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Role With It Baby: DIS & Their Roles

Role With It Baby: DIS & Their Roles. Featuring: The apolloza Tour! Jen Jackson, Program Consultant DSHS HIV/STD Prevention & Care. Why are we here?.

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Role With It Baby: DIS & Their Roles

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  1. Role With It Baby: DIS & Their Roles Featuring: The apolloza Tour! Jen Jackson, Program Consultant DSHS HIV/STD Prevention & Care

  2. Why are we here? To gain an understanding of what Partner Services is and to learn how we can support DIS in their disease intervention efforts to help stop the spread of disease in communities.

  3. What is a DIS? Disease Intervention Specialist: disease investigator identifies people who are infected or at risk of infection notifies of risk and offers testing, treatment ultimate goal is to understand and stop the movement of disease (source, spread)

  4. Big moments in STD history… • 1495-1496: First reports of Syphilis in Western Europe • 1595: Shakespeare writes of herpes in “Romeo and Juliet” • Early 1900s: Most physicians treat syphilis with mercury • 1936: First National Conference on Venereal Disease • WWI & II: 465,000 cases of syphilis

  5. Big moments in STD history… • 1943: penicillin determined effective syphilis and gonorrhea treatments • 1932-1972: Tuskegee Study - Black men not informed they had syphilis. • 1972: Federal gov’t creates laws to protect human subjects in research • 1997: Clinton formally apologizes to Tuskegee survivors and relatives on behalf of the nation

  6. Big moments in STD history… • 1965-1975: Sexual Revolution “Free Love” – Syphilis rate more than quadruple • Term VD is replaced by STD • 1976: Chlamydia first identified & HPV is identified as an STD • 1981: AIDS first identified • 1982: Time magazine devotes the cover story to Herpes

  7. Big moments in STD history… • 1985: HIV-1, a new sexually transmitted virus is identified • Ryan White barred from his high school after announcing he is HIV+ • Crack emerges & Syphilis rates rise • 1990s: At least one HIV case reported from each region worldwide • First FDA-approved HIV antibody test developed. Blood banks begin screening. • Ryan White dies at age 18 & Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is enacted

  8. Big moments in STD history… • 1990s: Magic Johnson announces he is HIV+ • Red ribbon introduced as the international symbol of AIDS awareness at the Tony Awards • PID impacts over a million women • HPV recognized to cause 90% of cervical cancers • 1999: STD infection estimates at all time high – 15.3 million new cases/year • Strains of HIV and gonorrhea begin showing resistance

  9. Big moments in STD history… • A New Millennium: more than 25 STDs in the U.S. • Estimated 45 million people infected with Herpes; 20 million with HPV • 2/3 of STD infections occur in people under 25 • Current trends: Crystal, Online hook-ups, Phone App hook-ups… STD History Slides adapted from “STIs: A Historical Perspective.” –CDC, PTC ISTDI (www.stdhivtraining.org)

  10. How do we stop the spread of disease once someone has been infected or exposed to an STD?

  11. Public Health Follow-up DIS are part of public health follow-up STD/HIV are not the only diseases which prompt public health investigation Many other diseases public health investigates: tuberculosis, rabies, anthrax, measles, mumps, brucellosis, cryptosporidiosis...

  12. Reportable STDs in Texas • HIV • Syphilis • Gonorrhea • Chlamydia • Chancroid

  13. These aren’t the only notifiable conditions in Texas...

  14. Public Health Follow-upSurveillance DIS rely on data collected by surveillance (it’s not what you think!) Disease surveillance: systematic collection and analysis of data to understand trends in disease Passive surveillance: collection of data Active surveillance: case finding

  15. Public Health Follow-upSurveillance DIS use this data to: know when to begin an investigation direct efforts in disease intervention to specific areas or populations analyze outcomes for quality control

  16. What does a DIS do? Interview clients Notify infected or at-risk clients Counsel and Test Lather, rinse, repeat

  17. The Interview DIS collect personal history medical history sexual history DIS also refer to appropriate services (including treatment) assist clients in reducing risk DIS interview infected and uninfected people in the course of an investigation

  18. Notification vs. Elicitation Partner elicitation is the process of gathering names and locating information of people at risk of infection Partner notification is the process of notifying those people of their risk and offering services

  19. Notification DIS first research all information available on the client Telephone call and/or email, if possible Field notification – visits to locations where the client may be located Often home, but can include other locations – hangouts, work, shelters, clubs, online, virtually anywhere Notification should be performed ONLY by trained DIS

  20. NotificationConfidentiality DIS are trained to carefully guard confidentiality when notifying clients If any method of notification is deemed a confidentiality risk, another method is chosen Notification should NEVER occur with others present or through others

  21. Counseling and Testing Pre-counsel: discuss status, address concerns, pre-test education Blood draw and/or clinic visit as necessary Post-test counsel, interview if investigation requires it Re-start the cycle

