Upon receipt of a reportable STI report from a health care
professional or laboratory, a local health department, designated agent or the
Department, as applicable, shall conduct a counseling session and offer partner
services in accordance with guidelines established by the Centers for Disease
Control and Prevention of the U.S. Public Health Service, Recommendations for
Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and
Chlamydial Infection, as follows:
a)
Counseling and partner services shall be provided only by staff of a local
health department, designated agent or the Department, as applicable, who have
completed a Department-approved training, or a training approved by the local
health department in cities with a population of 1,000,000 or more.
b) Any person diagnosed with early syphilis
or HIV/AIDS by any health care professional, or any person diagnosed with
gonorrhea or chlamydia by a local health department or designated agent shall
be counseled and offered partner services by the local health department,
designated agent, or Department, as applicable. "Early syphilis" means primary,
secondary or early non-primary non-secondary (NPNS) syphilis of less than one
year's duration.
c) Any person
diagnosed with an STI by a health care professional other than a local health
department shall be counseled and offered partner services (including expedited
partner therapy for chlamydia, gonorrhea and trichomonas) as resources permit
and within the discretion of the local health department, designated agent or
Department, as applicable.
d)
Counseling of reportable STI cases and partner services shall be conducted in a
confidential manner, and shall be documented either in electronic format or on
forms furnished by the Department, or by the local health department in cities
with a population of 1,000,000 or more.
e) All records regarding counseling of
reportable STI cases and partner services shall be confidential, and shall at
all times be maintained in the same manner as those maintained for reported
cases of STIs as required in Section
693.100 of this Part.
f) For reportable STI cases, counseling and
partner services shall be provided by the local health department, designated
agent or the Department, as applicable, and shall include the following:
1) An offer of assistance, with the consent
of the infected person, in locating and referring contacts for counseling,
testing and treatment, if indicated. All infected persons refusing assistance
shall be strongly encouraged to notify their critical period sex and
needle-sharing (HIV/AIDS) contacts of their possible exposure to STI, and to
refer these contacts for counseling, testing and treatment, if
indicated.
2) For each identified
contact, the counselor shall discuss with the infected person the time period
of exposure and the likelihood of STI transmission based on the type of sexual
or needle-sharing practice involved. Notification and referral shall be
provided to contacts for whom sufficient information to identify and notify the
person is available. When contacts can be linked to a website encounter, the
counselor will be authorized to implement an Internet Notification Protocol to
confer with and refer for clinical services contacts linked to an infected
person. Internet Partner Notification (IPN) services shall be provided only by
staff of a local health department, designated agent, or the Department, when
applicable, who have completed Department-approved IPN training, or IPN
training approved by the local health department in cities with a population of
1,000,000 or more.
3) Persons
choosing to self-refer their contacts shall receive intensive individualized
instruction and counseling in methods to provide this notification and
referral.
4) STI contacts
identified through the counseling and partner services process shall be
counseled confidentially regarding the possibility of infection and methods to
prevent the spread of infection, and shall be referred for testing and
treatment, if indicated.
5) For
STIs, if the person is legally unable to agree to counseling because of age or
legal incompetence, consent and participation in counseling shall be requested
of the individual's parent or legal guardian. If, in the professional judgment
of the counselor, the person is legally able to agree to, but appears to be
incapable of understanding and competently acting on, the counseling,
participation in counseling shall be requested of a parent or other person
chosen by the client.
g)
For the interview and investigation process concerning health care contacts:
1) Patients
A) An individual who has undergone invasive
procedures shall be provided an explanation of the potential risks of HIV
transmission to health care professionals during the performance of invasive
procedures and the legal requirements for notification of the health care
professionals who have performed invasive procedures on that
individual;
B) The individual shall
be asked to identify the specific invasive procedures that have been performed
on the individual, along with the name of the facility or location at which the
procedure was performed, and the name, address and telephone number of the
health care professional who performed the procedure; and
C) The individual shall be offered the
opportunity to self-notify those health care professionals within 45 days, in
accordance with the notification procedures described in Section
693.45 of this Part. If the
individual declines the opportunity to self-notify the individual's health care
professionals, or fails to do so in accordance with the requirements of this
Part, the case shall be referred to the Department for notification of
contacts. The Department will notify contacts in a timely
manner.
2) Health Care
Professionals whose work may result in secondary exposures to others, including
patients:
A) An individual who is a health
care professional whose work may result in secondary exposures to others, or
has worked as a health care professional shall be interviewed. The interview
will determine whether the type of health care practiced by the individual
involves the performance of invasive procedures, and whether the health care
professional has or is likely to have performed invasive procedures;
B) If the individual has or is likely to have
performed invasive procedures, the local health department shall refer the case
to the Department for risk assessment and follow-up;
C) The Department will interview the health
care professional whose work may result in secondary exposures to others or
their estate to complete the investigation and assess the potential risk of HIV
transmission from the health care professional including to their patients,
based on the professional's practice and the types and frequencies of invasive
procedures performed. Others may be interviewed as necessary to complete the
investigation and assess the potential risk of HIV transmission from the health
care professional to their patients;
D) The Department will provide the health
care professional with an explanation of the potential risks of HIV
transmission to patients during the performance of invasive procedures and the
legal requirements for notification of patients whom the Department determines
may have been at risk of HIV transmission from the health care professional,
including the patients;
E) If the
procedures performed by the health care professional were not invasive
procedures, and no other potential risk of transmission was identified by the
Department, the entity performing the investigation process shall provide the
health care professional with information concerning the use of universal
precautions and the recommendations of the Centers for Disease Control and
Prevention concerning the prevention of HIV transmission. The health care
professional shall also be advised to refrain from any future performance of
invasive procedures, except in accordance with the recommendations of an expert
review panel convened pursuant to the Centers for Disease Control and
Prevention's Recommendations for Preventing Transmission of HIV and Hepatitis B
Virus to Patients During Exposure-Prone Invasive Procedures (see Section
693.15(c)(3) of
this Part);
F) If any of the
procedures performed by the health care professional were invasive procedures,
or the Department identifies any other potential risk of transmission to
patients, the Department will advise the health care professional that these
patients must be notified of their potential risk of exposure to HIV. The
health care professional shall be given the opportunity to submit any
information and comments to the Department concerning the notification, and
shall be offered the opportunity to self-notify the patients within 45 days, in
accordance with the notification procedures described in Section
693.45 of this Part;
G) If the health care professional declines
the opportunity to self-notify the patients, or fails to do so in accordance
with the requirements of this Part, he or she shall provide the Department with
complete and immediate access to any records that identify or may lead to the
identification of the patients and the actual health care that was rendered.
The Department will review but will not copy or seize the provider's records.
The Department will identify and notify in a timely manner all patients who
received invasive procedures or have otherwise been determined by the
Department to have been at risk for HIV transmission; and
H) The health care professional shall also be
advised to address performance of invasive procedures in accordance with expert
review panel, Management of Healthcare Personnel Living with Hepatitis B,
Hepatitis C, or Human Immunodeficiency Virus in US Healthcare Institutions, and
SHEA Updates Guidance for Healthcare Workers with HIV, Hepatitis, Advances in
Care and Treatment of Bloodborne Pathogens Reflected in White
Paper.