This section provides partner notification standards for healthcare providers involved in the diagnosis and management of HIV and sexually transmissible infections (STI). Partner notification is also known as contact tracing.
This standard follows the NSW STI Strategy 2016–2020 and the NSW HIV Strategy 2016–2020 and follows NSW Public Health Regulation. The Public health Act along with the Public Health Amendment (Review) Act 2017 relating to sexually transmitted infections can be access here. http://www.health.nsw.gov.au/phact/Pages/default.aspx
Guidelines on the use of internet and social media prohibit health staff from using their personal social media accounts for professional purposes such as partner notification.
For contacts that are difficult to reach, the NSW Sexual Health Infolink Partner Notification Service undertakes partner notification via social media, sex networking websites or apps. PFSHSs can in turn prioritise for testing known partners contacted by the partner notification service.
Patient-delivered partner therapy (PDPT) for chlamydia is consistently offered to patients for eligible partners.
Each patient (index person) diagnosed with HIV or an STI is advised of the need for partner notification and assisted to notify their known partner(s) in a timely and supportive manner to reduce onward transmission of HIV and STIs and prevent reinfection of the patient.
Gain co-operation of the patient
Begin with a patient-centred discussion about the nature of the infection and benefits to informing partners. While the patient’s emotional state needs to be considered when timing the discussion, starting partner notification as soon as possible is considered best practice.
For patients reluctant to notify their partners, consider referral to counselling services, as perceived barriers can often be overcome.
In rare situations where partner information is known but the healthcare provider is unable to gain the consent of the patient seek advice from senior clinician. Consider for case conference. NSW Sexual Health Infoline Partner Notification Service can also offer guidance.
Establish trace-back periods. Consider the time periods over which partners require notification, as these vary by STI (refer to NSW STIPU STI/HIV Testing Tool for guidance). Assist patient to recall partners. Use cues such as location or events or use of mobile apps or websites to hook up with partners. Try to quantify and record the number of known partners requiring notification.
Identify the best method
Different methods of notification—by patient, provider, or Sexual Health Infolink Partner Notification Service—suit different patient presentations and different partners. Consider all options for patients. Offer patient-delivered partner therapy for heterosexual patients with laboratory-confirmed chlamydia. Patients may prefer to notify their own partner(s) in person, by phone, SMS or email, or using an SMS/email partner notification service (patient referral). Anonymous notification using a website is an option for notifying partners of an exposure to STIs other than HIV.
Patients may elect to have the diagnosing healthcare provider (or delegate) notify their partners on their behalf (provider referral). This can be undertaken by the provider or in partnership with the patient.
When is provider referrala the best option?
- Always preferred method when notifying a named partner of an exposure to HIV
- If any history or concern around violence in relationship
Actively offer provider referral in the following situations:
- Syphilis and gonorrhoea (due to higher morbidity)
- Casual or ex-partners, as research shows they are less likely to be notified
- Repeat infections, as a partner may not have been tested and treated
- Within Aboriginal communities, due to stigma and issues around confidentiality
- Incarcerated or detained partners, as they are more difficult to contact
- If a patient requests provider referral or seems reluctant, lacking in confidence or worried about a partner’s reaction.
a Adapted from Reddel S, et al. Partner notification of sexually transmitted infections in New South Wales: an informed literature review. Melbourne: Burnet Institute; 2010. Available at: https://stipu.nsw.gov.au/wp-content/uploads/NSW_STI_PN_PDF.pdf
Help the patient to inform known partners by providing relevant information such as STI fact sheets, safe sex practice information including condom use, safe injecting information, and websites offering online partner notification services. (Note: this is not available or recommended for HIV.)
www.letthemknow.org.au This website has information on STIs and practical tips for patients on how to inform partners. Offers the option of notifying contacts via email, SMS or letter either personally or anonymously.
www.thedramadownunder.info A website for men who have sex with men (MSM), with information about STIs experienced by gay men. It offers the option of notifying contacts via email or SMS either personally or anonymously.
Follow-up of patient notifying own partnersIf the patient (index case) chooses to notify their own partners, schedule a follow-up phone call or visit in one or two weeks to determine whether the patient was able to notify their partners. If the partners have not been notified, offer provider referral.
Collect as many contact details as possible for each partner. This may include questions about websites or mobile apps that are being used to meet sex partners. Contact can be made with the named partner by phone, email, SMS, a letter or in person. Allow time for the named partner to respond (e.g. ring early in the work day).
When conducting provider referral partner notification, every attempt should be made to protect the confidentiality of the patient (index person). Where mobile phones are shared, swapped or lent to others, limit the amount of information included in any messages left until the identity of the recipient is confirmed. If sending a letter use person-to-person registered post, which allows for proof of receipt, with a signature on delivery. This will ensure that the letter is not opened by another household member. The amount of information to be included within a letter will depend on the infection and previous efforts to date to notify the partner. Consider using the Sexual Health Infolink Partner Notification Service if it will help in protecting the identity of the patient.
If known partners can only be identified through social media (name, address, telephone or mobile are not known) or an email address, refer to the Sexual Health Infolink Partner Notification Service.
For STIs other than HIV, an online partner notification service is an acceptable method of notification and may be used by the provider as part of the initial patient consultation, or for follow-up where phone or other contact options have failed or are not available.
For HIV, follow-up of named partner(s) is required. The identity of the patient with diagnosed HIV must not be disclosed when contacting partners and advising them of a possible HIV exposure. It is recognised that in some circumstances (e.g. where a partner has only ever had one sexual relationship) the patient’s identity will be known. In such cases, the implications of the notification must be considered and managed. Consider referral to counselling services.
