HIV/STD Partner Services Recommendations

1. New and Improved HIV/STD Partner Services Recommendations Cindy Getty & Rheta Barnes Divisions of HIV/AIDS Prevention & STD Prevention National Centers for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention

2. Overview • Background on Partner Services • Rationale and Process for Revising the Recommendations • Emphasis of the New Recommendations • Dissemination, Implementation and Next Steps

3. Background on Partner Services

4. What is Partner Services? • A broad array of services that can be offered to persons with HIV and other STDs and their partners which includes: • Working w/ infected patients/clients to identify partners • Locating partners • Notifying partners that they may have been exposed to STD/HIV • Offering partners other prevention services

5. What is Purpose of Partner Services? • PS is a prevention activity with the twin goals of: • Interrupting disease transmission (infection control): public health and community benefit • Providing services to partners so they can receive evaluation and treatment or entry to care: individual benefit

6. What is Purpose of Partner Services? • Helping partners gain access to • Medical evaluation • Treatment or care • Counseling • Testing • Other prevention services

7. Identify PS candidates (index patients) PS Elements Contact index patients & interview about partners Notify partners of their exposure Provide counseling, testing, referral and/or treatment to partners

8. PS – Functions • Service • Assists persons w/ HIV or STD with notifying partners & accessing medical care, prevention, & other services • Assists partners with recognizing their risk, learning infection or disease status, and accessing medical, prevention, and other services • Ethical • Addresses partners’ “right to know” their risk • Public Health • Provides information that may be valuable for reducing transmission at the community level

9. Why Revise the Recommendations and How did CDC go About It?

10. Why Revise Recommendations? • Poor coverage of reported HIV cases (index interviews, partner name elicitation, partner interviews) • Separate HIV and STD Guidelines & two separate trainings related to PS: • Integrate documents • Reduce duplication, discrepancies, and confusion • New information from literature & program experience

11. Why Revise Recommendations? • Emerging issues • HIV surveillance data not being shared with PS programs • Need for ongoing partner services for person living with HIV • Unanswered questions • Use of Internet • Emerging Technology

12. Who Assisted in the Development of Recommendations? • Health Department employees (Directors, Program Managers and Disease Intervention Specialists) • Community activists (CHAMP, NMAC) • Professional organizations (NCSD, NASTAD, CSTE) • Academia (Researchers, Ethicists) • Lawyers (Lambda Legal) • CDC staff from DHAP and DSTDP

13. How were the Recommendations Developed? • Workgroups with members representing health departments, CPGs, academia and special populations • Members served as subject matter experts • Workgroups wrote sections of new Recommendations • Recommendations collated into one document by DSTDP and DHAP cross divisional team

14. Emphasis of Partner Services Recommendations

15. Emphasis of Partner Services Recommendations • Increased emphasis on Health Department involvement in partner services provision • Increased emphasis on active identification of PS candidates (i.e., index patients and partners) • All candidates should be offered assistance: level and nature may vary • Increased emphasis on linkage to care • Increased emphasis on quality assurance and evaluation standards

16. Emphasis of Partner Services Recommendations • Increased emphasis on collaboration with internal and external partners involved with PS • Increased emphasis on integration of PS into the spectrum of care • Nature of integration varies by infection • Stronger emphasis on innovative approaches to partner notification and subsequent case-finding • Shared Terminology

17. Dissemination, Implementation and Next Steps

18. Dissemination Activities • MMWR Publication • Internet Posting • Distribution of MMWR • Distribution of Other Documents

19. Dissemination Communication • Dear Colleague Letter • Expectations for programs • Resources for grantees • FAQ for CDC Staff • FAQ for External Partners

20. Implementation Input • Partner Services Steering Committee • Partner Services Lead Team • Focus Groups for CDC Staff • Focus Groups for Sr. Public Health Advisors • Draft Recommendations Reviewer Comments

21. Implementation Input Topics • Barriers for Organizations • Barriers for Individuals • Training & Technical Assistance Needs • Potential Challenges • Recommendations to CDC

22. Implementation Goal: Motivate and support substantial change in STD and HIV Programs with regard to partner services

23. Implementation • Some examples: • Increased number of candidates offered PS • Increased collaboration between PS Programs and Surveillance Programs resulting in data sharing between programs—Program Integration • Increased programmatic activities that reflect the HIV/STD Partner Services Recommendations

24. Implementation • CDC’s Implementation Plan • Implementation Team—15 members from DSTDP and DHAP • 9-step framework based on Rogers Diffusion of Innovation work • Focused on CDC activities to support uptake of HIV/STD PS Recommendations

25. Implementation Plan • Strategic Vision and Planning • Mission • Implementation plan • Marketing and Promotion • Presentations at conferences • Webinars • Policy Issues • Supports from CDC • Local supports

26. Implementation Plan • Complementary Resources • Operational guide • Tool kits • Training • Integrated curriculum design • Training plan • Technical Assistance • Individual • Agency or program-wide

27. Implementation Plan • Program Development and Infrastructure • Funding • New program ideas • Quality Assurance (of the plan) • Quality standards • Quality improvement • Evaluation (of the plan) • Standards • Measurement

28. Moving Forward • 1st Draft by March 31 • Meeting with DSTDP and DHAP Leadership • Input from stakeholders • Meetings • Webinars • Division of work between appropriate work units

29. Thank You!