1. Implementing HIV Partner Services
HIV Surveillance Perspective
In Four Health Departments
17th Texas HIV/STD Conference
Austin, Texas
Shirley Chan, MPH
Houston Department of Health and Human Services
Bureau of Epidemiology
HIV/AIDS Surveillance Program

2. Legal and Ethical Concerns
• “Each state holds the legal authority for partner
notification and referral of persons infected with
HIV/STD”
• “The 10th amendment of the US constitution
provides states the authority to establish laws
and regulations to protect the health, safety and
welfare of their citizens”
• “Each state has unique regional and
demographic factors that impact the health of
the citizen”
• “State laws will reflect these differences”

3. Collective Goals of
Partner Services (PS)
To identify new HIV+ individual and their partners and to
offer PS in a timely manner
• For the patients
– Provide the patients with support and link to care and
interventions
– Ensure their partners are confidentially informed
• For the partners
– Maximize the proportion of partners who are notified
– Maximize early linkage to test, care and prevention interventions
• For the community – Aid in early diagnosis, treatment and
provide prevention services to reduce rate of transmission

4. Rationale for PS
– Can play an essential role in preventing and
controlling HIV
– Can identify a mean of 20% (14% -26%) of those
partners tested as newly HIV+
– Can increase the identification of HIV-infected
persons in a high-prevalence population
– Can be cost effective

5. Challenges
• PS acceptance by patients?
– Potential for abuse
– Potential negative effects on relations
• PS in non-public health clinic settings?
– Provider may not report
• Private providers – Acceptance by physicians?
• Link to surveillance data?
– HIV surveillance program is to provide data
– HIV surveillance data is not designed for case
management
– Lack of additional funding

6. Linkage with Disease Reporting
• 2007 CSTE survey
– 71% of respondents reported sharing data in
some form
– 43% of respondents reported sharing
individual-level data including personal
identifiers

7. MMWR
November 7, 2008 / Vol.57 /No.RR-9
Recommendation for Partner Services Programs for HIV Infection,
Syphilis, Gonorrhea, and Chlamydia Infection
Differ from previous PS guidelines
– Integration of services at the client level
– Linkage between surveillance and program
activities for PS
– Contact as soon as possible after diagnosis
– Linkage to medical and prevention services
– Program monitoring and evaluation

8. Partner Services

9. Table 1. Summary of Characteristics in Four Health Departments
"State" Health Department "Local" Health Department
Colorado Florida Houston San Francisco
Ranking (Cumulative
Approx. 20 #3 as a state #8 as a city #3 as a city
AIDS)
Average number of
infection/year (in the past 400-450 4,000 approx 1,200 550-600
5 years)
2002 code-base; 2006
Year named-reporting 1985 1997 1999
named-based
Chapter 384; reporting
Texas Health & Safety
statue 381.0031, Rule Health & Safety Code,
Law regarding PS CRS25-4-1401 Code, Chapter 81,
64D-3 Florida Adm 12015
Sec.81.051
Code
Providers 2 weeks; Lab
HIV reporting 7 days 7 days Lab 7 days
3 days
HIV surveillance and STD
Yes No 2010 No
surveillance Integrated?
Database use PRISM PRISM STD*MIS
Year PS initiated 1986 1986 - 87 2002 2008
Is PS implemented in
public section or private Both Both Both Both
sector or both?
Demographics White/Hispanic Black/Hispanic Black/Hispanic 70% White young male
Same guidelines as in Same guidelines as in Same guidelines as in HIV Same guidelines as in
Confidentiality
HIV surveillance HIV surveillance surveillance HIV surveillance
On-line partner
Inspot PENSHOUSTON Inspot
notification

10. Partner Services

11. Colorado
Lab Reports Hospitals
STI / HIV
Surveillance
Health Program
Departments
Physicians
Vital
Statistics
and other Counseling
and Testing
Disease Partner Services sites
Registries
Patient and partner
notification
Prevention counseling and
testing
Linkage to care

12. Partner Services

13. Florida Public Sector –
Private Sector –
HIV+ lab reports processed from
HIV+ labs from private State Lab (health department and
providers (ELR or mailed) CBOs from ELR)
HIV STD
Surveillance Surveillance
Program Program
Prism Prism
Partner Services
Patient and partner
notification
Prevention counseling and
testing
Linkage to care

14. Partner Services

15. San Francisco
Private Sector –
Public Sector –
HIV+ labs from private
providers HIV+ reports from public
clinics and hospital
HIV Request
Surveillance physician STD Clinics
Program approval for PS (SFCC)
Inspot
HIV Prevention
Partner Services
Patient and partner
notification
Prevention counseling and
testing
Linkage to care

16. Partner Services

17. Houston
Lab Reports
OOJ
HIV STD
Surveillance Surveillance
Private
Program Program
Physician
Reports CBOs
STD*MIS
Other
Facility
Reports HIV Prevention Insurance
Partner Services
Patient and partner notification
Prevention counseling and
testing/risk reduction/treatment
Linkage to care
City of
Houston Correctional
Health Facilities
Clinics

18. Information Shared
To DIS: To Surveillance:
• Name
• Risk factors
• Address
• Date of birth • Previous testing
• Race/ethnicity history
• Gender • Treatment history
• HIV status
• Date & type of HIV test
• Additional locating
information

19. Confidentiality / Data Security
• DIS required to attend annual Security and
Confidentiality training
– Expected to comply with same Security and
Confidentiality procedures as HIV Surveillance
– Requires high level of trust between programs
• DIS gather information from patient interview
– Data is entered in STD*MIS
• HIV case information is entered into HARS
– Only HIV surveillance staff have access to HARS

20. Discussion
• Using surveillance data for PHFU has proven to be
effective (Partner notification reveal a high seroprevalence rate ranging
from 11% to 39%)
• Linking surveillance with case management services
must not compromise the quality or integrity of the
surveillance system (HIV surveillance program and prevention
program should establish policies and procedures based on both principles
and practices)
• Partner services should be voluntary, informed and not
coerced
• PS should be performed in a timely manner
• Enforcing strict security and confidentiality guidelines

21. What needs to be done
• New HIV testing technologies can be useful to identify
newly infected persons and provide immediate
counseling, support and referral to services.
• Health department could forge closer ties with
providers
• Online partner notification can be an efficient method
• PS programs should be monitored and evaluated to
ensure quality of care are delivered

22. Acknowledgements
• Special thank you goes to my co-presenters at the 2009 National
HIV Prevention Conference –
– Becky Grigg at Department of Health, State of Florida
– Maree Kay Parisi at San Francisco Department of Health
– Pam Montoya at Colorado Department of Public Health
• HIV/STD Surveillance Program Staff
• Bureau of HIV, STD, and Viral Hepatitis Prevention
• Sources of Support: This study was supported by Cooperative Agreement Number
PS08-802 from the Centers for Disease Control and Prevention. Its contents are
solely the responsibility of the authors and do not represent the official views of the
Centers for Disease Control and Prevention

23. Contact Information
Shirley Chan
shirley.chan@cityofhouston.net
Houston Department of Health and Human Services
Bureau of Epidemiology, 4th Floor
8000 N. Stadium Drive
Houston, TX 77054
Tel: (713) 794-9441
Fax: (713) 794-9391