An assessment of contact tracing as a strategy of HIV control in sub-Saharan Africa

Two common means of controlling infectious diseases are screening and contact tracing. Contact tracing (CT), also know as “partner notification by provider referral” has been highly effective in controlling diseases like syphilis. While both screening and CT are broadly used to combat the HIV/AIDS epidemic in the US by health departments, governments and funding agencies have favored screening in sub-Saharan countries. This is largely the case because of concerns related to (i) the costs and efficiency of contact tracing in high HIV prevalence settings, and (ii) stigma and discrimination attached to HIV/AIDS. However, the perceived inefficiency of CT comes from mathematical models, which rely heavily on a small set of unrealistic parameters describing sexual behaviors. Recently, the roll-out of antiretroviral treatments (ARV) has also considerably lowered the stigma attached to HIV infection. The main goal of this application is therefore to (re)assess the potential benefits and the feasibility of a CT intervention in a sub-Saharan setting. The specific aims of the project include (a) a modeling of the epidemiological conditions under which CT can be an effective HIV control strategy in sub-Saharan Africa by using innovative and usual data collected as part of the Likoma Network Study in Malawi, and (b) the collection of a cross-sectional surveys of attitudes and beliefs towards CT to assess the acceptability of this intervention among the general population of two rural areas of Malawi (Likoma and Balaka) and the outpatient population of a large urban hospital of Botswana (where researchers from the Penn medical school have long-standing ties).