Contact Tracing f or General Practice

1. Contact Tracing for General Practice DATE LOCATION

2. Acknowledgements SSWAHS  – Loretta Healey , Liverpool and RPA Sexual Health Services SESIAHS  - Sydney Sexual Health Centre NSCCAHS – Holden St Clinic SWAHS    – Parramatta Sexual Health Service

3. Learning ObjectivesContact Tracing By the end of this session participants should: • Understand contact tracing • Know practitioner and patient responsibilities when an STI is diagnosed • Feel confident to initiate discussions on contact tracing with patients • Be confident to support patients to notify their partner(s) • Know where to get help with contact tracing

4. Session Outline • What is contact tracing? • How to contact trace? • How can I support patient -initiated contact tracing? • How do I undertake provide-initiated contact tracing? • Where to go for help with contact tracing? • Case studies

5. What is a Contact? “The process of identifying relevant contactsof a person with an infectious disease and ensuring that they are aware of their exposure” Oral, anal or vaginal A contact is a person who has had sex reused injecting equipment or has had some other relevant exposure to the index case

6. What are the aims of contact tracing ?

7. Aims of Contact Tracing • Interrupt ongoing transmission of infection. • Minimise complications in those infected. • Prevents re-infection from an untreated partner

8. Contact Tracing • Should be a confidential process • It is the diagnosing clinician’s or delegate’s responsibility to initiate a discussion about contact tracing • Different methods available • patient initiated referral- contact letters, SMS or direct contact • provider initiated referral- telephone, letter or home visit • Advantages and disadvantages with each method • Help and support is available

9. How to contact tracing

10. How to contact tracing • Introduce the reasons for contact tracing • Help identify which partners need to be informed • Explain the methods and offer choice • Patient-Initiated Contact Tracing or • Provider-Initiated Contact Tracing • Document discussions

11. Support patient-initiated contact tracing • Provide written STI information • Discuss how partner(s) might react; problem solve • Highlight different options (in person, telephone, SMS, email) • Websites offer partner notification services • Let them Know www.letthemknow.org.au/ • MSM www.thedramadownunder.info/ • Young Aboriginal People Better to know www.bettertoknow.org.au • Provide treatment letter(s) available at www.gpnsw.com.au • Schedule a follow up visit or phone call

21. SMS Drama Down Under "A msg from www.dramadownunder.info - (First Name) U may have been exposed to (insert STI). U may need to a sexual health check-up. See www.thedramadownunder.info/beentold for info. PLS DO NOT REPLY" Let them know "A msg from www.letthemknow.org.au (First Name) you may have been at risk of (insert STI). Pls have a sexual health check. See web 4 more info. PLS DO NOT REPLY"

22. Provider Initiated Contact Tracing Consider provider referral when: • HIV, Syphilis and gonorrhoea • Repeat infections • Aboriginal Communities • Incarcerated or detained partners • Casual or ex-partners • If the patient requests

23. Provider initiated contact tracing By phone: • Client should be asked if able to take call, private space etc • Confirm that it is the person you want • Be careful not to disclose name or location of index patient • Consider timing of the call

24. Provider initiated contact tracing • Explain your duty of care to them • Offer immediate information and counselling • Explain confidentiality of index patient • Explain the new client’s right • If interested or inter-country have relevant local information

25. Provider contact tracing • Do not give feedback to index patient • Acknowledge that some people can work out identity of index patient • Ensure there is appropriate documentation of outcomes - Note made in index patient file

26. Contact tracing- how far back to go?

27. Contact Management

28. Support for contact Tracing • Local sexual health clinics http://www.health.nsw.gov.au/PublicHealth/sexualhealth/sexual_phus.asp • Sexual Health Infoline-

29. Role Play and Case Studies • Split into groups • Worksheet available • Feedback to group

30. Role Play - Michelle Michelle is a young Aboriginal woman who lives in regional NSW. She has commenced a new job at a cafe. She is sexually active and has been with her boyfriend for 2 months. She has come to see you today as she wants a new script for the pill. You feel it is a good idea to raise the idea of a sexual health check up, especially for Chlamydia. How might you raise the idea of STI Testing?

