三个公共卫生部门艾滋病毒检测项目中确定的自愿感染艾滋病毒的受试者中获得的。受试者被随机分配到患者转诊组（患者有通知其伴侣的最初责任）或提供者转诊组（研究顾问通知其伴侣）。通过与实地和卫生部门的咨询师进行访谈，监测了通知伴侣的成功尝试。在卫生部门确定的534名艾滋病毒阳性患者中，247人（46%）在检测后没有返回咨询，8人在研究之外接受咨询，117人（22%）不符合条件。被邀请参加的162人中，88人（54%）拒绝，74人（46%）同意。研究对象大多是男性（69%）、黑人（87%）、同性恋或双性恋（76%），平均年龄为30岁。39人被分配到医生转诊组，35人被分配到病人转诊组。在医生转诊组，157名合作伙伴中有78名（50%）被成功通知，而在病人转诊组，153名合作伙伴中只有10名（7%）被通知。在咨询师通知的伴侣中，94%的人不知道自己已经感染了艾滋病毒。总的来说，23%的被告知并接受检测的伴侣是hiv阳性的。在这项试验中，尽管北卡罗来纳州的法律要求通知合作伙伴，但将合伙人的通知留给受试者（患者转诊）是相当无效的。由公共卫生顾问（提供者转介）通知伴侣明显更有效。尽管通知程序的有效性受到艾滋病毒感染患者提供的信息的准确性的限制，但将感染患者的情况通知伴侣的咨询人员可以将其转介到针对艾滋病毒感染高风险人群的教育、医疗和支助服务机构，并可能鼓励采取风险较低的行为。
Background. We sought to compare two methods of notifying sex partners of subjects infected with the human immunodeficiency virus (HIV) or persons who had shared needles with them (needle-sharing partners): "patient referral," in which the responsibility for notifying partners was left to the patient, and "provider referral," in which providers attempted to notify partners.Methods. Names of sex partners and needle-sharing partners and information on how to locate them were obtained from consenting HIV-infected subjects identified in the HIV-testing programs at three public health departments in North Carolina. The subjects were randomly assigned to a patient-referral group (in which patients had the initial responsibility for notifying their partners) or a provider-referral group (in which the study counselor notified the partners). The success of attempts to notify partners was monitored by means of interviews with counselors conducted both in the field and at the health department.Results. Of 534 HIV-positive persons identified at the health departments, 247 (46 percent) did not return for counseling after the test, 8 were counseled outside the study, and 117 (22 percent) were ineligible. Of the 162 invited to participate, 88 (54 percent) declined and 74 (46 percent) agreed. The subjects were mostly male (69 percent), black (87 percent), homosexual or bisexual (76 percent of the men), and had a median age of 30 years. Thirty-nine were assigned to the provider-referral group and 35 to the patient-referral group. In the provider-referral group 78 of 157 partners (50 percent) were successfully notified, whereas in the patient-referral group only 10 of 153 (7 percent) were notified. Of the partners notified by the counselors, 94 percent were not aware that they had been exposed to HIV. Overall, 23 percent of the partners notified and tested were HIV-positive.Conclusions. In this trial, leaving the notification of partners up to the subjects (patient referral) was quite ineffective, despite the North Carolina law requiring that partners be notified. Partner notification by public health counselors (provider referral) was significantly more effective. Although the effectiveness of notification procedures is constrained by the accuracy of the information provided by HIV-infected patients, counselors who notify the partners of an infected patient can refer them to educational, medical, and support services targeted to persons at high risk for HIV infection and may encourage the adoption of less-risky behavior.