Sexually Transmitted Diseases  >  Program Guidelines  >  Partner Services

Program Operations Guidelines for STD Prevention
Partner Services

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Sections on this page:

• INTRODUCTION
• Shared Principles
• Overview
• Legal Authority
• Case Management
• Resource Requirements
• Safety
• Confidentiality

INTRODUCTION PS-1

Shared Principles

Both STD prevention programs and HIV programs provide guidance on services to partners. Although STD prevention programs call these services "Partner Services," and HIV programs call these services "Partner Counseling and Referral Services," the services offered share many principles. Those principles are listed below.

1. Voluntary—Partner services are voluntary on the part of the infected person and his or her partners.
2. Confidential—Every part of the partner service process is confidential.
3. Science-Based—Partner service activities are science-based and require knowledge, skill, and training.
4. Culturally Appropriate—Partner services are to be delivered in a nonjudgmental, culturally appropriate, and sensitive manner.
5. A Component of a Comprehensive Prevention System—Partner services is one of a number of public health strategies to control and prevent the spread of STD and HIV. Other strategies include accessible clinics, outreach to, and targeted screening of at-risk populations, behavioral interventions, and educational programs.
6. Diverse Referral Approaches—Partner services may be delivered through two basic approaches: provider referral, whereby the provider locates and informs partners of their exposure; and client referral, whereby the infected person takes responsibility for informing his or her partners.  Sometimes a combination of these approaches is used.
7. Support Services and Referral—Partner services are delivered in a continuum of care context that includes the capacity to refer partners to HIV counseling, testing, and treatment, as well as other services (e.g., family planning, violence prevention, drug treatment, social support, housing).
8. Analysis and Use of Partner Service Data—Programs should collect confidential data on the counseling and referral services provided and use the data for evaluating and improving program efficiency, effectiveness, and quality.
9. Counseling and Support—Counseling and support for those who choose to notify their own partners is essential. Assistance to patients in deciding if, how, to whom, where, and when to disclose their infection can help them avoid stigmatization, discrimination, and other potential negative effects.
10. Client-Centered Counseling—Providing client-centered counseling for STD-infected individuals and their partners can reduce behavioral risks for acquiring or transmitting STDs.
11. Increased Importance as New Technologies Emerge—As new technologies emerge, such as more sophisticated testing procedures and behavioral interventions, partner services will become an increasingly important prevention tool.

Overview

Partner services have evolved from an exclusive focus on finding the sexual contacts of infected persons to a broad view of the clinical and epidemiologic activities needed to help persons infected with STDs. The basic process - interviewing infected persons and others potentially involved in transmission, identifying persons still at risk (whether through direct exposure or indirect involvement), and bringing the latter to diagnosis and treatment - has changed little, but the context for such activity has greatly changed. Partner services play several roles in this context. First, they are a clinical tool for identifying a patient's needs and requirements and connecting the patient to appropriate care. Second, partner services provide the basis for assessing local epidemiologic conditions, targeting resources, and evaluating program performance. Third, follow-up of partners who are at risk is a powerful tool for understanding the dynamics of disease transmission.

Partner services are offered to individuals who are infected with STD, to their partners, and to other persons who are at increased risk for infection in an effort to prevent transmission of these diseases and to reduce suffering from their complications. Services include:

• providing information regarding current infection(s) and other STDs;
• ensuring confidential notification, appropriate medical attention, and appropriate social referrals for partners and other high-risk individuals;
• using client-centered counseling to develop risk reduction plans to reduce the likelihood of acquiring future STDs;
• providing needed referrals to additional medical or social services; and
• defining and better targeting the at-risk community while assuring complete confidentiality for the patient.

Provision of partner services involves discussion and documentation of highly sensitive personal information about patients and their partners. Therefore, programs must demonstrate the highest regard for individual privacy, confidentiality of medical records, disease histories, and related information. Programs must be perceived by at-risk populations in particular and by the community in general as being fully committed  to this principle. STD program staff must understand and adhere to their responsibilities with regard to confidentiality and to the overall quality of partner services and must be held accountable by performance guidelines and by supervisor observation. For the purpose of these guidelines, the term Disease Intervention Specialist (DIS) will be used to describe those personnel who are charged with providing partner services once a person has been diagnosed with a STD.

Effective prevention of disease transmission begins with infections that are properly diagnosed, appropriately treated, and fully reported in accordance with established laws and regulations. Cases reported from non-STD clinic settings must be carefully reviewed and record searched before contact with the reporting provider is initiated to confirm diagnoses and treatment status and to obtain, if necessary, permission to contact patients regarding partner services. Oftentimes, prior agreement or a memorandum of understanding with a provider allows routine permission to follow up.

Each program must individually determine those STDs for which partner services will be made available and to what extent these services will be provided. Factors to be considered include staffing, specific morbidity, infectiousness of disease (and stage of infection for syphilis), public health costs of infections and their sequellae, cost benefit of services, and amenability of the disease to the intervention planned. The availability of resources and the ability to enlist the support and cooperation of the medical community—particularly those located in or serving high risk communities-also play a role in the decision-making process with respect to partner services. Measures should be implemented to identify such providers and to develop a wide range of strategies, including informing providers about the components and importance of partner services, to gain their support and cooperation. One example might be collaboration with high-volume providers such as family planning clinics, juvenile detention facilities, selected jails and correctional facilities, delivery hospitals, drug rehab groups, or other high-volume providers to ensure more comprehensive testing, appropriate treatment, early reporting, and the availability of partner services.

