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Appendix B

Glossary

Associate. A person, named by another person who is not infected with the disease in question, as someone who might benefit from counseling, examination, or testing for human immunodeficiency virus (HIV) infection or other sexually transmitted diseases (STDs). Typically, associates are persons named by noninfected partners of index patients, but they also might be named by social contacts or other associates. Associates might include persons with symptoms suggestive of disease, partners of other persons known to be infected, or others who might benefit from examination.

Client. Any person served by a health department or other health or social services provider.

Client referral. See self-referral.

Cluster interview. An interview with a noninfected partner (or social contact or associate), conducted to elicit information about persons within the social network (e.g., associates) who might benefit from counseling, examination, or testing for HIV and other STDs. Such persons might include persons with symptoms suggestive of disease, partners of other persons known to be infected, or others who might benefit from examination.

Clustering. The process of eliciting information from index patients about persons in their social networks, other than partners, who might benefit from counseling, examination, or testing for STDs/HIV. These persons are referred to as social contacts (or suspects, in traditional STD program terminology) and might include persons with symptoms suggestive of disease, partners of other persons known to be infected, or others who might benefit from examination.

Comprehensive risk counseling and services (CRCS). An intensive, client-centered counseling process aimed at ensuring the adoption and maintenance of HIV risk-reduction behaviors designed for HIV-infected persons who continue demonstrating risk behaviors and for HIV-negative persons who are at high risk for acquiring HIV infection and other types of STDs.

Confidentiality. The ethical principle associated with the health profession (or the legal right of a client receiving health-care services) in which health professionals do not disclose information relating to a patient unless the patient gives consent permitting disclosure or disclosure is necessary to protect public health.

Contract referral. A partner notification strategy in which an index patient identifies a specific partner to notify the partner of possible exposure and agrees to do so within a specific time frame, with the understanding that if notification does not occur within the designated time frame, the disease intervention specialist (DIS) will notify the partner.

Core area. A specific, typically geographically defined area, such as a neighborhood or census tract, in which a relatively high concentration of disease exists and which likely accounts for a large proportion of transmission in a community.

Core groups. Socially defined groups of persons who, as a consequence of continuing risky sexual or drug-injecting behavior, are likely to be sources of continued disease transmission in a network or community (i.e., are core transmitters).

Core transmitter. A person who, as a consequence of continuing risky sexual or drug-injecting behavior, is likely to be a source of continued disease transmission in a network or community.

Disease intervention. The process of stopping the spread of a disease and the complications of disease.

Disease intervention specialist (DIS). A health department staff member who is specially trained to interview persons infected with HIV or another STD (i.e., index patients); elicit information about their partners and associates; notify the partners of their possible exposure; ensure that the partners are offered appropriate services, including examination, treatment, and referrals; and provide prevention counseling to index patients, partners, social contacts, and associates.

Drug-injection partner. A person with whom a patient shares drug-injection equipment (e.g., needles, syringes, cottons, cookers, or rinse water). These persons have been traditionally referred to as needle-sharing partners or syringe-sharing partners.

Dual referral. A notification strategy in which an index patient, together with a health-care provider (typically a disease intervention specialist) notifies a partner of the partner's possible exposure. The strategy allows the provider to provide direct support to the index patient during the notification process and provide the partner with immediate access to counseling, testing, and other information resources (e.g., referrals).

Duty to warn. A legal concept that a health-care provider who learns that an HIV-infected client is likely to transmit the virus to another identifiable person must take steps to warn that person. State laws determine which circumstances constitute a duty to warn.

Early syphilis. Primary, secondary, and early latent syphilis.

Expedited partner therapy (EPT). The process by which treatment for partners of persons diagnosed with gonorrhea or chlamydial infection is administered before clinical evaluation. Medications or prescriptions are delivered through either 1) the index patient (i.e., patient-delivered partner therapy) or 2) a disease intervention specialist (i.e., field-delivered therapy).

HIV prevention community planning group (CPG). A planning group consisting of local health officials, representatives from affected communities, and technical experts who share responsibility for developing a comprehensive HIV prevention plan for their community. The intent of the process is to increase meaningful community involvement in prevention planning, to improve the scientific basis of program decisions, and to target resources to those communities at highest risk for HIV transmission and acquisition.

HIV prevention counseling. An interactive process between client and counselor aimed at reducing risky sex and drug-injection behaviors related to HIV acquisition or transmission.

Index case. The first case recognized or reported during an outbreak or epidemic. In epidemiology, the term case generally refers to an episode of infection or disease, not to a unique person. An index case is not necessarily the source of an outbreak or epidemic; it is simply the first case identified. In the context of HIV/STD partner services, an index case is a newly reported case that prompts the initiation of an investigation to identify other possibly related cases. For curable STDs, the term index case refers to discrete episodes of infection. A person who has recurrent episodes of a curable STD during a defined time period is counted as a separate index case for each episode. For example, a person who has three reported episodes of gonorrhea during 1 year would represent three index cases during that year. In contrast, once a person is infected with HIV, the person remains infected; therefore, once a person with HIV infection is identified, the person will not be counted as an index case again in the future.

Index patient. The person in whom an index case occurs and who prompts the initiation of an investigation to identify other possibly related cases. Index patients also are sometimes referred to as "original patients" (i.e., the original patient identified in an investigation, not necessarily the original patient in a chain of transmission).

Indicator. A measure used to determine an organization's performance of a particular element of care over time. The indicator might measure a particular function, process, or outcome

Interview period. The period of time for which an index patient is asked to recall sex or drug-injection partners. Because of differences in biological factors and progression of various diseases, the recommended interview period varies by disease.

Ongoing partner services. The concept that partner services should be available to persons with HIV infection at any time needed throughout the course of their life.

