Sexually Transmitted Diseases  >  Program Guidelines  >  Partner Services

Program Operations Guidelines for STD Prevention
Partner Services

Previous Page

Table of Contents

Next Page

Appendix PS-G

INTERSTATE TRANSMISSION OF STD INTERVENTION INFORMATION

Basic Policy

The Interstate Transmission of STD Intervention Information is the system that oversees the transmission of STD intervention information among project areas. Success of the system depends on the willingness of each program manager to take the steps necessary to assure that its provisions are observed and to hold one another accountable when deviations occur. While these guidelines are designed to support and, where necessary, refine or clarify the process and procedures, project areas should review their protocols and procedures to ensure that they specify how to handle incoming and outgoing intervention requests. In reviewing or developing these protocols and procedures, programs are encouraged to consider these national guidelines in order to ensure consistency with respect to transmission of STD information between jurisdictions. Investigations should be conducted in accordance with local protocol, with respect to contacting partners outside your jurisdiction. There are situations where local protocol will specifically permit or prohibit cross-jurisdiction investigations. Disease prevention will be facilitated by the confidential sharing of information on STD cases, partners, suspects, and associates between jurisdictions.

All requests received by an area for conducting an interstate STD investigation, interview or counseling session, reinterview, etc., should be accorded at least the same priority as the same program activity initiated within the receiving area. It is suggested that the receiving area process cases from other areas, even if the program area does not process these same type of cases for patients in its own jurisdiction. To the extent possible, information on sex partners that is transmitted should focus on disease intervention priorities. Program areas should review the information carefully before transmitting information about partners or individuals with a last exposure date that represents a minimal likelihood of disease intervention and, if such a request is made, should explain the reason for the request. While each case is unique and rules must allow for flexibility, programs should assume that managers in other areas are exercising appropriate professional judgment when requests for follow-up are made. Therefore, the receiving area should accept these follow-up requests and act upon them without challenge. Questionable records should be brought to the attention of a supervisor. If it appears that areas are overloading the system with questionable requests, program managers are encouraged to discuss the issue with their counterparts in other program areas.

The following categories of partners and individuals are considered high priority:

• Women who are known to be pregnant and exposed to confirmed infectious syphilis, gonorrhea, chlamydia, or who have a reactive test for HIV.
• Women or infants with reactive prenatal or postpartum serologies and unknown treatment status.
• Persons with positive tests for or symptoms of gonorrhea, chlamydia, syphilis, and with unknown treatment status.
• Persons with positive tests for HIV (Not all areas will investigate HIV. If your area investigates HIV positives, then you should initiate an out-of- urisdiction HIV positive. The receiving area will determine whether to investigate based on local policies and priorities).
• All partners who could be incubating disease because of a recent exposure to an infectious individual.

Areas with staff, workload capability, and desire to follow persons exposed to diseases beyond the normally prescribed periods should make this known in writing to other program areas. High-priority persons are those about whom the program has sufficient information to indicate that they may have been exposed to an infectious person, or those who the program has reason to believe may be infected and that locating them would prevent the further spread of disease.

Field Records

Field records (FR) that are initiated by a program area that are to be transmitted for investigations out of jurisdiction should be as accurate and complete as possible, and should at a minimum include the following information:

• For sex partners, suspects, or associates, a complete identification and physical description (name, sex, age, weight, height, complexion, ethnicity, etc.) as well as exposure dates, test results, and basis for the diagnosis of the original patient to whom the partner, suspect, or associate is linked, if applicable.
• At least two items of locating information (home address and telephone number are considered as one item). Other locating information could include place of work; work telephone number; beeper or cell phone numbers; friend or relative or other person known by the person; hangouts; make, model, color of car, etc.
• When a male partner is known to have the same name as his father or son, care should be taken to ensure that correct designations such as "Jr." or "Sr." are communicated to help avoid the potential for confidentiality problems.

