Program Operations Guidelines for STD Prevention

1 Program Operations Guidelines for STD Prevention Partner Services Table of Contents FOREWARD iii INTRODUCTION iv Program Operations Guidelines Workgroup Members vi Partner Services Subgroup Members vii Partner Services Internal/External Reviewers vii INTRODUCTION PS-1 Shared Principles PS-1 Overview PS-2 Legal Authority PS-3 Case Management PS-3 Resource Requirements PS-3 Safety PS-4 Confidentiality PS-4 PARTNER SERVICES PS-5 Patient

2 Types PS-5 Volunteers and Index Patients PS-5 Partners to the Index Patient PS-6 Index Patients Referred by Other Providers PS-7 Presumptive Interviews PS-7 Pre-interview Activities PS-7 Setting Priorities PS-7 Interview Periods PS-8 The Interview Setting PS-8 Pre-interview Analysis (patient assessment) PS-9 Types of Interviews and Their Objectives PS-9 Original Interview PS-10 Reinterview PS-10 The Cluster Interview PS-11 Other Important Interview Concepts PS-11 Motivational Techniques to Encourage Voluntary Disclosure PS-11 Client-centered Approach to Risk Reduction PS-12 Referrals PS-12 Post-interview Activities PS-13 Documentation PS-13 Partner Services i

3 Analysis of Case Information and Problem Solving PS-14 Prioritization of Partners, Suspects.

4 And Associates PS-14 Obtaining Further Information PS-14 Using Information Obtained From the Interview to Identify Possible Outbreak Situations PS-15 Lot System: A Case Management Tool PS-15 Lot System Forms PS-15 Partner Notification Strategies PS-16 Provider Referral PS-16 Self (Patient) Referral PS-16 Contract Referral PS-17 Evidence Supporting Partner Notification PS-18 Other Important Concepts About Partner Notification PS-18 Encouraging the Partner to Seek Medical Treatment PS-18 Follow-up to Ensure Notification Is Received and Understood PS-18 Ensuring That the Partner Has Access to Health Care PS-18 Diagnostic Assessment of Partners in the Field PS-19 Case Closure PS-20 SPECIAL CONSIDERATIONS PS-20 Collaborating With Other Service Providers PS-20 Interstate Transmission of STD Intervention Information PS-20 Suggested Strategies for Patients With Repeat Infections PS-20 EVALUATION AND QUALITY ASSURANCE PS-20 Case Management PS-20 Components of Case Management Quality Assurance PS-21 Using Information Gathered to Describe and ReachTarget Populations PS-21 Measures for Evaluating Program Effectiveness PS-22 COMMUNITY-BASED OUTREACH PS-23 Overview of Interventions PS-24 Social Network Analysis PS-24 Targeted

5 Screening and Field Testing PS-26 Community Outreach PS-27 STD Clinic Outreach PS-28 Appendix PS-A Interview Periods by Disease PS-29 Appendix PS-B Original Interview Format PS-30 Appendix PS-C Reinterview Format PS-32 Appendix PS-D Cluster Interview Format PS-33 Appendix PS-E Lot System Forms PS-35 Appendix PS-F Field Investigations PS-46 Appendix PS-G Interstate Transmission of STD Intervention Information PS-49 Appendix PS-H Skills Inventory PS-53 Appendix PS-I Evaluation Tables PS-62 Appendix PS-J Glossary of Terms Associated With Partner Services PS-63 Appendix PS-K Tools for Network Analysis PS-66 References PS-68 Program Operations Guidelines for STD Prevention ii Foreword The development of the Comprehensive STD Prevention Systems (CSPS) Program announcement marked a major milestone in the efforts of CDC to implement the recommendations of the Institute of Medicine report, The Hidden Epidemic, Con fronting Sexually Transmitted Diseases, 1997.

6 With the publication of these STD Program Operations Guidelines , CDC is providing STD programs with the guid ance to further develop the essential functions of the CSPS. Each chapter of the Guidelines corresponds to an essential function of the CSPS announcement. This chapter on partner services is one of nine. With many STDs, such as syphilis, on a downward trend, now is the time to employ new strategies and new ways of looking at STD control. Included in these Guidelines are chapters that cover areas new to many STD programs , such as com munity and individual behavior change, and new initiatives, such as syphilis elimi nation. Each STD Program should use these Program Operations Guidelines when deciding where to place priorities and resources. It is our hope that these Guidelines will be widely distributed and used by STD programs across the country in the future planning and management of their Prevention efforts.

7 Judith N. Wasserheit Director Division of STD Prevention Partner Services iii Introduction These Guidelines for STD Prevention Program Operations are based on the essential functions contained in the Comprehensive STD Preven tion Systems (CSPS) Program announcement. The Guidelines are divided into chapters that follow the eight major CSPS sections: Leadership and Program Management, Evaluation, Training and Professional Development, Surveillance and Data Management, Partner Services, Medical and Laboratory Services, Community and Individual Behavior Change, Out break Response, and Areas of Special Emphasis. Ar eas of special emphasis include corrections, adoles cents, managed care, STD/HIV interaction, syphilis elimination, and other high-risk populations. The target audience for these Guidelines is public health personnel and other persons involved in man aging STD Prevention programs . The purpose of these Guidelines is to further STD Prevention by providing a resource to assist in the design, implementation, and evaluation of STD Prevention and control programs .

8 The Guidelines were developed by a workgroup of 18 members from Program Operations , research, sur veillance and data management, training, and evalua tion. Members included CDC headquarters and field staff, as well as non-CDC employees in State STD Pro grams and university settings. For each chapter, subgroups were formed and as signed the task of developing a chapter, using evidence-based information, when available. Each subgroup was comprised of members of the workgroup plus subject matter experts in a particular field. All subgroups used causal pathways to help determine key questions for literature searches. Literature searches were conducted on key questions for each chapter. Many of the searches found little evidence-based information on particular topics. The chapter containing the most evidence-based guidance is on partner services. In future versions of this guidance, evidence-based information will be ex panded. Recommendations are included in each chap ter.

9 Because programs are unique, diverse, and locally driven, recommendations are Guidelines for opera tion rather than standards or options. In developing these Guidelines the workgroup fol lowed the CDC publication CDC Guidelines Im proving the Quality , published in September, 1996. The intent in writing the Guidelines was to address appropriate issues such as the relevance of the health problem, the magnitude of the problem, the nature of the intervention, the guideline development methods, the strength of the evidence, the cost effectiveness, implementation issues, evaluation issues, and recom mendations. STD Prevention programs exist in highly diverse, complex, and dynamic social and health service set tings. There are significant differences in availability of resources and range and extent of services among different project areas. These differences include the level of various STDs and health conditions in com munities, the level of preventive health services avail able, and the amount of financial resources available to provide STD services.

10 Therefore, these Guidelines should be adapted to local area needs. We have given broad, general recommendations that can be used by all Program areas. However, each must be used in con junction with local area needs and expectations. All STD programs should establish priorities, examine options, calculate resources, evaluate the demographic distribution of the diseases to be prevented and con trolled, and adopt appropriate strategies. The success of the Program will depend directly upon how well Program Operations Guidelines for STD Prevention iv Program personnel carry out specific day to day re sponsibilities in implementing these strategies to in terrupt disease transmission and minimize long term adverse health effects of STDs.