Legal authority

Legal authority for the notification and referral of partners to persons with known STD infections resides with the states. Program policies and procedures should be consistent with applicable state laws, statutes, and regulations.

Case Management

Case management is the systematic pursuit, documentation, and analysis of medical and epidemiologic case information that focuses on opportunities to develop and implement timely disease intervention plans. Effective case management normally progresses through a very specific process: pre- interview analysis, interview (original, reinterviews, and cluster interviews), post-interview analyses, referral of sex partners, and case closure. Although the concepts and techniques of case management are usually consistent in various program areas, specific policies may differ.

Effective case management is sustained by 1) identifying the information needs of individual and related cases; 2) developing agendas for prospective interviews; 3) assuming responsibility for critical communications with other members of the staff; and 4) remaining current on progress of case elements assigned to others. The DIS must promptly pursue case needs and activities resulting from personal analysis, supervisory input, or the contributions by other staff members—both within and outside of the immediate program area.

Resource Requirements

Programs should provide DIS and managers with the tools, training, and resources necessary to conduct partner services successfully. Interview rooms that are quiet and contain at least a desk or table, three chairs, a telephone, and appropriate support materials should be readily accessible to the DIS. Also, DIS should have access to appropriate STD clinic patient records, program interview and investigative files, relevant maps, telephone books, and cross directories. Investigative resources should be carefully developed and maintained. At a minimum, efforts should be made to develop access to department of motor vehicles (DMV), welfare, utilities, post office, local schools, and health department records.

DIS should be encouraged to identify, develop, and share information with each other on agencies that serve or that have information on at-risk populations. Such efforts would include identifying specific members of the at-risk community willing to advocate community support for program activities. Programs are further encouraged to develop and implement interview records and data collection instruments that reflect information needed by the program, that are easy to complete, that can be stored and retrieved electronically, and that will assist program efforts to better define and serve at-risk populations. Programs should make maximum possible use of current technology to facilitate DIS record keeping and case management, including computer storage and case analysis software when available. Case management tools can be stored and retrieved electronically, provided the security and confidentiality of those tools are maintained.

Safety

Many field activities may pose potential unsafe situations for public health workers. Program managers should develop and maintain detailed guidelines for ensuring DIS safety in the performance of their responsibilities. Training should include a common-sense approach to field work (appropriate dress; expensive looking jewelry, purses, and other valuables kept out of sight; car doors locked and windows rolled up; constant awareness of surroundings; and the importance of relying on instincts). DIS should be provided picture identification (ID) and the ID should be required to be in an employee's possession when in the field. An employee file should be kept on each field worker which can be shared with authorities in case of emergency. This file should include name, address, physical description, emergency locating information, a recent picture of the employee, a description of the employee's vehicle, and the vehicle license number.  Other steps that programs might take to promote safety include allowing DIS to work in pairs as situations warrant, making cellular phones and pagers available and requiring DIS to call in when changing plans or when an investigation becomes problematic. Some programs require DIS to have all field notes prepared ahead of time to ensure the DIS is efficient and alert to the surroundings. Others require that DIS submit a daily route sheet of intended stops to the supervisor so that a DIS route can be followed if an emergency arises. Although route sheets change as a DIS develops investigational leads, such sheets offer a place to start.

Before allowing new DIS to conduct field work alone, immediate supervisors or other, more experienced workers should be assigned to accompany them for purposes of identifying locations within the community where high-risk activities take place—drug houses, parks, bars, prostitution stroll areas, or those controlled by gangs—and to model desired behavior. When working in such areas, DIS must learn to be particularly alert. Safety issues and emerging problem areas should be routinely discussed in staff meetings and daily debriefings.

The primary protection from unsafe situations is the DIS's knowledge of the community and visibility in important locations. Programs should understand the need for DIS to spend time in areas to establish critical personal rapport with members of the community. This can be accomplished while performing outreach activities, organizing field screenings, and participating with CBOs in outreach activities.

Other safety issues involve "occupational infections in the workplace." At a minimum, local policies and procedures should encompass those in the Occupational Safety and Health Administration policy (more current information may be obtained from the OSHA website at www.osha.gov). Each program area must have a local policy for avoiding occupational exposure and for dealing with such exposures, should they occur. Each DIS should be required to practice local policies and procedures for avoiding infection(s) that could be acquired in the performance of their program responsibilities. These policies and procedures should be regularly updated and formally reviewed with staff members at least yearly. The section titled "Diagnostic assessment of partners in the field" also addresses this issue.

Confidentiality

Confidentiality policies of public health agencies are designed to prevent unauthorized persons from learning information shared in confidence. Confidential information includes any material, whether oral or recorded in any form or medium, that identifies or can readily be associated with the identity of a person and is directly related to their health care.

Minimum professional standards for any agency handling confidential information should include providing employees with appropriate information regarding confidential guidelines and legal regulations. All public health staff involved in partner notification activities with access to such information should sign a confidentiality statement acknowledging the legal requirements not to disclose STD/HIV information.

Efforts to contact and communicate with infected patients, partners, and spouses must be carried out in a manner that preserves the confidentiality and privacy of all involved. This includes counseling partners in a private setting; trying to notify exposed partners face-to-face; never revealing the name of the original patient to the partner; not leaving verbal messages that include STD/HIV on answering machines; not leaving written messages that include any mention of STD/HIV; not giving confidential information to third parties (roommates, neighbors, parents, spouses, children).

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