title: Partner testing, linkage to care, and HIV-free survival in a program to prevent parent-to-child transmission of HIV in the Highlands of Papua New Guinea.
abstract: BACKGROUND
  To eliminate new pediatric HIV infections, interventions that facilitate adherence, including those that minimize stigma, enhance social support, and mitigate the influence of poverty, will likely be required in addition to combination antiretroviral therapy (ART). We examined the relationship between partner testing and infant outcome in a prevention of parent-to-child transmission of HIV program, which included a family-centered case management approach and a supportive environment for partner disclosure and testing.
  
  
  METHODS
  We analyzed routinely collected data for women and infants who enrolled in the parent-to-child transmission of HIV program at Goroka Family Clinic, Eastern Highlands Provincial Hospital, Papua New Guinea, from 2007 through 2011.
  
  
  RESULTS
  Two hundred and sixty five women were included for analysis. Of these, 226 (85%) had a partner, 127 (56%) of whom had a documented HIV test. Of the 102 HIV-infected partners, 81 (79%) had been linked to care. In adjusted analyses, we found a significantly higher risk of infant death, infant HIV infection, or loss to follow-up among mother-infant pairs in which the mother reported having no partner or a partner who was not tested or had an unknown testing status. In a second multivariable analysis, infants born to women with more time on ART or who enrolled in the program in later years experienced greater HIV-free survival.
  
  
  CONCLUSIONS
  In a program with a patient-oriented and family-centered approach to prevent vertical HIV transmission, the majority of women's partners had a documented HIV test and, if positive, linkage to care. Having a tested partner was associated with program retention and HIV-free survival for infants. Programs aiming to facilitate diagnosis disclosure, partner testing, and linkage to care may contribute importantly to the elimination of pediatric HIV.
authors.affiliation: Clinton Health Access Initiative, Goroka, Papua New Guinea; acarmone@clintonhealthaccess.org.
authors.forename: Andy
authors.initials: A
authors.lastname: Carmone
authors.affiliation: Goroka Family Clinic, Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea.
authors.forename: Korai
authors.initials: K
authors.lastname: Bomai
authors.affiliation: Clinton Health Access Initiative, Goroka, Papua New Guinea.
authors.forename: Wayaki
authors.initials: W
authors.lastname: Bongi
authors.affiliation: Clinton Health Access Initiative, Goroka, Papua New Guinea.
authors.forename: Tarua Dale
authors.initials: TD
authors.lastname: Frank
authors.affiliation: Goroka Family Clinic, Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea.
authors.forename: Huleve
authors.initials: H
authors.lastname: Dalepa
authors.affiliation: Goroka Family Clinic, Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea.
authors.forename: Betty
authors.initials: B
authors.lastname: Loifa
authors.affiliation: Clinton Health Access Initiative, Goroka, Papua New Guinea.
authors.forename: Mobumo
authors.initials: M
authors.lastname: Kiromat
authors.affiliation: Clinton Health Access Initiative, Goroka, Papua New Guinea.
authors.forename: Sarthak
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019090:Case Management; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening; D010219:Papua New Guinea; D012424:Rural Population; D012747:Sexual Partners
chemical_list: D044966:Anti-Retroviral Agents
keywords: PMTCT; case management; mother-to-child transmission; retention; rural; vertical transmission