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Implementing HIV Partner Services HIV Surveillance PerspectiveIn Four Health Departments
17th Texas HIV/STD ConferenceAustin, Texas
Shirley Chan, MPHHouston Department of Health and Human Services
Bureau of EpidemiologyHIV/AIDS Surveillance Program
• “Each state holds the legal authority for partner notification and referral of persons infected with HIV/STD”
• “The 10th amendment of the US constitution provides states the authority to establish laws and regulations to protect the health, safety and welfare of their citizens”
• “Each state has unique regional and demographic factors that impact the health of the citizen”
• “State laws will reflect these differences”
Legal and Ethical Concerns
Collective Goals of Partner Services (PS)
To identify new HIV+ individual and their partners and to offer PS in a timely manner
• For the patients– Provide the patients with support and link to care and
interventions – Ensure their partners are confidentially informed
• For the partners– Maximize the proportion of partners who are notified– Maximize early linkage to test, care and prevention interventions
• For the community – Aid in early diagnosis, treatment and provide prevention services to reduce rate of transmission
Rationale for PS
– Can play an essential role in preventing and controlling HIV
– Can identify a mean of 20% (14% -26%) of those partners tested as newly HIV+
– Can increase the identification of HIV-infected persons in a high-prevalence population
– Can be cost effective
Challenges• PS acceptance by patients?
– Potential for abuse– Potential negative effects on relations
• PS in non-public health clinic settings? – Provider may not report
• Private providers – Acceptance by physicians?
• Link to surveillance data?– HIV surveillance program is to provide data– HIV surveillance data is not designed for case
management– Lack of additional funding
Linkage with Disease Reporting
• 2007 CSTE survey
– 71% of respondents reported sharing data in some form
– 43% of respondents reported sharing individual-level data including personal identifiers
MMWRNovember 7, 2008 / Vol.57 /No.RR-9
Recommendation for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydia Infection
Differ from previous PS guidelines
– Integration of services at the client level
– Linkage between surveillance and program activities for PS
– Contact as soon as possible after diagnosis
– Linkage to medical and prevention services
– Program monitoring and evaluation
Partner Services
Table 1. Summary of Characteristics in Four Health Departments"State" Health Department "Local" Health Department
Colorado Florida Houston San FranciscoRanking (Cumulative AIDS) Approx. 20 #3 as a state #8 as a city #3 as a city
Average number of infection/year (in the past 5 years)
400-450 4,000 approx 1,200 550-600
Year named-reporting 1985 1997 1999 2002 code-base; 2006 named-based
Law regarding PS CRS25-4-1401
Chapter 384; reporting statue 381.0031, Rule 64D-3 Florida AdmCode
Texas Health & Safety Code, Chapter 81,Sec.81.051
Health & Safety Code, 12015
HIV reporting 7 days Providers 2 weeks; Lab 3 days 7 days Lab 7 days
HIV surveillance and STD surveillance Integrated? Yes No 2010 No
Database use PRISM PRISM STD*MIS
Year PS initiated 1986 1986 - 87 2002 2008
Is PS implemented in public section or private sector or both?
Both Both Both Both
Demographics White/Hispanic Black/Hispanic Black/Hispanic 70% White young male
Confidentiality Same guidelines as in HIV surveillance
Same guidelines as in HIV surveillance
Same guidelines as in HIV surveillance
Same guidelines as in HIV surveillance
On-line partner notification Inspot PENSHOUSTON Inspot
Partner Services
Colorado
Partner ServicesPatient and partner
notification
Prevention counseling and testing
Linkage to care
Hospitals
STI / HIV Surveillance
Program
Physicians
Lab Reports
Health Departments
Vital Statistics and other Disease Registries
Counseling and Testing
sites
Partner Services
Florida
Partner ServicesPatient and partner
notification
Prevention counseling and testing
Linkage to care
HIV Surveillance
Program
Prism
STD Surveillance
Program
Private Sector –
HIV+ labs from private providers (ELR or mailed)
Public Sector –
HIV+ lab reports processed from State Lab (health department and CBOs from ELR)
Prism
Partner Services
San Francisco
HIV PreventionPartner ServicesPatient and partner
notification
Prevention counseling and testing
Linkage to care
HIV Surveillance
ProgramSTD Clinics
(SFCC)
Private Sector –HIV+ labs from private providers
Public Sector –HIV+ reports from public clinics and hospital
Inspot
Request physician approval for PS
Partner Services
Houston
HIV PreventionPartner Services
Patient and partner notificationPrevention counseling and
testing/risk reduction/treatmentLinkage to care
OOJ
HIV Surveillance
Program
CBOs
Lab Reports
STD Surveillance
ProgramPrivate Physician Reports
Other Facility Reports Insurance
City of HoustonHealth Clinics
Correctional Facilities
STD*MIS
Information SharedTo DIS:• Name• Address• Date of birth• Race/ethnicity• Gender• HIV status• Date & type of HIV test• Additional locating
information
To Surveillance:• Risk factors• Previous testing
history• Treatment history
Confidentiality / Data Security
• DIS required to attend annual Security and Confidentiality training– Expected to comply with same Security and
Confidentiality procedures as HIV Surveillance– Requires high level of trust between programs
• DIS gather information from patient interview– Data is entered in STD*MIS
• HIV case information is entered into HARS– Only HIV surveillance staff have access to HARS
Discussion• Using surveillance data for PHFU has proven to be
effective (Partner notification reveal a high seroprevalence rate ranging from 11% to 39%)
• Linking surveillance with case management services must not compromise the quality or integrity of the surveillance system (HIV surveillance program and prevention program should establish policies and procedures based on both principles and practices)
• Partner services should be voluntary, informed and not coerced
• PS should be performed in a timely manner
• Enforcing strict security and confidentiality guidelines
What needs to be done
• New HIV testing technologies can be useful to identify newly infected persons and provide immediate counseling, support and referral to services.
• Health department could forge closer ties with providers
• Online partner notification can be an efficient method
• PS programs should be monitored and evaluated to ensure quality of care are delivered
Acknowledgements• Special thank you goes to my co-presenters at the 2009 National
HIV Prevention Conference –– Becky Grigg at Department of Health, State of Florida
– Maree Kay Parisi at San Francisco Department of Health
– Pam Montoya at Colorado Department of Public Health
• HIV/STD Surveillance Program Staff
• Bureau of HIV, STD, and Viral Hepatitis Prevention
• Sources of Support: This study was supported by Cooperative Agreement Number PS08-802 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not represent the official views of the Centers for Disease Control and Prevention
Contact Information
Shirley [email protected]
Houston Department of Health and Human ServicesBureau of Epidemiology, 4th Floor8000 N. Stadium DriveHouston, TX 77054
Tel: (713) 794-9441Fax: (713) 794-9391