  22. How do DIS decide which partners to elicit? Incubation period Testing history Symptom history Sexual history

  23. Treatment Medication is offered to infected and some uninfected clients Treatment for uninfected: sex partners within incubation periods (potentially developing disease) Treatment is always at the medical provider and client’s discretion

  24. Disease intervention Primary intervention: treatment which aborts incubating infection Prevents development of symptoms, potential to spread disease to others Secondary intervention: treatment of infection indicated by symptoms and/or positive test results

  25. Disease InterventionPreventive Treatment Gonorrhea, chlamydia, PID, LGV Partners exposed last 60 days Syphilis Primary: 3 months plus symptom duration Secondary: 6 months plus symptom duration Early latent: within the last year Chancroid Partners exposed in the last 10 days

  26. Is there primary intervention for HIV? In limited cases, there has been success with post-exposure prophylaxis (PEP), typically in the case of occupational exposures (needle-sticks) PEP is rare at this time

  27. Characteristics of a Good DIS good communication skills quick learner persistent non-judgmental careful, methodical, good eye for detail able to adjust rapidly to changing situations

  28. Types of Notification • DIS Notification: DIS notifies partners for the infected individual. • Face-to-Face • Confidential • Self-Notification: infected individual notifies partner(s) • Face-to-Face • One-on-One • May have a DIS present • inSpot • Confidential • Anonymous

  29. The apolloozaTour Starring: .org

  30. “Gotta get myself…gotta get myself…gotta get myself connected….” • E-mail: often, a preferred method of contact • Online Connections: chat, personals, cruising/social networking sites

  31. “I Need You Tonight…” • “Your moves are so raw”: Insufficient public health resources to utilize partner services for STDs other than HIV and syphilis. • “I’ve got to let you know”: Expanding services for STD partner self-notification to the web. Herpes Scabies Trich NGU Crabs HPV Molluscum Hepatitis

  32. “Who are you?Who who…who who?” • “Hello, it’s me”: • Self notification tool (for those diagnosed with an STD) • User-friendly IPN service, created in 2004 by ISIS Inc (http://www.isis-inc.org) • Purpose: To utilize current technology to prevent the transmission of disease and educate communities

  33. “Here’s a little story, I got to tell…” • inSpot was first launched in San Francisco, CA • Moved to servicing specific states, targeted cities, and some international locations • Recent changes to InSpot – National inSpot (U.S.) • inSpot currently services: Canada, United States, Guam, American Samoa, Northern Mariana and Puerto Rico

  34. “More than words….” • Default Language: U.S. English • “Voices Carry”: Other language selections • Canadian English • French • Spanish

  35. “I want you to want me.” • “Where it’s at…”:(web address) http://www.inspot.org • inSpot currently provides: • Tell them: STD self-notification through a variety of anonymous or confidential e-mail postcards • STD info: Up-to-date information on STD signs and symptoms • Testing: Links to local testing • Resources: Links to websites with more information • Tips for self-notification

  36. “What I am is what I am…” • What inSpot is: • A tool for notification of partners of persons with gonorrhea, Chlamydia and other STDs for which health department notification services are not available. • What inSpot is not: • inSpot is not an alternative to Partner Services. • It does not contain any tracking software to identify individuals or confirm testing/treatment. • It is not a site that compiles names of people with STDs to “out” those infected and it does not post names on the internet. • Not a data collection tool: • Keeps a count of number of e-cards sent and received • Collects optional demographic and disease data

  37. “Is it worth it? Let me work it.” • How can public health use inSpot? • Referrals to inSpot can be made by: • Health Departments • CBOs • Community Clinics/Family Planning Clinics • Referrals can be made by anyone who counsels patients about notifying their sexual partners of a possible exposure: • Providers, Nurses/Nursing Assistants • Case Managers • Risk Reduction Specialists • Health Educators/Outreach Workers

  38. “I always feel like somebody’s watching me…..” The preferred method for notification for syphilis and HIV is DIS notification; however DIS may refer clients to inSpot Texas for e-mail self-notification to augment sexual contact notification efforts.

  39. “Peeeeeek-A-Boo!”

  40. “Wow. This STD is no fun. I guess I should tell my partners so they can get tested and treated!”

  41. “Okay…my language is English (U.S.) and my region is Texas. Hmmm…time to pick a card.”

  42. “Yup. I guess sometimes there ARE strings attached. This is a good card to send them.”

  43. “Wow. A security question. I guess they really don’t want bots spamming inSpot e-cards!”

  44. “Okay..what’s next? Time to create my message, huh?

  45. “Okay…message created. All six email addresses entered.”

  46. “What’s next? Optional demographics used for statistical purposes only? Hmm…ok. I’ll fill it in.”

  47. “Time to preview this card so I can send it and get back to work.”

  48. “Rock!! Hey, that was easy!” (Hey there, baby…what are you doing later…?) • Sending an inSpot card is as easy as 6 simple steps: • Select language • Select region • Pick a card (enter the security words) • Create message (optional statistical data) • Preview • Send

  49. “Wait! Oh yes, wait a minute mister postman!” What’s that in my inbox? Oh look! An email from Jesse!

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