ENHANCING PARTNER NOTIFICATION (PN) IN YOUR LOCALITY

Why Improve PN? Prevents reinfection for index Breaks cycle of infection Reduces amount of infection in the community Prevents the effects of untreated STIs

Areas to focus on Community Hospital Sexual Health Service

Community: School Nurses Meet with School Nurse Lead Integrate PN and Provider Notification (PR) into teaching on Sexual Health And in 1-1 sessions on sexual health with students Involves linking with the School Nurse Lead in your area and supporting with teaching materials – this may mean only writing a couple of slides . Students should understand the value of PN & PR: it is of benefit to the community, is confidential and may benefit them when sexually active. It’s important that they understand PN & PR as a public health measure before they ever need it

Community: working with the CSP Meet with local CSP Lead. Joint working could involve discussing: Sharing practice around PN for CSP staff Comparing audit outcomes CSP leaflets explain PN & PR PN & PR emphasised in teaching to external agencies eg. GPs and colleges (and a referral pathway offered to GPs) Many CSPs are integrated into Sexual Health and will have these bases covered. For those that aren’t, it may be worth identifying gaps. Here are some suggestions for joint working

Community: GPs Liaise with local CSP Lead (and or Microbiology department): Identify GP Surgeries with highest numbers of positive Chlamydia results Offer support and information/training on PN & PR Offer Community contact slips and/or referral to Sexual Health Microbiology will have the figures for those Surgeries with the highest numbers of patients testing positive for Chlamydia Work with Surgeries that already have a proven ‘track-record’ of testing patients for STIs – this will utilise your time most productively. Can also write a piece for GP Newsletter

Hospital: Obstetrics and Gynaecology Liaise with local Leads. Meetings could involve ensuring that patients testing Chlamydia/ Gonorrhoea positive have access to: Relevant literature Sexual Health Website Tests for other STIs PN/PR or referral to Sexual Health via agreed pathway Relevant follow up Look f

Clinic: teaching and training Plan: Teaching to all clinic staff on PN/ PR Audit presentations 1:1 for selected staff plus supervision Referral slips to SHA Attendance on STIF course BASHH/ SSHA competency SSHA PN study days (2019) All staff should have an investment in PN & PR. Eg reception need to understand PR for when the contact phones back or attends. Present on PN at a clinic meeting. High rates of PN & PR are likely to be a KPI so present the annual audits Teaching and training depends on your clinic model. SHAs may do all the PN & PR. Or nurses may cover when a SHA is not available. The latter means selecting nurses to train and be supervised in PN & PR. If nurses get PN details/ PRs, design a simple referral form to the SHA (Index no, date, code, tx; contact name, dob and means of contact). Attendance on STIF and competencies help staff see PN as part of their role Whole clinic needs to have an investment in PN & PR, so present to staff at a staff meeting. High rates of PN & PR are likely to be a KPI

Clinic: PN standards and audit Gonorrhoea PN: 0.4 per index case large conurbations, 0.6 per index case other areas Chlamydia PN: 0.6 per index case Health Care Worker verified/ index reported Standards for the management of STIs, BASHH 2014 https://www.bashh.org/about-bashh/publications/standards-for-the-management-of-stis/ BASHH statement on Partner Notification for Sexually Transmitted Infections https://www.bashhguidelines.org/media/1090/2012-partner-notification-statement.pdf Present annual audits and ensure that PN features, where relevant, in other audits

Clinic: PN standards and audit HIV PN: 0.6 HCW verified HIV PN 0.8 Index reported/ HCW verified HIV Partner Notification for Adults: definitions, outcomes and standards NAT, BASHH, SSHA, BHIVA 2015 https://www.bashhguidelines.org/media/1070/hiv_partner_notification_standards_2015.pdf PR: no national standards

Clinic: PR standards and audit No national standards for PR Advice: System is to able to log, monitor PR progress and pull an annual PR report Facility to email and SMS contacts through NHS.net address Annual PR report: Number of PRs obtained Number of PRs obtained as a proportion of +ve diagnoses Proportion of patients attending of those who were known to have been contacted 0.1 -0.15 per index case is thought to be a good rate of PR

Clinic: research https://www.lustrum.org.uk/information-for-healthcare-professionals.html

Clinic: innovation PN fact sheet for patients testing positive Include information on PN in Sexual Health Service leaflets Social Media The PN fact sheet is posted on the service website and is viewed before their attendance by patients who test positive. The PN factsheet explains the benefits of PN and PR and ‘nudges’ the patient to contact their partners/ ask the SHA to do so

Patient Information Sheet YOUR APPOINTMENT, TREATMENT AND PARTNER NOTIFICATION Your appointment When you come for your appointment you will receive information about your infection and treatment. The Sexual Health Adviser will also ask about ‘partner notification’. What is Partner Notification? Sexual partners may not have any signs or symptoms so may not know they have an infection. Letting them know so they can get tests and treatment is known as ‘partner notification’. What’s important about this appointment? The Sexual Health Adviser will help you with questions such as: ‘How could I have got this infection?’ ‘Can I still get it if I’ve used a condom?’ ‘How long could I have had it for?’ ‘How will it affect me?’ ‘Who could I have got it from?’ ‘Who could I have passed it on to?’ ‘How do I tell them?’ So the appointment is important for your sexual health and the sexual health of other people. What happens at your appointment? At your appointment the Sexual Health Adviser will explain how to take your treatment (antibiotics) and how to manage your sex life until the infection has gone. You can get accurate information about the infection and think about who should be contacted so they can get tests and treatment, too. It can be difficult to raise this with your partners and the Sexual Health Adviser will help you with this. If it’s too hard for you to contact partners yourself, the Sexual Health Adviser can contact them confidentially, without disclosing that it involves you – you can ask about this at your appointment. What will I be asked? During the appointment you will be asked about who you are having/have had sex with over a period of time. Any information you give is used to help ensure that current and ex partners get the tests and treatment they need. Your attendance and anything you have discussed is kept strictly confidential. What happens next? At the end of the appointment a plan can be agreed about who may need to be contacted and arrangements are made for your follow up. Point to salient parts of the sheet. Presents PN as a good intervention. Partners won’t know they have it; encourages questions that don’t make assumptions; encourages patient to consider that partners should have the same access to tx as they have had; supports PR; stresses confidentiality

Resources Guidance: SSHA Guidance on PN 2015 http://ssha.info/wp-content/uploads/ssha-guidance-on-partner-notification-aug-2015.pdf Wider context and research: Public Health Benefits of PN for STI and HIV European Centre for Disease Prevention and Control 2013 http://ssha.info/wp-content/uploads/partner-notification-for-hiv-sti-june-2013.pdf Detail: SSHA Manual Support: SSHA Regional Reps

Recommendations Young people are made aware of the benefits of PN at school Patients have the opportunity to consider PN options before they get treated (eg PN Patient information sheet) Partner agencies have the opportunity to receive information on PN Information on PN is available in relevant areas (website, leaflets, teaching to GPs/ Colleges) All staff are aware of PN Staff are appropriately trained and supervised Annual audits on PN are presented Systems are in place to log, monitor and produce an annual report on PR if required This is just a plan! For some not realistic – so give yourselves a pat on the back for whatever you’re already doing and start with what you can!