31. Michelle You decide to test for: • Chlamydia –First pass urine for chlamydia and gonorrhoea OR self collected vaginal swabs • Hepatitis B virus - Serology

32. Michelle • Michelle returns for her results: • Hepatitis B negative. • Gonorrhoea negative • Chlamydia positive • You discuss treatment for Chlamydia and vaccination for HBV further with Michelle. • You also explain contact tracing to Michelle.

33. Michelle Are there any final things you would discuss? • Benefits of condom use • No sex for 7 days • Benefits of having her current partner tested, and any other partners from the last 6 months • If she is contact her own partners; arrange follow up • Encourage Michelle to come and see you again if she has any concerns or questions.

34. Michelle Tips: • STI’s can be a sensitive issue for both aboriginal & non-Aboriginal people; approach topic with respect • Idea of men’s and women’s business may be more fluid today; ask client’s preference. • Be awareness of local community resources & health care workers (HCW), www.bettertoknow.org.au for Aboriginal Youth • Use of contact tracing letters less appropriate; mobiles may be shared – check with patient best contact method. • If another HCW assisting in trace; get as much contact information as possible (full name, DOB & nicknames)

35. Case Study 1 – Kim • 16 year old girl • She presents with a vaginal discharge. • She is sexually active but does not want her parents to know. • She is diagnosed with Chlamydia. • Her sexual contacts are three young men. • She does not wish to contact them herself as she is embarrassed and fears being labelled promiscuous. • One sex partner is her boyfriend and she wants to maintain the relationship. • She is does not want contact tracing and declines to take a letter from you.

36. Kim What would you discuss with Kim in this situation? What could you offer her to assist with contact tracing? What other issues would you raise with Kim as part of the consultation?

37. Case Study 2 – Max Just returned from a business trip to Bangkok. He comes to your practice, (not his usual family practice) reporting a penile discharge. Sexual history - a few days before he was given oral sex in Bangkok by a woman for whom he bought drinks and dinner. He says he felt safe because he didn’t think she was a sex worker and they did not have intercourse. On his return to Sydney he had unprotected sexual intercourse with his wife. You diagnose him with gonorrhoea. He is very distressed and says that he does not want to tell his wife. He says that he will disclose to his wife only if she gets symptoms.

38. Max How would you respond to Max’s plan to only tell his wife if she gets symptoms? What could you offer Max to assist him to disclose to his wife?

39. Case Study 3 - Alan • 36 year old homosexually active man, with a regular partner. • He also sometimes has sex with men in his friendship network. • 4 weeks ago, you diagnosed Alan with HIV. • Contact tracing was delayed until today’s consult visit.

40. Alan What would you plan to discuss with Alan today?

41. Alan • Alan looks well and has support from the AIDS Council. There are a few men who need to be contact traced. • How would you start this discussion? • Alan is frightened about telling his partner of the diagnosis as he believes his partner may terminate the relationship. • What support could you offer Alan? • Alan says that he has the names and mobile numbers of the friends that he sometimes has sex with but feels too distressed to contact them himself. • What would you offer in that situation?

42. Further help • NSW Sexual Health Info Line 1800 451 624 www.stipu.nsw.gov.au/shil/ • Local Sexual Health Service www.health.nsw.gov.au/PublicHealth/sexualhealth/sexual_phus.asp • Aboriginal Community Controlled Health Services www.health.nsw.gov.au/publichealth/sexualhealth/community.asp • Let them Know www.letthemknow.org.au/ • The drama down under www.thedramadownunder.info • Better to knowwww.bettertoknow.org.au • GP NSW Contact Tracing Page www.gpnsw.com.au • FACT SHEETS http://www.health.nsw.gov.au/publichealth/sexualhealth/sex_factsheets.asp

43. Resources and references • Australasian Contact Tracing Manual ASHM 4th Edition http://ctm.ashm.org.au/ • NSW STI Contact Tool for General Practice http://www.stipu.nsw.gov.au/resources.html • Contact Tracing Guidelines for the Sexually Transmitted Diseases and Blood Borne Viruses 2005 NSW Health Policy Directive www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_184.pdf

44. Please fill out your EVALUATION!