Section 693.40 Counseling and Partner Services

Section 693

Section 693.40  Counseling

and Partner Services

Upon receipt of a reportable STI

report from a health care professional or laboratory, a local health

department, designated agent or the Department, as applicable, shall conduct a

counseling session and offer partner services in accordance with guidelines

established by the Centers for Disease Control and Prevention of the U.S.

Public Health Service, Recommendations for Partner Services Programs for HIV

Infection, Syphilis, Gonorrhea, and Chlamydial Infection, as follows:

a)         Counseling and partner services shall be provided only by staff

of a local health department, designated agent or the Department, as applicable,

who have completed a Department-approved training, or a training approved by

the local health department in cities with a population of 1,000,000 or more.

b)         Any person diagnosed with early syphilis or HIV/AIDS by any

health care professional, or any person diagnosed with gonorrhea or chlamydia

by a local health department or designated agent shall be counseled and offered

partner services by the local health department, designated agent, or

Department, as applicable. "Early syphilis" means primary, secondary

or early non-primary non-secondary (NPNS) syphilis of less than one year's

duration.

c)         Any person diagnosed with an STI by a health care professional

other than a local health department shall be counseled and offered partner

services (including expedited partner therapy for chlamydia, gonorrhea and

trichomonas) as resources permit and within the discretion of the local health

department, designated agent or Department, as applicable.

d)         Counseling of reportable STI cases and partner services shall

be conducted in a confidential manner, and shall be documented either in

electronic format or on forms furnished by the Department, or by the local

health department in cities with a population of 1,000,000 or more

mit and within the discretion of the local health

department, designated agent or Department, as applicable.

d)         Counseling of reportable STI cases and partner services shall

be conducted in a confidential manner, and shall be documented either in

electronic format or on forms furnished by the Department, or by the local

health department in cities with a population of 1,000,000 or more.

e)         All records regarding counseling of reportable STI cases and

partner services shall be confidential, and shall at all times be maintained in

the same manner as those maintained for reported cases of STIs as required in

Section 693.100 of this Part.

f)         For reportable STI cases, counseling and partner services

shall be provided by the local health department, designated agent or the

Department, as applicable, and shall include the following:

1)         An offer of assistance, with the consent of the infected

person, in locating and referring contacts for counseling, testing and

treatment, if indicated. All infected persons refusing assistance shall be

strongly encouraged to notify their critical period sex and needle-sharing (HIV/AIDS)

contacts of their possible exposure to STI, and to refer these contacts for

counseling, testing and treatment, if indicated.

2)         For each identified contact, the counselor shall discuss with

the infected person the time period of exposure and the likelihood of STI

transmission based on the type of sexual or needle-sharing practice involved. Notification

and referral shall be provided to contacts for whom sufficient information to

identify and notify the person is available.  When contacts can be linked to a

website encounter, the counselor will be authorized to implement an Internet

Notification Protocol to confer with and refer for clinical services contacts

linked to an infected person

xual or needle-sharing practice involved. Notification

and referral shall be provided to contacts for whom sufficient information to

identify and notify the person is available.  When contacts can be linked to a

website encounter, the counselor will be authorized to implement an Internet

Notification Protocol to confer with and refer for clinical services contacts

linked to an infected person.  Internet Partner Notification (IPN) services

shall be provided only by staff of a local health department, designated agent,

or the Department, when applicable, who have completed Department-approved IPN

training, or IPN training approved by the local health department in cities

with a population of 1,000,000 or more.

3)         Persons choosing to self-refer their contacts shall receive

intensive individualized instruction and counseling in methods to provide this

notification and referral.

4)         STI contacts identified through the counseling and partner

services process shall be counseled confidentially regarding the possibility of

infection and methods to prevent the spread of infection, and shall be referred

for testing and treatment, if indicated.

5)         For STIs, if the person is legally unable to agree to

counseling because of age or legal incompetence, consent and participation in

counseling shall be requested of the individual's parent or legal guardian.  If,

in the professional judgment of the counselor, the person is legally able to

agree to, but appears to be incapable of understanding and competently acting

on, the counseling, participation in counseling shall be requested of a parent

or other person chosen by the client

incompetence, consent and participation in

counseling shall be requested of the individual's parent or legal guardian.  If,

in the professional judgment of the counselor, the person is legally able to

agree to, but appears to be incapable of understanding and competently acting

on, the counseling, participation in counseling shall be requested of a parent

or other person chosen by the client.

g)         For

the interview and investigation process concerning health care contacts:

