The Partner Counseling and Referral Service Model

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The Partner Counseling and Referral Service Model

• Janet Furseth, RN BN
• Public Health Nurse
• Harm Reduction Team
• Calgary Health Region

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The PCRS Process
Pre-test Counseling
Post-test Counseling
Partner Notification
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History of Partner Notification

• 1930s Contact Tracing
• Prevent spread of syphilis
• Later expanded to included gonorrhea and other
  Sexually Transmitted Infections (STI)
• 1980s Partner Notification
• HIV became a Public Health issue
• Sexual and needle sharing partners
• Late 1990s Partner Counseling and Referral
  Services
• Reflects the range of services offered

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Unique Issue with Partner Notification and HIV
Infection

• lack of a drug therapy to cure HIV or prevent
  transmission
• a long incubation period which makes it difficult
  for patients to name and locate past partners
• serious concerns about confidentiality and social
  stigma.

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• The medical officer of health shall ensure that
  an attempt is made to identify, locate and offer
  counseling and testing to sexual, needle sharing
  and perinatal contacts of the patient
• Province of Alberta
• Public Health Act

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Why Do Partner Counseling

• Required, according to the Public Health Act
• To identify people who may be at risk
• To identify people who may be putting others at
  risk
• Education opportunity
• Decrease the incidence of HIV infection

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Four Major Stakeholders in PCRs

• The HIV infected clients
• Their partners
• The community
• Health care providers

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HIV Infected Client

• Needs to believe in the process
• People can not be coerced into providing
  information
• Needs to be able to trust the process
• Confidentiality respected
• safety
• Fulfills ethical responsibility to partner
• Opportunity for behavior change

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Partners

• Education opportunity regardless of HIV status
• Early diagnosis and treatment/medical care
• May perceive invasion of privacy
• Need to know who gave their name

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The Community

• Reduce the burden of disease
• Reduce the transmission within the community
• Sense of feeling protected
• Normalize testing
• May be seen as intrusive

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Health Care Provider

• Public Health Nurse
• Family Doctor
• STI Clinic
• Outreach worker (safeworks van)
• A client is more likely to disclose to a
  health care worker they are comfortable with/have
  a relationship with

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The Process essential Concepts

• PCRS is voluntary
• Client Centered
• PCRS in ongoing
• Confidential

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Voluntary

• Relies on the willing participation of HIV
  infected individual
• Can not be mandatory or coercive
• An atmosphere of trust must be created
• Client must believe in the process

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Client Centered

• Focus on clients feelings
• Deal with clients real situation
• Allow individual to find their own solutions
• Ensure safety (i.e. current partner)
• Non judgmental

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Ongoing

• PCRS activities need to be offered whenever an
  HIV infected person accesses services (not just
  when 1st )
• When diagnosed with any other STI
• During appointments for other health matters
• When discussing family planning/ birth control
• Accessing alcohol drug counseling

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Confidential

• No client information will be released to
  partners (name, gender, type of exposure,
  time/location of exposure)
• Health care provider may or may not know identity
  of case
• Phone messages Janet a nurse
• Letters/email need to discuss a health matter
• Client is not entitle to be told results of
  partners
• Case partners are not linked in documentation

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Four Options

• Provider Option
• Client Option
• Dual Option
• Combination Option

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Provider Option

• Done at request of client
• Gather as much information a possible from case
• anonymous

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Required Partner Information

• Name
• Address
• Phone number
• Gender
• Age
• Tattoos
• Piercing
• Scars

• Eye color
• Hair color
• Family contacts
• Friends
• Employer
• School
• Hang outs
• Car

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• Just thinking about calling my ex makes me
  feel sick!

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Client Option

• Client takes responsibility for contact and
  talking partner
• Health care provider provides resources,
  guidelines and coaching
• No need to gather partner information

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• I was dreading having to give you the list

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Dual Option

• Client tells partner in presence of the health
  care provider
• Provider is then available to address partner
  concerns and questions.
• Confidentiality is still respected
• Plan in advance how interaction will go and
  provide client coaching

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Combination Option

• Client agrees to talk with partners but if unable
  the health care provider will assume
  responsibility (confidentially)
• Agree on a timeline for completion
• Health care provider follows up to confirm client
  was able to notify partners

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Time Frame

• 6 months before last negative
• If no negative test result lifetime partners
• More recent the contact the better the success in
  locating individuals
• Current partners, encourage notification by
  client

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Locating Partners

• Phone
• Letter
• Email
• the van
• other city/provinces
• Confidentiality is maintained at all times

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Counseling Partners

• Ensure it is the right person
• Private/safe area to talk
• Answer questions
• What is HIV
• How is it spread/prevented
• Direct to testing facility

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Benefits of PCRS

• Allows client to inform partners without
  revealing own HIV status
• Relieves client of responsibility (legal and
  ethical)
• Opportunity for behavior change/education
• Linkage to other services
• Opportunity for early diagnosis/treatment
• Reduces transmission in the community

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Challenges/Concerns of PCR

• Threat to confidentiality
• Fear of Judgment
• Threat of discrimination
• Intrusion on personal life
• Potential for violence
• Cost

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