Assisted partner notification as a strategy to enhance Pre-Exposure Prophylaxis (PrEP) screening and uptake - results from a prospective cohort study in Lilongwe, Malawi.

Background: Pre-exposure prophylaxis (PrEP) prevents HIV acquisition but strategies are needed to improve uptake among high-risk groups. Assisted partner notification (aPN), proven for HIV case-finding, may expand PrEP services to sexual partners of sexually transmitted infection (STI) patients. While passive (index-led) partner notification for STI treatment receipt is standard, offering an assisted strategy may increase linkage to PrEP for HIV vulnerable partners who may otherwise be missed. This study explored the feasibility and outcomes of integrating aPN into PrEP programs at an STI clinic in Malawi.

Methods: Between March 2022 and January 2023, this prospective cohort study enrolled men and women presenting for STI services who were initiating PrEP (index PrEP user) and their referred sexual partners. Using World Health Organization-recommended aPN methods, recent (within last 6 months) sexual partners named by index participants were traced via phone or in-person. We assessed demographic characteristics of index participants and referred partners, tracing outcomes, and PrEP initiation among partners.

Results: 174 index PrEP user participants were enrolled, most were male (109/174; 63%) with median age of 27 years (IQR 22, 32). The 174 index participants were asked to provide contact information for their partners, 69 of whom did. These 69 participants named 101 sexual partners (57% female). Partners were named as primary partners (53%), casual partners (41%), or sex workers (6%). Tracing efforts were employed for 52 partners with phone tracing yielding a 57% contact success and physical tracing yielding a 10% contact success. 58 partners (including those not traced) presented at the clinic for screening. Most presenting partners were female (39/58; 67%) and the median age was 28 years (IQR 23, 31). Among the presenting partners, 34/58 were eligible for PrEP, and 31/34 (91%) initiated PrEP. 20 of 55 named partners who agreed to testing were HIV positive, with 20% of these newly diagnosed during PrEP screening.

Conclusions: aPN, including passive notification, effectively identifies and links at-risk partners of persons initiating PrEP to HIV prevention services, achieving high rates of PrEP uptake among eligible presenting partners, though less than half of index PrEP users named partners for tracing. Notably, phone tracing was more effective than physical tracing, but phone number availability was limited. This study highlights the potential of aPN in expanding PrEP access and strengthening HIV prevention efforts among persons seeking STI services.

Trial registration: This trial is registered on 5 October, 2023 at ClinicalTrials.gov NCT05307991 .