The minimum follow-up of a named partner is at least four attempts over two weeks, using two different notification methods (if available) and including attempts outside normal business hours. This is a minimum and continued attempts at contact may be warranted.
Where the partner cannot be located or does not respond to contact efforts, seek advice from a senior clinician. Consider having a case conference where complex partner notification cases can be discussed by a multidisciplinary team.
Additional measures may be possible through the NSW Sexual Health Infolink Partner Notification Service. The service will undertake complex partner notifications (using social media, sex networking websites or apps).
Referrals can be made securely online to the Sexual Health Infolink Partner Notification Service or by calling 1800 451 626 Monday to Friday, 9 am to 5.30 pm. If requested, an outcome of the referrals will be provided.
If you have concerns that a person with HIV may be infecting others, discuss the case with a senior clinician. For a document providing a framework for the management of people with HIV infection who risk infecting others, including interventions at the local level and how to seek further support, see https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2009_023.pdf
For HIV, offer postexposure prophylaxis (PEP) to any sexual or injecting partners if exposure has occurred in the past 72 hours. Pre-exposure prophylaxis (PrEP) may be offered to partners engaging in HIV risk practices. For HIV, partner notification should be an ongoing conversation while the patient has a detectable viral load.
Undertaking partner notification within Aboriginal communities
Consider Aboriginal culture when undertaking discussions around partner notification with Aboriginal patients. Historic experiences with health services, as well as the private nature of sexual health, can for some Aboriginal people make discussing STIs and HIV more difficult. It is important for healthcare providers to be aware of and sensitive to these experiences and feelings. For some Aboriginal people sexual health may be considered men’s and women’s business. Also linked is the importance of confidentiality. These beliefs are not universal to every Aboriginal person and should be considered in the context of the individual patient.
Where available, Aboriginal patients should be offered the option of support and assistance with the partner notification process from an Aboriginal health practitioner/worker. Inform the patient who the Aboriginal health practitioner/worker is, what their role within the team will involve and obtain the patient’s consent. This empowers the patient to decide who is and is not involved in their care, reducing the risk of a negative experience and possible disengagement from the service.
If the patient wishes to include an Aboriginal health practitioner/worker, include them as early as possible in the process. Try to accommodate gender preferences; if this is not an option explain why and consider other options (e.g. phone consultation, referral to another service).
For additional information and guidance refer to the NSW Aboriginal sexual health resource Cultural respect & communication guide. Although the statistical information may be outdated, the inclusive approach remains relevant.
Undertaking partner notification on behalf of an external healthcare provider
As the first point of contact, NSW sexual health services are best placed to respond to requests from general practitioners and other healthcare workers seeking assistance with partner notification for STIs and HIV. The NSW Sexual Health Infolink Partner Notification Service is also available to support general practice and healthcare providers.
When the details of named partners are forwarded to a service for the purpose of notification, information should be stored securely according to local and NSW health policy. Staff should refer to local policies with regard to the management of electronic health records.
Documentation of the partner notification process is important and must be kept for both clinical and medico-legal purposes. Information about a named partner’s contact(s) is legally confidential and accordingly must be kept securely. The following should be included in the client’s medical record:
- the partner notification discussion
- the number of named contacts to be notified
- the method chosen
- arrangements for follow-up
- active follow-up undertaken
- at follow-up, the number of named contacts the patient reports as successfully notified.
Additional documentation requirements for provider referral
For healthcare workers, notifying a named partner of their potential risk exposure does not give rise to a doctor–patient relationship. Therefore a separate medical record for a contact is not required according to NSW Health Policy.The registration of contacts as clients of the service is also not required (NSW Health Client Registration Policy).
Information related to the contact person (named partner), such as the partner notification discussion, including any information provided by the contact regarding their infection status or further follow-up, is legally confidential information about the contact person. It would also be health information regarding the contact person for the purposes of the Health Records and Information Privacy Act 2002. Additional operational guidance is provided in sections 12 and 15 of the Privacy Manual for Health Information.
For services using paper medical records, it is recommended that the partner notification process be documented as a separate entry from progress notes and filed at the back of the medical file, facing backwards. This provides separation of the partner notification entry within the patient’s health file.
All entries should identify the information as a record of partner notification, and advise that details are not to be disclosed to the index patient. If an index patient requests access to their medical record through the Health Records and Information Privacy Act 2002, refer the request to the appropriate Health Information Service privacy officer.
All attempts of contacting known partners should be documented in the medical record, whether successful or unsuccessful.
References and further reading
- Temple-Smith M, Hopkins C, Fairley C, Tomnay J, Pavlin N, Parker R et al. The right thing to do: patients’ views and experiences of telling partners about chlamydia. Family Practice. 2010;27(4):418–23. Abstract available at: https://www.ncbi.nlm.nih.gov/pubmed/20444842
- Australasian Society for HIV Medicine. Australasian contact tracing guidelines. Sydney: ASHM; 2016. Available at: http://ctm.ashm.org.au/
- Reddel S, et al. Partner notification of sexually transmitted infections in New South Wales: an informed literature review. Melbourne: Burnet Institute; 2010. Available at: https://stipu.nsw.gov.au/wp-content/uploads/NSW_STI_PN_PDF.pdf
- Cultural respect & communication guide: a resource to assist sexual health service delivery to Aboriginal communities. Lismore (NSW): North Coast Area Health Service; 2009. Available at: http://www.healthinfonet.ecu.edu.au/uploads/resources/19163_19163.pdf
- NSW STI/HIV Testing Tool
- Australasian Contact Tracing Guidelines
- NSW Sexual Health Infolink Partner Notification Service or call 1800 451 626, Monday to Friday, 9 am to 5.30 pm.