Original interview. The first interview conducted with an infected patient. The primary purpose of the original interview is to gather information from index patients about partners they have had during the relevant interview period.

Original patient. See index patient.

Outcomes. Benefits or other results (positive or negative) for clients that might occur during or after their participation in a program. Outcomes can be client level or system level.

Overall responsible party (ORP). The person who accepts overall responsibility for implementing and enforcing HIV/AIDS and STD data security standards and who might be liable for any breaches of confidentiality.

Partner. For persons with syphilis, gonorrhea, or chlamydial infection: refers to sex partners (i.e., persons with whom an index patient has had sex at least once, not just regular or main partners); for persons with HIV infection: refers to sex and drug-injection partners (i.e., persons with whom an index patient has had sex or shared drug-injection equipment at least once, not just regular or main partners).

Partner elicitation. The process of obtaining the names, descriptions, and locating information of persons who are partners (or social contacts) of an index patient. Partner elicitation is one step in the process of partner referral

Partner notification. The process of locating and confidentially notifying partners that they have been exposed to an infection. Partner notification is one step in the process of partner referral.

Partner referral. The process in which partner names are elicited (i.e., partner elicitation), partners are located and notified of their exposure (i.e., partner notification), and notified partners receive a combination of counseling and referrals for testing (or in some cases, testing in the field) and other social support services.

Partner services. A broad array of services that should be offered to persons with HIV infection, syphilis, gonorrhea, or chlamydial infection and their partners. Identifying partners and notifying them of their exposure (i.e., partner notification) are two critical elements of these services. Other elements include prevention counseling, testing for HIV and other types of STDs, linkage to medical evaluation and treatment, and linkage or referral to other services, such as reproductive health, prenatal care, substance abuse treatment, social support, housing, legal services and mental health services.

Patient. A client who is diagnosed with HIV infection or another STD.

Patient referral. See self-referral.

Performance measure. A quantitative tool that provides an indication of an organization's performance in relation to a specified process or outcome.

Personal identifier. A datum or collection of data that allows the identity of a single person to be determined with a specified degree of certainty.

Postexposure prophylaxis (PEP). Administration of antiretroviral drugs to HIV-negative persons who have been exposed to HIV in an effort to prevent establishment of infection. The treatment is initiated within 72 hours of exposure and generally continues over the course of a 28-day period.

Prevention counseling. An interactive process between client and counselor aimed at reducing risky sex and drug-injection behaviors related to acquisition or transmission of HIV and other types of STDs.

Prison Rape Elimination Act of 2003 (PREA). A public law that provides for analysis of the incidence and effects of prison rape in federal, state, and local institutions and for information, resources, recommendations, and funding to protect persons in prison from rape.

Privilege to warn. The legal concept that a health-care worker is legally permitted to warn the partners of an HIV-infected person of the risk of past or future exposure to HIV.

Program collaboration and service integration. A mechanism of organizing and blending interrelated health concerns, separate activities, and services to maximize public health impact through new and established linkages among programs to facilitate delivery of services.

Provider referral. A notification strategy in which a health department specialist (e.g., disease intervention specialist) confidentially notifies a partner of possible exposure.

Quality. The degree to which a health or social service meets or exceeds established professional standards and user expectations.

Quality improvement. An approach to the continuous study and improvement of the processes of providing services to meet the needs of the person and others.

Reactor grid. The use of quantitative test results, age, and sex criteria to identify which persons with reactive syphilis tests are most likely to be untreated and infectious cases.

Reinterview. An interview that follows the original interview with an index patient. The reinterview is used to gather additional locating information about partners identified by index patients during the original interview, monitor the status of partners index patients initially decided to notify themselves, elicit names of additional partners index patients might not have recalled in the original interview, and verify that index patients have received adequate treatment or additional tests.

Ryan White CARE Act Amendments of 1996. The law reauthorizing the Ryan White HIV/AIDS Program, a program administered by the Health Resources and Services Administration that provides for grants to support the medical care needs of low-income, uninsured, and underinsured persons living with acquired immunodeficiency syndrome (AIDS) and HIV infection.

Self-referral. A notification strategy in which an index patient accepts full responsibility for informing a partner of possible exposure and referring the partner to appropriate services. A health-care provider helps the index patient determine when, where, and how to notify the partner as well as how to cope with potential reactions. This process is also known as client referral and patient referral.

Social contact. A person named by the index patient during an interview as part of the social network who is not a sex or drug-injection partner of the index patient. Social contacts (referred to as suspects in previous STD partner services guidelines) might include persons with symptoms suggestive of disease, partners of other persons known to be infected, or others who might benefit from examination.

Social network. A group of persons connected by various types of social relationships, such as family, work and recreational relationships, sexual partnerships, and drug-using relationships. The social network might also include venues in which interactions among members of a social network occur. Persons in a social network might share social, economic, cultural, or behavioral characteristics that influence their risk for various health conditions, including HIV infection and other STDs.

Standards. Elements or procedures that must be followed by CDC grantees in virtually all instances in which CDC funds are used to support services.

Suspect. A social contact. This term has historically been used to describe a person named by an index patient as part of the social network who is not a sex or drug-injection partner of the index patient. These persons might have symptoms suggestive of disease, might be partners of other persons known to be infected, or might be other persons who might benefit from examination.

System. A group of related processes.

Third-party provider. A health or social services professional not affiliated with a health department (e.g., physicians, nurses, or counselors) who might participate in certain aspects of partner services, such as partner elicitation or partner notification via dual referral

Third-party referral. A notification strategy by which a partner is notified of exposure to HIV or another STD by a professional other than a health department staff member (e.g., a private physician).

Window period. The time interval after infection during which a serologic test might be negative because antibodies have not reached a detectable level.



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