1. Best Practices for Effective Partner Services Outcomes

2. Describe the goals of partner services List the core functions of conducting partner services Describe the process of conducting partner services work Discuss the components of an effective partner services interview List suggested time frames for completion of interviews, field work, and Syphilis case management activities Describe key partner services process and outcome measurement Identify a minimum of two resources to support/improve partner services practices Session Objectives:

3. Partner services is a program designed to provide a broad array of services that should be offered to those with STDs and/or HIV. They include: Partner notification STD/HIV testing, treatment, and other relevant services Prevention counseling Hepatitis screening and vaccination Treatment and/or linkage to medical care for those living with HIV What is Partner Services?

4. Goals of Partner Services Maximize access to partner services by providing all infected persons with support to ensure that the partners and social contacts are confidentially informed of their exposure. Maximize effective linkage to medical care, treatment, and prevention interventions to reduce the risk for transmission to others, and other services. Working with Infected Persons:

5. Goals of Partner Services Working with Partners/Social Contacts: Maximize the proportion of partners and social contacts that are notified of their exposure. Maximize early linkage of partners and social contacts to testing, medical care, prevention interventions, and other services.

6. Goals of Partner Services Working with Communities: Reduce future rates of transmission by aiding in early diagnosis and treatment (or linkage to treatment, for those with HIV infection) and provision of prevention services to infected persons.

7. Core Functions of Partner Services Interviewing Follow-up and Field Investigation/Notification Case Management

8. What We Know Chance of re-infection for most STDs is high when partners are not treated The younger female client has a higher chance of becoming re- infected Females recently treated for CT, in particular, often will have sex with the same partner without knowing partner’s infection or treatment status Effective referral of sex partners for treatment is an essential component of good patient care

9. Behavioral Counseling Partner Services Clinical Management Components of Infection Management

10. Keeping the Benefits of Partner Services In Mind To the Patient: Allows patient to inform partners anonymously without revealing own disease status Relieves patient of responsibility to notify partners Offers peace of mind to patient by fulfilling ethical responsibility to partners Opportunity for behavior change Linkages to other needed social and medical services

11. Keeping the Benefits of Partner Services In Mind To Partners: Information about real risk Impetus for entering counseling and/or testing Provide opportunity to be tested or treated for STDs/HIV Referral to counseling and support services Opportunity for behavior change For Infected Partners: Opportunity to avoid inadvertent transmission to partners “Wake up call” to practice risk reduction Assistance in notifying their other partners

12. Partner Services Flow Chart Confirmed Positive - Not treated 1. Record search to confirm all pertinent information regarding patient (e.g., lab results, treatment, locating information) 2. Notify patient of positive lab result(s) and ensure treatment Confirmed Positive- Treated 1.Record search to confirm all pertinent information regarding patient (e.g., lab results, treatment, locating information) 2. Contact patient to secure a partner services Original Interview 3. Conduct Partner Services Original Interview l. Introduction a. Introduction of self b. State purpose/role c. Assure confidentiality ll.Patient Assessment a. Patient concerns c. Medical history d. Disease comprehension llll.Disease Intervention a. Partner/Social contact elicitation b. Risk reduction and linkage to care/social services lV.Conclusion 4. Document the interview and Record search all partners/social contacts named and initiate Field Records for follow- up/investigation and notification of exposure to STD and/or HIV 5. Document partner dispositions on original patient’s Interview Record 6. Submit records (Field Records, Interview Records) to supervisor for review and closure

13. I Need to Ask What?!!

14. Effective Questioning OPEN ENDEDPOLITE IMPERATIVES Who…? What…? When…? Where…? Why…? How…? Give Me…? Tell Me…? Show Me…? Explain to me…? Describe… (Silence)… Are There? Is There? Do You? Will You? Did You? Can You? AVOID!

