Transcript Contact Tracing

Contact Tracing
for General Practice
DATE
LOCATION
Acknowledgements
SSWAHS – Loretta Healey , Liverpool and RPA Sexual Health Services
SESIAHS - Sydney Sexual Health Centre
NSCCAHS – Holden St Clinic
SWAHS – Parramatta Sexual Health Service
Learning Objectives
Contact 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
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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
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What is a Contact?
“The process of identifying relevant
contacts of a person with an infectious
disease and ensuring that they are aware
of their exposure”
A contact is a person who has had
sex
Oral, anal
or vaginal
reused injecting equipment or
has had some other relevant
exposure to the index case
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What are the aims of contact tracing ?
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Aims of Contact Tracing
• Interrupt ongoing transmission of infection.
• Minimise complications in those infected.
• Prevents re-infection from an untreated partner
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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
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How to contact tracing
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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
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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
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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"
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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
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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
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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
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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
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Contact tracinghow far back to go?
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Contact Management
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Support for contact Tracing
• Local sexual health clinics
http://www.health.nsw.gov.au/PublicHealth/sexualhealth/sexual_phus.asp
• Sexual Health Infoline-
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Role Play and Case Studies
• Split into groups
• Worksheet available
• Feedback to group
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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?
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Michelle
You decide to test for:
• Chlamydia –First pass urine for chlamydia and
gonorrhoea OR self collected vaginal swabs
• Hepatitis B virus - Serology
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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.
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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.
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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)
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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.
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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?
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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.
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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?
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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.
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Alan
What would you plan to discuss
with Alan today ?
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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?
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Further help
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NSW Sexual Health Info Line 1800 451 624
www.stipu.nsw.gov.au/shil/
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Local Sexual Health Service
www.health.nsw.gov.au/PublicHealth/sexualhealth/sexual_phus.asp
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Aboriginal Community Controlled Health Services
www.health.nsw.gov.au/publichealth/sexualhealth/community.asp
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Let them Know www.letthemknow.org.au/
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The drama down under www.thedramadownunder.info
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Better to know www.bettertoknow.org.au
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GP NSW Contact Tracing Page www.gpnsw.com.au
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FACT SHEETS
http://www.health.nsw.gov.au/publichealth/sexualhealth/sex_factsheets.asp42
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
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