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Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection

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Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection Morbidity and Mortality Weekly Report www.cdc.gov/mmwr Early Release October 30, 2008 / Vol. 57 Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection depardepardepartment of health and human servicesvicesvices Centers for Disease Control and PreventionPrevention Early Release CONTENTS The MMWR series of publications is published by the Coordinating Center for Health Information and Service, Centers for Disease Introduction......................................................................... 1 Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Methods .............................................................................. 2 Suggested Citation: Centers for Disease Control and Prevention. How These Recommendations Differ from Previous [Title]. MMWR Early Release 2008;57[Date]:[inclusive page numbers]. Partner Services Guidelines ................................................ 3 Centers for Disease Control and Prevention Terminology ........................................................................ 3 Julie L. Gerberding, MD, MPH Definition and Overview of Partner Services ........................ 4 Director Legal and Ethical Concerns ................................................. 8 Tanja Popovic, MD, PhD Chief Science Officer Elements of Partner Services .............................................. 10 James W. Stephens, PhD Identifying Index Patients ................................................... 10 Associate Director for Science Prioritizing Index Patients................................................... 16 Steven L. Solomon, MD Director, Coordinating Center for Health Information and Service Interviewing Index Patients ................................................ 17 Jay M. Bernhardt, PhD, MPH Risk-Reduction Interventions for Index Patients .................. 24 Director, National Center for Health Marketing Katherine L. Daniel, PhD Treatment for Index Patients .............................................. 26 Deputy Director, National Center for Health Marketing Referring Index Patients to Other Services ......................... 27 Editorial and Production Staff Notifying Partners of Exposure ........................................... 27 Frederic E. Shaw, MD, JD Risk-Reduction Interventions for Partners ........................... 33 Editor, MMWR Series Cluster Interviewing Partners ............................................. 35 Susan F. Davis, MD (Acting) Assistant Editor, MMWR Series Testing Partners ................................................................. 35 Teresa F. Rutledge Treatment for Partners ....................................................... 37 Managing Editor, MMWR Series Referring Partners to Other Services .................................. 39 David C. Johnson (Acting) Lead Technical Writer-Editor Specific Populations ........................................................... 39 Catherine B. Lansdowne, MS Strategies to Enhance Case Finding and Partner Project Editor Notification ...................................................................... 44 Peter M. Jenkins (Acting) Lead Visual Information Specialist Program Collaboration and Service Integration ................. 47 Malbea A. LaPete Program Monitoring, Evaluation, and Quality Stephen R. Spriggs Visual Information Specialists Improvement .................................................................... 50 Kim L. Bright, MBA Support of Staff Members .................................................. 55 Quang M. Doan, MBA Erica R. Shaver References......................................................................... 57 Information Technology Specialists Appendices ....................................................................... 64 Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN David W. Fleming, MD, Seattle, WA William E. Halperin, MD, DrPH, MPH, Newark, NJ Margaret A. Hamburg, MD, Washington, DC King K. Holmes, MD, PhD, Seattle, WA Deborah Holtzman, PhD, Atlanta, GA John K. Iglehart, Bethesda, MD Dennis G. Maki, MD, Madison, WI Sue Mallonee, MPH, Oklahoma City, OK Stanley A. Plotkin, MD, Doylestown, PA Disclosure of Relationship Patricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WI CDC, our planners, and our content experts wish to disclose they Barbara K. Rimer, DrPH, Chapel Hill, NC have no financial interests or other relationships with the John V. Rullan, MD, MPH, San Juan, PR Anne Schuchat, MD, Atlanta, GA manufacturers of commercial products, suppliers, or commercial Dixie E. Snider, MD, MPH, Atlanta, GA services, or commercial supporters. Presentations will not include John W. Ward, MD, Atlanta, GA any discussion of the unlabeled use of a product or a product under investigational use. Vol. 57 Early Release 1 Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection Prepared by Division of STD Prevention Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Summary This report provides updated, integrated recommendations for services provided to partners of persons with human immunodeficiency virus (HIV) infection and three other sexually transmitted diseases (STDs) (i.e., syphilis, gonorrhea, and chlamydial infection) and replaces the CDC 2001 Program Operations Guidelines for STD Prevention—Partner Services and the 1998 HIV Partner Counseling and Referral Services Guidance (1,2). These recommendations are intended for health department program managers responsible for overseeing partner services programs for HIV infection and the three other STDs at the state and local levels. The recommendations also might be beneficial for HIV prevention community planning groups, STD program advisory bodies, technical assistance providers, community-based organizations, and clinical care providers. The value of partner services in the control of syphilis and gonorrhea is widely accepted. However, such services are underused among partners of persons with HIV infection. On the basis of evidence of effectiveness and cost-effectiveness of these services, CDC strongly recommends that all persons with newly diagnosed or reported HIV infection or early syphilis receive partner services with active health department involvement. Persons with a diagnosis of, or who are reported with, gonorrhea or chlamydial infection also are suitable candidates for partner services; however, resource limitations and the numerous cases of these infections might preclude direct health department involvement in certain instances. Health departments might need to limit direct involvement in partner services for gonorrhea and chlamydial infection to selected high-priority cases and use other strategies for the remainder (e.g., expedited partner therapy). These recommendations highlight the importance of program collaboration and service integration in the provision of partner services. Because coinfection with HIV and one or more other STDs is common, all persons with a diagnosis of HIV should be tested for other types of STDs, and vice versa; rates of coinfection with HIV and syphilis have been particularly high in recent years. Many persons at risk for these infections also are at risk for other infectious diseases, such as tuberculosis and viral hepatitis, as well as various other health conditions. STD and HIV partner services offer STD, HIV, and other public health programs an opportunity for collaboration to deliver comprehensive services to clients, improve program efficiency, and maximize the positive effects on public health. Introduction determining the role of expedited partner therapy for partners Inconsistencies in the partner services module of the CDC of patients with gonorrhea or chlamydial infection. To reduce 2001 Program Operations Guidelines for STD Prevention and duplication and discrepancies, incorporate new information, the 1998 HIV Partner Counseling and Referral Services Guidance and address emerging challenges, this report integrates (1,2) have been confusing for providers of partner services for guidelines for partner services for HIV infection, syphilis, human immunodeficiency virus (HIV) infection and three gonorrhea, and chlamydial infection into a single set of other sexually transmitted (STDs) for which partner services recommendations. These updated, integrated recommendations are often provided: syphilis, gonorrhea, and chlamydial serve as a basis for delivery of partner services and related infection. In addition, new information has become available training and technical assistance. through research and program experience, new technologies These recommendations are intended for health department are available (e.g., rapid HIV tests), and new challenges have program managers responsible for overseeing partner services emerged, such as finding sex partners via the Internet and programs for HIV infection, syphilis, gonorrhea, and chlamydial infection at the state and local levels and were Corresponding preparer: Samuel W. Dooley, MD, National Center for developed to help program managers plan, implement, and HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, 1600 Clifton evaluate partner services for infected persons and their partners. Road, NE, MS D-21, Atlanta, GA 30333; Telephone: 404-639-5229; The recommendations should be used to help plan and manage Fax: 404-639-0897; E-mail: [email protected].
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