15. Chlamydia w/SX’s Chlamydia w/o SX’s Gonorrhea w/SX’s Gonorrhea w/o SX’s Primary Syphilis Secondary Syphilis Early Latent Syphilis* 60 days before onset of symptoms through date of treatment 60 days before date of specimen collection through date of treatment 90 days prior to date of onset of primary lesion through date of treatment 6.5 months prior to date of onset of secondary symptoms through date of treatment 1 year prior to start of treatment 60 days before onset of symptoms through date of treatment HIV 1 or 2 years before date of first positive HIV test through date of interview. All current or former spouses during 10 years before diagnosis. Interview Periods

16. Introduction Patient Concerns Disease Comprehension Discussion of Sex Partners Risk Reduction Plan Conclusion STD Counseling/Interview Format

17. Introduction Patient Concerns Disease Comprehension Discussion of Sex Partners Risk Reduction Plan Conclusion STD Counseling/Interview Format

18. Who gave you my name? Who else is going to find out about this? Can I give this to my kids? How long is this going to take? Why do you need to talk to me about my partners? When can I have sex again? Anticipate Patient Concerns and Have a Planned Set of Responses

19. Introduction Patient Concerns Disease Comprehension Discussion of Sex Partners Risk Reduction Plan Conclusion STD Counseling/Interview Format

20. Disease Comprehension- “Must Do” Complications of Untreated Disease C C HIV Connection H H Asymptomatic Infection A A Re-Infection R R Transmission – All modes T T

21. Female PIDOvarian Abscess SalpingitisEctopic Pregnancy Scarring/InfertilitySevere/Chronic Pain Male Urethral Scarring Swelling/Pain of Testes Epididymitis Newborn ConjunctivitisPneumonia Complications of Chlamydia

22. Untreated genital CT infection PID Ectopic pregnancy Chronic pelvic pain Infertility 20-40% 6% 20% 18% Complications of Genital Chlamydia in Women

23. Introduction Patient Concerns Disease Comprehension Discussion of Sex Partners Risk Reduction Plan Conclusion STD Counseling/Interview Format

24. Partner/Social Contact Elicitation NameExposureLocatingClusteringDescription FOUNDATION NumberBehaviorSetting

25. Introduction Patient Concerns Disease Comprehension Discussion of Sex Partners Risk Reduction Plan Conclusion STD Counseling/Interview Format

26. Establish and/or improve patient’s perception of risk What do you think your chances are of getting this infection again? Identify and support patient’s previous behavior changes What types of things have you been able to do in the past to help keep yourself safe from infection? Negotiate a simple, realistic and incremental plan for reducing risk What one or two things could you do to help protect yourself from getting an infection in the future? Facilitating The Risk Reduction Plan

27. Introduction Patient Concerns Disease Comprehension Discussion of Sex Partners Risk Reduction Plan Conclusion STD Counseling/Interview Format

28. “What Your Partner Needs to Do Next” Where? When? What? Business Cards/Clinic Brochure/ STD Pamphlet “How to Handle Your Partners Reaction” How will your partner react? How will you handle that reaction? “End on a Positive Note” Coaching the Patient to Refer Partner to Care “Approaching Your Partner” When will you do it? Where will you do it? What will you say? “Key Points to Remember” C = Complications of Untreated Disease H = HIV Connection A = Asymptomatic R = Re-Infection T = Transmission – all modes

29. Work Done By Phone

30. Contacting A Patient or Partner by Phone Call from private area Make sure you’re talking to the partner Secure line Deliver message Unproductive calls must result in a field investigation No more than 3 calls should be attempted before a field visit is conducted A patient who is unresponsive to the initial call should be telephoned the 2 nd time only under unusual circumstances

31. BUZZ “BUZZ” Words and Key Phrases for Telephone Interviews Are you somewhere where you can speak freely? What you share here will help me provide better services to you How can your partner be privately reached? Your help with this is critical to your overall care Again, my goal is to provide you with the best service I can to protect your health Thank you so much, this is very important to your care

32. Work Done In The Field

33. Field Notification Steps Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7

34. You Want It Done When?!!

35. Time Frames/Considerations for Completion of Work Patients with untreated disease should be contacted within 24 hours and treated Original interviews should occur within 72 hours Initiation of follow-up of partners should begin within 24 hours Field visits should begin within 24 hours if unable to contact by phone, text, or e-mail All partners should be located, tested, and treated within 7 days Syphilis cases should be managed and closed within 15 days, or as prescribed by local program policy

36. You Want Me To Measure What?!!

37. Measure This- At A Minimum! The number of eligible patients interviewed The average number of partners identified in interviews The number of partners notified of exposure and how quickly The number of new cases identified The number of patients/partners treated The number of newly tested HIV positive patients linked to care services

38. PS Evaluation Field Guide

39. Resources and Tools

40. Insert website

44. Epidemiologic Control Record- Sample

45. Guidance Documents

46. Thank You! Denise Tafoya, MPA Denise.Tafoya@ucsf.edu (562) 570-4371