partner notification support unit department of human services public health branch office of the...
TRANSCRIPT
Partner Notification Support Unit
Department of Human ServicesPublic Health Branch
Office of the Chief Health Officer
Partner Notification Officers
Beth Hatch
Robert Barlow
Tom Carter
Four areas of responsibility:
P.O.A.R.
Contact Tracing
Epidemiology
Other duties as directed
Placing Others at Risk
(P.O.A.R.)
Placing Others at Risk:
Members of the public, professionals make allegations that a person is HIV positive and either not warning their sex partners of their HIV pos status, before sex occurs, so they can make informed choice OR they are not practising safe sexual activity (condom use)
Used to be referred to as “Knowing and Reckless”
The person making the allegation has two options of intervention:
Option One:
Make the allegation to the police
Act under the Crimes Act
Charges
Option 2:
Make the allegation to the Health Department (DHS)
Office of the Chief Health Officer
PNO’s deal with the matter
Health Act 1958 – new Act is about to go before parliament
The CHO has the power under this Act to take actions to prevent a person transmitting an infectious disease to the community
Section 121 Health Act 1958
PNO’s meet with informant:
Preferably face to face What is “the story”? How do you know that the person is positive? Are you a partner? Has it happened before/to others? Informant can go to police Care for the informant Confidentiality of informant
PNO’s meet with the client:
When, where, how? Put allegation to client for their response Full assessment of client – medical,
psychiatric, history, forensic, social, drug/alcohol
Look after client – educate, inform, refer, support
Give literature to client Client given our contact details PNO’s will get back to client re DHS decisions
CHO/PNSU informed:
If urgent or sensitive:ImmediatelyCommence management strategy
If not urgent:Full discussion at next CMMDevelop management strategy
Client informed of outcome
Case management:
The CHO makes a decision with input, if appropriate, from other members of PNSU, other agencies, the Panel to:
Close the case PNO’s monitor the case Commence 5 step plan
5 step plan:
1. Counselling, education, support and referral
2. Formal request for involvement of CHO. Involvement of Case Management Panel
3. Letter of Warning
4. Restriction of movement
5. Isolation
The Panel:
Advisory Panel of independent experts – including I.D. specialist, psychiatrist, PLWHA, lawyer, counsellor
The Panel is convened when CHO would like their advice
The Panel can be called at any stage of the 5 step plan
Client details remain confidential
CMM:
All members of PNSU meet fortnightly to review cases and develop plans
Chairperson of panel as well Every active case is reviewed Clients can move up and down 5 step plan Police informed if criminal activity – sex with
children, pornography Plans are flexible and fluid
Partner Notification
Contact Tracing
Based on principle:
“it takes two or more people to tango”
Dr David Bradford 1983:
Quote:
“Good STI management and prevention requires three things to be done well:
Good clinical care Effective prevention education Good contact tracing
If any one of these three things are lacking then the battle can’t be won”
If you just manage the client and don’t consider partners – you are only doing half the job
There is no law to done contact tracing
Why do we contact trace:
Prevent transmission of infection Find people who may benefit from treatment
– thus avoiding potential complications Provide direct counselling and education to
people to bring about behaviour change – it personalises the risk and realities
Generally – identify and reach populations at particular risk in order to influence community norms
Partner Notification can be done three ways:
The client notifies his/her partner/s themselves – by far the most common way. Often given a letter to give the partner to take to their doctor
The client and health professional notify the partner/s together
The PNO’s do the partner notification work
CONFIDENTIALITY OF THE INDEX CASE MUST BE MAINTAINED AT ALL TIMES
Open and honest communication is essential
Contact tracing relies completely on the index case – if they wont tell the health care professional anything, it can’t be done
How to contact trace:
Telephone:
Advantage –
time saving, cost effective, confidential, allays anxiety
Disadvantage –
provides verbal cues only, limited control over response, possible problems with confidentiality
Letter:
Advantage –
little effort
Disadvantage –
creates anxiety, can be intercepted, inappropriate for disclosing details, what if people can’t read
Visit:
Advantage –
more personal, can give details as appropriate, make assessment of response, give referrals if needed. Testing and treatment can be done
Disadvantage –
lack of confidentiality, can be time consuming, may not accept referrals
The PNO’s contact trace for:
notifiable STI’s:
HIV
Gonorrhoea
Syphilis
Chlamydia (LGV)
PNO’s take referrals from:
Index case – will mean PNO’s may know their indentification details
Health professionals
Details of contact:
Personal details – name, address, work, interests, age, description – height, weight, hair, accent, glasses, etc
PNO be aware of safety; and psychiatric history, drug and alcohol use, behavioural issues
Anything else that may be of help – where sex occurred, do anyone else know partner details
PNO’s team discussion:
On the information we have, considerations for the interview:
Who does it Where is it done When is it done How is it done Any special considerations
The PNO’s then do the intervention and appropriate ongoing care and management
Epidemiology
HIV:
Call back to testing health professionals who have a new HIV positive test result
Clarify epidemiology Seek further (enhanced) epidemiology Educate health professional if needed Suggest referrals Discuss contact tracing Pick up on trends early and act on them Often speak to client and do what is needed
Blood, Tissue or Organ Donations
Check if client has donated and blood, body fluids or body parts for use in medical area
To be done two weeks after test validation If answer is yes – notify blood bank who
immediately start an investigation and take appropriate action
If answer is unknown – notify blood bank who will check their database
HIV information collected:
Under code Discussed at fortnightly meeting with HIV
epidemiologist (Burnett) and HIV VIDRL lab Each case discussed individually Clarification of information Pick up early any concerns Victoria has best HIV epidemiology in
Australia
Other STI’s:
Call testing doctors and complete epidemiology data – educate, clarify, send information, discuss contact tracing, often speak to clients
Intensive interventions if there is a concerning event identified in data – eg syphilid outbreak
V.I.F.M.:
When there is a HIV positive test result for a deceased person the PNO’s become involved
Inform next of kin – if appropriate Do any contact tracing needed Attempt to stop transmission of infection and
manage those who may be infected
Unknown risk of transmission:
Unable for health care professional and client to determine how client became infected with HIV
Referred to PNO’s Interview client and do CDC assessment of
routes Intervene in any areas where there may be a
risk to public health
Other Duties as Directed:
Sex Industry:
Infectious Diseases Regulations 2006 – PNO visit and inspect all legal/registered brothels once a year for health matters
PNO’s follow-up formal complaints about brothels and ‘workers’
Education:
PNO’s do lectures to health professionals, courses, organisations, schools – if they have the time
Golden rules of Contact Tracing:
Honesty Trust Confidentiality Client driven Flexibility Laughter
