Bringing HIV Partner Services Into the Age of Social Media and Mobile Connectivity Chi-Chi N. Udeagu, MPH, Angelica Bocour, MPH, Sharmila Shah, MD, MPH, Yasmin Ramos, Rodolfo Gutierrez, BA, and Colin W. Shepard, MD Background: A substantial proportion of recent sex partners named by persons with sexually transmitted infections are not notified about their exposure despite attempts by public health officials. Although text mes- saging (texting) and Internet-based communications (dating Web sites, e-mail, etc) are used by a large segment of the public for regular commu- nications, these tools have been underused for partner services (PS). Methods: We augmented PS for HIVin New York City using texting and Internet-based means to contact persons for whom traditional infor- mation (landline telephone number, postal address) was unavailable. We compared traditional PS (traditionalPS), Internet-based PS (IPS) in January 2011 to October 2012, and texting PS (txtPS) from January 2012 (when txtPS was initiated) through October 2012 on outcomes of contact attempts, notification, and HIV testing. Results: From January 2011 to October 2012, of 3319 partners elicited, 2604 and 275 partners had traditional and only Internet-based contact in- formation and were selected for traditionalPS and IPS, respectively. From January to October 2012, 368 of 1569 partners had only texting-enabled cellphone numbers and were selected for txtPS. The contact rate for txtPS (285/368 [77%]) was significantly higher (P G 0.0001) than the contact rates for traditionalPS (1803/2604 [69%]) and IPS (112/275 [41%]). There was a higher likelihood of notifying contacted IPS (odds ratio, 2.1; 1.2Y3.4) and txtPS (odds ratio, 2.4; 1.7Y3.2) than traditionalPS partners (P e 0.0001). However, among the notified partners, traditionalPS partners were signif- icantly (P G 0.0001) more likely than txtPS or IPS partners to test for HIV after partner notification (69% vs 45% and 34%, respectively). Conclusions: Augmenting traditionalPS with txtPS and IPS enabled notification of hundreds of previously untraceable partners and several new HIV diagnoses. S ince the 1930s, the practice of partner notification (PN) and contact tracingValso known as ‘‘partner services’’ (PS)Vhas been the cornerstone of public health efforts to control sexually transmitted diseases 1 and has increasingly been applied to HIV control efforts in the last 10 years. 2 The core feature of a well- functioning PS program is efficient and effective communication with patients, for example, interviews to elicit names and contact information of recent sex partners, and timely PN and testing to minimize the risk of onward transmission by HIV-infected but unaware persons. However, most health department PS protocols used today were developed for an age and an environment in which home visits, landline telephones, and postal mail delivery were the only available options for communication. The need for health departments to use new forms of communication to enhance PS is clear. Ninety-one percent of American adults own cellphones, and among them, 55% own smartphones. A sizeable and growing minority of the US adult population (skewed toward the poor and persons G30 years of age) do not have a landline telephone, 3 and many more are ‘‘cellphone- primary users’’Vpersons who own landline but receive most calls via cellphone. 4 Text messaging (texting) continues to grow in volume and popularity, with most cellphone users now using texting. 3,5 Internet-based means, including mobile phone appli- cations, are used by a substantial proportion of sexually active gay men to find sex partners on ‘‘hookup Web sites,’’ 6Y9 and there is evidence that men who have sex with men (MSM) who use mobile phone applications specifically designed for MSM seeking partners are more sexually active and more likely to report a recent sexually transmitted disease. 10 In recent years, there has been increasing recognition of the potential of texting, e-mail, and social media to enhance and augment PS. 11Y15 However, many of the published descriptions of health department efforts to augment PS with new communi- cations technology have noted the collaboration of a university partner, 11 supplemental grant funding, or restriction of their efforts to small pilot projects. 13Y15 For health departments that wish to enhance PS with new communications technology program-wide and without such supplemental support, the challenges can be daunting. Investments must be made in new equipment, training, and the revision of protocols. The myriad of different forms of communicationVe-mail, texting, dating or hookup Web sites, social media, and mobile applicationsVquickly overwhelm ef- forts to take a comprehensive approach and leave less-well-funded PS operations with the question of how to prioritize efforts given limited resources. The New York City (NYC) health department’s HIV Field Services Unit (FSU), established in 2006 to provide PS to HIV- diagnosed persons outside the city health department sexually transmitted disease clinics, 16,17 implemented enhanced efforts in 2011 and 2012 to contact persons with nontraditional contact information (Internet or cellphone-only contact information) for THE REAL WORLD OF STD PREVENTION Sexually Transmitted Diseases & Volume 41, Number 10, October 2014 631 From the HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY Acknowledgments: The authors thank all patients, partners, medical providers, and program staff involved in providing partner services in New York City. They are particularly grateful to Stephan Adelson for providing expert training for our staff and Peter Laqueur for support and encouragement in implementing these enhanced efforts. This work was supported with funds from the Centers for Disease Control and Prevention: Comprehensive HIV Prevention Programs for Health Departments, PS 12-1201, and Enhancing Lab Reporting, PS 12-1201. Authors’ contributions: C. Udeagu directed the program, conceived the study, and drafted the manuscript; A. Bocour and S. Shah analyzed the data and contributed to the interpretation and presentation of the data; Y. Ramos implemented the initiatives and contributed to retooling and program enhancements; R. Gutierrez supervised the implementation of the initiatives, including staff training and protocol development; C. Shepard contributed to the conception of the manuscript, critical interpretation of the data, revisions of the manuscript. Human participation protection: No institutional review board approval was necessary because this is a secondary analysis of data collected as part of the New York City Department of Health and Mental Hygiene routine case and partner services program. No conflict of interest exists. Correspondence: Chi-Chi N. Udeagu, MPH, New York City Depart- ment of Health and Mental Hygiene, New York, NY 11101. E-mail: cudeagu@health.nyc.gov. Received for publication April 22, 2014, and accepted July 24, 2014. DOI: 10.1097/OLQ.0000000000000181 Copyright * 2014 American Sexually Transmitted Diseases Association All rights reserved. Copyright © 2014 by the American Sexually Transmitted Diseases Association. Unauthorized reproduction of this article is prohibited.