Implementing HIV Partner Services
           HIV Surveillance Perspective
           In Four Health Departments


   17th ...
Legal and Ethical Concerns

• “Each state holds the legal authority for partner
  notification and referral of persons inf...
Collective Goals of
             Partner Services (PS)
To identify new HIV+ individual and their partners and to
  offer P...
Rationale for PS

– Can play an essential role in preventing and
  controlling HIV
– Can identify a mean of 20% (14% -26%)...
Challenges
• PS acceptance by patients?
   – Potential for abuse
   – Potential negative effects on relations
• PS in non-...
Linkage with Disease Reporting

• 2007 CSTE survey
  – 71% of respondents reported sharing data in
    some form
  – 43% o...
MMWR
           November 7, 2008 / Vol.57 /No.RR-9
Recommendation for Partner Services Programs for HIV Infection,
       ...
Partner Services
Table 1. Summary of Characteristics in Four Health Departments
                                         "State" Health Dep...
Partner Services
Colorado
             Lab Reports                                Hospitals


                                 STI / HIV
  ...
Partner Services
Florida                    Public Sector –
Private Sector –
                                                            HI...
Partner Services
San Francisco
Private Sector –
                                                              Public Sector –
HIV+ labs fro...
Partner Services
Houston
             Lab Reports
                                                                              OOJ

      ...
Information Shared
To DIS:                     To Surveillance:
• Name
                            • Risk factors
• Addres...
Confidentiality / Data Security
• DIS required to attend annual Security and
  Confidentiality training
  – Expected to co...
Discussion
• Using surveillance data for PHFU has proven to be
  effective (Partner notification reveal a high seroprevale...
What needs to be done
• New HIV testing technologies can be useful to identify
  newly infected persons and provide immedi...
Acknowledgements
•   Special thank you goes to my co-presenters at the 2009 National
    HIV Prevention Conference –
     ...
Contact Information


  Shirley Chan
  shirley.chan@cityofhouston.net


  Houston Department of Health and Human Services
...
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Implementing hiv partner services

  1. 1. Implementing HIV Partner Services HIV Surveillance Perspective In Four Health Departments 17th Texas HIV/STD Conference Austin, Texas Shirley Chan, MPH Houston Department of Health and Human Services Bureau of Epidemiology HIV/AIDS Surveillance Program
  2. 2. Legal and Ethical Concerns • “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”
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. MMWR November 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
  8. 8. Partner Services
  9. 9. Table 1. Summary of Characteristics in Four Health Departments "State" Health Department "Local" Health Department Colorado Florida Houston San Francisco Ranking (Cumulative Approx. 20 #3 as a state #8 as a city #3 as a city AIDS) Average number of infection/year (in the past 400-450 4,000 approx 1,200 550-600 5 years) 2002 code-base; 2006 Year named-reporting 1985 1997 1999 named-based Chapter 384; reporting Texas Health & Safety statue 381.0031, Rule Health & Safety Code, Law regarding PS CRS25-4-1401 Code, Chapter 81, 64D-3 Florida Adm 12015 Sec.81.051 Code Providers 2 weeks; Lab HIV reporting 7 days 7 days Lab 7 days 3 days HIV surveillance and STD Yes No 2010 No surveillance Integrated? Database use PRISM PRISM STD*MIS Year PS initiated 1986 1986 - 87 2002 2008 Is PS implemented in public section or private Both Both Both Both sector or both? Demographics White/Hispanic Black/Hispanic Black/Hispanic 70% White young male Same guidelines as in Same guidelines as in Same guidelines as in HIV Same guidelines as in Confidentiality HIV surveillance HIV surveillance surveillance HIV surveillance On-line partner Inspot PENSHOUSTON Inspot notification
  10. 10. Partner Services
  11. 11. Colorado Lab Reports Hospitals STI / HIV Surveillance Health Program Departments Physicians Vital Statistics and other Counseling and Testing Disease Partner Services sites Registries Patient and partner notification Prevention counseling and testing Linkage to care
  12. 12. Partner Services
  13. 13. Florida Public Sector – Private Sector – HIV+ lab reports processed from HIV+ labs from private State Lab (health department and providers (ELR or mailed) CBOs from ELR) HIV STD Surveillance Surveillance Program Program Prism Prism Partner Services Patient and partner notification Prevention counseling and testing Linkage to care
  14. 14. Partner Services
  15. 15. San Francisco Private Sector – Public Sector – HIV+ labs from private providers HIV+ reports from public clinics and hospital HIV Request Surveillance physician STD Clinics Program approval for PS (SFCC) Inspot HIV Prevention Partner Services Patient and partner notification Prevention counseling and testing Linkage to care
  16. 16. Partner Services
  17. 17. Houston Lab Reports OOJ HIV STD Surveillance Surveillance Private Program Program Physician Reports CBOs STD*MIS Other Facility Reports HIV Prevention Insurance Partner Services Patient and partner notification Prevention counseling and testing/risk reduction/treatment Linkage to care City of Houston Correctional Health Facilities Clinics
  18. 18. Information Shared To DIS: To Surveillance: • Name • Risk factors • Address • Date of birth • Previous testing • Race/ethnicity history • Gender • Treatment history • HIV status • Date & type of HIV test • Additional locating information
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. Contact Information Shirley Chan shirley.chan@cityofhouston.net Houston Department of Health and Human Services Bureau of Epidemiology, 4th Floor 8000 N. Stadium Drive Houston, TX 77054 Tel: (713) 794-9441 Fax: (713) 794-9391

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