Partner Notification Support Unit

1. Partner Notification Support Unit Department of Human Services Public Health Branch Office of the Chief Health Officer

2. Partner Notification Officers • Beth Hatch • Robert Barlow • Tom Carter

3. Four areas of responsibility: • P.O.A.R. • Contact Tracing • Epidemiology • Other duties as directed

4. Placing Others at Risk (P.O.A.R.)

5. Placing Others at Risk: • Members of the public, professionals make allegations that a person is HIV positive and either not warning their sex partners of their HIV pos status, before sex occurs, so they can make informed choice OR they are not practising safe sexual activity (condom use) • Used to be referred to as “Knowing and Reckless”

6. The person making the allegation has two options of intervention:

7. Option One: • Make the allegation to the police • Act under the Crimes Act • Charges

8. Option 2: • Make the allegation to the Health Department (DHS) • Office of the Chief Health Officer • PNO’s deal with the matter • Health Act 1958 – new Act is about to go before parliament

9. The CHO has the power under this Act to take actions to prevent a person transmitting an infectious disease to the community Section 121 Health Act 1958

10. PNO’s meet with informant: • Preferably face to face • What is “the story”? • How do you know that the person is positive? • Are you a partner? • Has it happened before/to others? • Informant can go to police • Care for the informant • Confidentiality of informant

11. PNO’s meet with the client: • When, where, how? • Put allegation to client for their response • Full assessment of client – medical, psychiatric, history, forensic, social, drug/alcohol • Look after client – educate, inform, refer, support • Give literature to client • Client given our contact details • PNO’s will get back to client re DHS decisions

12. CHO/PNSU informed: • If urgent or sensitive: Immediately Commence management strategy • If not urgent: Full discussion at next CMM Develop management strategy • Client informed of outcome

13. Case management: The CHO makes a decision with input, if appropriate, from other members of PNSU, other agencies, the Panel to: • Close the case • PNO’s monitor the case • Commence 5 step plan

14. 5 step plan: • Counselling, education, support and referral • Formal request for involvement of CHO. Involvement of Case Management Panel • Letter of Warning • Restriction of movement • Isolation

15. The Panel: • Advisory Panel of independent experts – including I.D. specialist, psychiatrist, PLWHA, lawyer, counsellor • The Panel is convened when CHO would like their advice • The Panel can be called at any stage of the 5 step plan • Client details remain confidential

16. CMM: • All members of PNSU meet fortnightly to review cases and develop plans • Chairperson of panel as well • Every active case is reviewed • Clients can move up and down 5 step plan • Police informed if criminal activity – sex with children, pornography • Plans are flexible and fluid

17. Partner Notification Contact Tracing

18. Based on principle: “it takes two or more people to tango”

19. Dr David Bradford 1983: Quote: “Good STI management and prevention requires three things to be done well: • Good clinical care • Effective prevention education • Good contact tracing If any one of these three things are lacking then the battle can’t be won”

20. If you just manage the client and don’t consider partners – you are only doing half the job

21. There is no law to done contact tracing

22. Why do we contact trace: • Prevent transmission of infection • Find people who may benefit from treatment – thus avoiding potential complications • Provide direct counselling and education to people to bring about behaviour change – it personalises the risk and realities • Generally – identify and reach populations at particular risk in order to influence community norms

23. Partner Notification can be done three ways: • The client notifies his/her partner/s themselves – by far the most common way. Often given a letter to give the partner to take to their doctor • The client and health professional notify the partner/s together • The PNO’s do the partner notification work

24. CONFIDENTIALITY OF THE INDEX CASE MUST BE MAINTAINED AT ALL TIMES

25. Open and honest communication is essential • Contact tracing relies completely on the index case – if they wont tell the health care professional anything, it can’t be done

26. How to contact trace: Telephone: Advantage – time saving, cost effective, confidential, allays anxiety Disadvantage – provides verbal cues only, limited control over response, possible problems with confidentiality

27. Letter: Advantage – little effort Disadvantage – creates anxiety, can be intercepted, inappropriate for disclosing details, what if people can’t read

28. Visit: Advantage – more personal, can give details as appropriate, make assessment of response, give referrals if needed. Testing and treatment can be done Disadvantage – lack of confidentiality, can be time consuming, may not accept referrals

29. The PNO’s contact trace for: notifiable STI’s: HIV Gonorrhoea Syphilis Chlamydia (LGV)

30. PNO’s take referrals from: • Index case – will mean PNO’s may know their indentification details • Health professionals

31. Details of contact: • Personal details – name, address, work, interests, age, description – height, weight, hair, accent, glasses, etc • PNO be aware of safety; and psychiatric history, drug and alcohol use, behavioural issues • Anything else that may be of help – where sex occurred, do anyone else know partner details

32. PNO’s team discussion: On the information we have, considerations for the interview: • Who does it • Where is it done • When is it done • How is it done • Any special considerations

33. The PNO’s then do the intervention and appropriate ongoing care and management

34. Epidemiology

35. HIV: • Call back to testing health professionals who have a new HIV positive test result • Clarify epidemiology • Seek further (enhanced) epidemiology • Educate health professional if needed • Suggest referrals • Discuss contact tracing • Pick up on trends early and act on them • Often speak to client and do what is needed

36. Blood, Tissue or Organ Donations • Check if client has donated and blood, body fluids or body parts for use in medical area • To be done two weeks after test validation • If answer is yes – notify blood bank who immediately start an investigation and take appropriate action • If answer is unknown – notify blood bank who will check their database

37. HIV information collected: • Under code • Discussed at fortnightly meeting with HIV epidemiologist (Burnett) and HIV VIDRL lab • Each case discussed individually • Clarification of information • Pick up early any concerns • Victoria has best HIV epidemiology in Australia

38. Other STI’s: • Call testing doctors and complete epidemiology data – educate, clarify, send information, discuss contact tracing, often speak to clients • Intensive interventions if there is a concerning event identified in data – eg syphilid outbreak

39. V.I.F.M.: • When there is a HIV positive test result for a deceased person the PNO’s become involved • Inform next of kin – if appropriate • Do any contact tracing needed • Attempt to stop transmission of infection and manage those who may be infected

40. Unknown risk of transmission: • Unable for health care professional and client to determine how client became infected with HIV • Referred to PNO’s • Interview client and do CDC assessment of routes • Intervene in any areas where there may be a risk to public health

41. Other Duties as Directed:

42. Sex Industry: • Infectious Diseases Regulations 2006 – PNO visit and inspect all legal/registered brothels once a year for health matters • PNO’s follow-up formal complaints about brothels and ‘workers’

43. Education: PNO’s do lectures to health professionals, courses, organisations, schools – if they have the time

44. Golden rules of Contact Tracing: • Honesty • Trust • Confidentiality • Client driven • Flexibility • Laughter

45. PNO’s contact: Level Three 580 Swanston Street Carlton 3053 PH: 9347 1899 Email: contact.tracers@dhs.vic.gov.au