Partner Notification

2 Learning Outcomes At the end of this session you should be able to: Describe the aims of partner notification (PN) List the key elements of PN process Evaluate the issues relating to PN in Primary Care

3 Definition of partner notification “..the process of contacting the sexual partners of an individual with a sexually transmitted infection including HIV, and advising them that they have been exposed to infection. By this means, people who are at high risk of STI/HIV, many of whom are unaware that they have been exposed, are contacted and encouraged to attend for counselling, testing and other prevention and treatment services.” W.H.O Further information:

Challenges around PN Use PN scenario from this online video clip: What challenges can you identify? In your practice what issues may affect undertaking PN?

5 Rationale for PN Break the chain of transmission Prevent re-infection of the index patient Prevent complications of untreated infection Moral duty/ ethics to inform?

6 Securing co-operation with PN Voluntary Non-judgmental and supportive approach Emphasize patient choice / control Confidentiality Patient risk of re-infection Partner at risk from untreated infection Risk of transmission to others

Contact tracing issues 7

8 Partner notification methods Patient referral Provider referral Conditional or contract referral

Contact slips / cards Can provide anonymity and confidentiality for the index patient Enable sexual contacts to seek medical advice or treatment Inform the contact’s clinic of index patient’s diagnosis, and date of diagnosis. Enable cross-referencing and evaluation of partner notification 9

10 Identifying partners at risk Look-back periods Refer to sexual history Condom use/ safer sex advice Memory prompts may help recall Document details to track progress

11 Provider referral methods Tracing partners from incomplete data Contact methods – phone, letter, text Encouraging attendance

Innovative Approaches Social Media Young people now report using Facebook® and other social websites for contact tracing. –Caution: - if posted to the “wall ” all friends will see message. 12

Internet partner notification …I didn't know I had Chlamydia when we were together. You should get tested. You may have been exposed to Gonorrhoea. Please get checked soon. oops 13

15 PN resolution Follow up for each partner identified Re-interview patient if partner/s not attended Audit outcomes against national standard (Chlamydia is currently 0.4 contacts per index case in large towns/cities and 0.6 contacts elsewhere- verified per case within 4 weeks)

16 PN in Primary Care Advise patients with an STI that partner/s will need testing / treating Offer choices of partner notification e.g. – patient to inform their contacts Consider local referral pathways for management of patient with STI to include PN arrangements

17 Management options for STIs diagnosed in primary care 1.Manage all aspects of PN in- house, including provider referral and follow-up 2.Treat, interview patient re partners, pass details to HA if provider referral requested 3.Treat and refer to GUM / Community Health Adviser for PN only (HA to telephone pt, no trip to GUM needed) 4.Treat and refer to GUM for Test Of Cure / PN 5.Refer patient to GUM for all management

18 Practical Session Healthcare provider information: Sarah – is a 25 year old nurse who presented to 2 weeks ago with 2 months irregular inter-menstrual bleeding despite taking her COC pill correctly. She re- attends and you have already explained that she has Chlamydia, what it is and how it should be treated. NOW DISCUSS PARTNER NOTIFICATION.

19 Practical Session (2) Patient information: You are Sarah, a 25 year old woman who attended your GP surgery 2 weeks ago, complaining of 2 months history of irregular bleeding between periods. You are currently taking COC correctly. Your GP has just informed you that your Chlamydia test from the previous visit 2 weeks ago is positive. You have a regular partner called Tom who you have been with for the last 6 months. Prior to this you recently split with Dick after a year of being together. Three months ago you had unprotected sex with an old friend Harry.

20 Outcomes At the end of this session you should be able to: Describe the aims of partner notification (PN) List the key elements of PN process Evaluate the issues relating to PN in Primary Care