Prison-based HIV partner notification in Indonesia: rationale and design of a hybrid type 1 effectiveness-implementation study

With HIV Assisted Partner Notification (APN), individuals with HIV voluntarily name and authorize trained health care workers to inform their at-risk partner of possible exposure to the virus without disclosing the identity of who had named them. Although APN is safe and effective in increasing HIV partner notification and testing, its successful implementation in prison settings to assist incarcerated people with HIV (IPWH) to inform their pre-incarceration partners of possible HIV exposure has yet to be demonstrated. Set in Indonesia where many people with HIV are diagnosed during incarceration, this high-impact study will evaluate the implementation, effectiveness, reach, and sustainability of a prison-based partner notification intervention (Impart) to increase HIV notification and testing among IPWH’s pre-incarceration sex and/or drug partners in the community. A hybrid type 1 effectiveness-implementation study conducted at eight Indonesia jails/prisons will test Impart’s effectiveness to increase HIV partner notification and testing when delivered by non-governmental HIV organizations and their field staff across differing prison contexts. A two-group randomized controlled trial with 216 IPWH recruited as “index participants” will compare Impart (choice of APN or self-tell per partner) with a self-tell only notification condition (Aim 1). Effectiveness outcomes will consist of the proportion of partners within each arm notified of HIV exposure, HIV tested, diagnosed, and beginning antiretroviral therapy if needed within 6-weeks post-randomization. Drawing on the Consolidated Framework for Implementation Research, a mixed method approach will evaluate the multi-level factors (prison characteristics, staff, and implementation processes) required for the model’s successful and sustained implementation when delivered by Impart-trained counseling and notification staff within Indonesia’s prison system (Aim 2). Key factors that contribute to Impart’s reach, fidelity, and sustainment will be identified from stakeholder interviews, prison administrative records, staff logs, and fidelity checks. If proved effective and organizationally sustainable, Impart will provide the first scientifically-tested prison-based APN model to increase HIV testing, diagnosis, and care referral among IPWH’s possibly HIV-exposed sex and/or drug injection partners living in the community. The study’s findings will identify the key elements needed for Impart’s successful implementation and sustainability in Indonesia and potentially other countries with large IPWH populations. This study was registered prospectively at: https://clinicaltrials.gov/study/NCT07103928. Division of AIDS Research, National Institute of Mental Health suzy.pollard@nih.gov