1)         Patients

A)        An individual who has undergone invasive procedures shall be

provided an explanation of the potential risks of HIV transmission to health

care professionals during the performance of invasive procedures and the legal

requirements for notification of the health care professionals who have

performed invasive procedures on that individual;

B)        The individual shall be asked to identify the specific invasive

procedures that have been performed on the individual, along with the name of

the facility or location at which the procedure was performed, and the name,

address and telephone number of the health care professional who performed the

procedure; and

C)        The individual shall be offered the opportunity to self-notify

those health care professionals within 45 days, in accordance with the

notification procedures described in Section 693.45 of this Part.  If the

individual declines the opportunity to self-notify the individual's health care

professionals, or fails to do so in accordance with the requirements of this

Part, the case shall be referred to the Department for notification of

contacts.  The Department will notify contacts in a timely manner.

2)         Health Care Professionals whose work may result in secondary

exposures to others, including patients:

A)        An individual who is a health care professional

whose work may result in secondary

exposures to others,

or has worked as a health care professional

shall be interviewed

to the Department for notification of

contacts.  The Department will notify contacts in a timely manner.

2)         Health Care Professionals whose work may result in secondary

exposures to others, including patients:

A)        An individual who is a health care professional

whose work may result in secondary

exposures to others,

or has worked as a health care professional

shall be interviewed.  The interview will determine

whether the type of health care practiced by the individual involves the

performance of invasive procedures, and whether the health care professional

has or is likely to have performed invasive procedures;

B)        If the individual has or is likely to have performed invasive

procedures, the local health department shall refer the case to the Department

for risk assessment and follow-up;

C)        The Department will interview the health care professional whose

work may result in secondary exposures to others or their estate to complete

the investigation and assess the potential risk of HIV transmission from the health

care professional including to their patients, based on the professional's

practice and the types and frequencies of invasive procedures performed.

Others may be interviewed as necessary to complete the investigation and assess

the potential risk of HIV transmission from the health care professional to their

patients;

D)        The Department will provide the health care professional with

an explanation of the potential risks of HIV transmission to patients during

the performance of invasive procedures and the legal requirements for

notification of patients whom the Department determines may have been at risk

of HIV transmission from the health care professional, including the patients;

E)        If the procedures performed by the health care professional

were not invasive procedures, and no other potential risk of transmission was

identified by the Department, the entity performing the investigation process

shall provide the health care professional wit

Department determines may have been at risk

of HIV transmission from the health care professional, including the patients;

E)        If the procedures performed by the health care professional

were not invasive procedures, and no other potential risk of transmission was

identified by the Department, the entity performing the investigation process

shall provide the health care professional with information concerning the use

of universal precautions and the recommendations of the Centers for Disease

Control and Prevention concerning the prevention of HIV transmission.  The

health care professional shall also be advised to refrain from any future

performance of invasive procedures, except in accordance with the

recommendations of an expert review panel convened pursuant to the Centers for

Disease Control and Prevention's Recommendations for Preventing Transmission of

HIV and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures

(see Section 693.15(c)(3) of this Part);

F)         If any of the procedures performed by the health care professional

were invasive procedures, or the Department identifies any other potential risk

of transmission to patients, the Department will advise the health care professional

that these patients must be notified of their potential risk of exposure to

HIV.  The health care professional shall be given the opportunity to submit any

information and comments to the Department concerning the notification, and

shall be offered the opportunity to self-notify the patients within 45 days, in

accordance with the notification procedures described in Section 693.45 of this

Part;

G)        If the health care professional declines the opportunity to

self-notify the patients, or fails to do so in accordance with the requirements

of this Part, he or she shall provide the Department with complete and

immediate access to any records that identify or may lead to the identification

of the patients and the actual health care that was rendered

d in Section 693.45 of this

Part;

G)        If the health care professional declines the opportunity to

self-notify the patients, or fails to do so in accordance with the requirements

of this Part, he or she shall provide the Department with complete and

immediate access to any records that identify or may lead to the identification

of the patients and the actual health care that was rendered. The Department will

review but will not copy or seize the provider's records.  The Department will

identify and notify in a timely manner all patients who received invasive

procedures or have otherwise been determined by the Department to have been at

risk for HIV transmission; and

H)        The health care professional shall also be advised to address

performance of invasive procedures in accordance with expert review panel,

Management of Healthcare Personnel Living with Hepatitis B, Hepatitis C, or Human

Immunodeficiency Virus in US Healthcare Institutions, and SHEA Updates Guidance

for Healthcare Workers with HIV, Hepatitis, Advances in Care and Treatment of

Bloodborne Pathogens Reflected in White Paper.