When field records that are transmitted out of jurisdiction do not include any of these provisions, the initiating area should include the reason for the omission. An acceptable reason for omitting information should not include failure on the part of the initiating area to pursue the information. If the reason provided by the initiating agency is acceptable, receiving areas should accept and proceed with the individual requests. When an acceptable reason for omission of information is not given, receiving areas may demand one or suspend further action until an acceptable reason is given. Program areas should exercise sound judgment when making a decision to reject or suspend an investigation on technicalities since the primary concern for all areas should be the health of the individual and the prevention, or further spread, of disease in the community.

Military Patients

Program managers are encouraged to work closely with military installations in their jurisdictions to ensure that the military understands these guidelines for transmitting information on persons initiated during the course of their STD investigation, providing that no other system has been established. Any domestic military installation that initiates STD intervention information on civilians for investigation outside of its jurisdiction should forward the information through the appropriate state control point. The STD prevention program should review the information for appropriateness and comprehensiveness then transmit appropriately. Program managers should discourage military installations from sending investigative information directly to the Centers for Disease Control and Prevention (CDC).

Corrections

Program managers are encouraged to work closely with prisons, local jails, and juvenile detention centers. See the chapter on Special Emphasis for a detailed discussion of corrections issues.

Transmission and Disposition Procedures

When possible, program areas should telephone state control points in the receiving areas with all information on persons (see the following appendix for current list of interstate control points). When telephoning or transmitting STD intervention information, strict rules of confidentiality must be followed. The person responsible for transmitting that information between control points should observe confidentiality by affirming that the control point called is the correct one, and by receiving assurance that the person receiving the information is authorized to accept STD related intervention information. This assurance should come before the discussion of any STD intervention information. If either the initiating or receiving area is concerned about the confidential nature of the call, communication should cease until such time as confidentiality can be assured by both parties. The initiating area should keep a record of the date, time of day, and name of the individual receiving the STD information. Confirmation of telephoned information can be mailed if requested by the receiving area.

Before telephoning or mailing STD investigation information, it would help the receiving area if the initiating area checked zip code directories and long distance telephone information to verify the spelling of the name and address and that the address and telephone number exist. Initiating areas should let receiving areas know if these verification activities were conducted and the results of those activities.

Priority STD intervention information, and information on individuals on which a "return disposition" is requested should be recorded on the Field Record, CDC 73.2936S, or a similar local form by the receiving area. Field record control numbers (preprinted number on a field record) and disposition due date should be exchanged between initiating and receiving areas. This information will be used by both areas to track the investigation request. The disposition due date is generally established as 14 calendar days from the date of receipt.

Low priority reactive serologic tests for syphilis (STS) are those tests that would not receive high priority attention within an area. Low priority requests should be written on Field Records and exchanged by mail. The information should be exchanged even if these low priority reactors would be administratively closed in the initiating area, or if they could be closed through a record search by the initiating area. A reason for exchanging the information is to give the receiving area test results that could be used for updating records. If a record exists on the reactor in the initiating area, and if local policy permits, that information should also be included on the field record when transmitted out of jurisdiction.

Initiating areas should not routinely expect or request a "return disposition" on low priority reactors unless there is a compelling reason to ask for the disposition. In those instances when a "return disposition" is desired, initiating areas should indicate "return disposition requested" on the field record. Requests for "return dispositions" on low priority reactors should be kept to a minimum. Sex partner information on uncomplicated gonorrhea and chlamydia should be written on a field record and exchanged by mail or phone. As with low priority reactors, "return dispositions" should not be routinely requested unless there is a compelling reason. Areas requesting "return dispositions" should follow procedures previously described in these guidelines.

Maps

A map showing where an individual may be found might prove critical to the success of an investigation. Since it could prove difficult to communicate the details of a map orally to the investigating area, the initiating area should prepare the field record with the map and mail it to the investigating area. If the request is a priority investigation, the investigating area should be telephoned and alerted to expect the mailed field record. Program areas should also consider faxing the information if it can be assured that the faxed information would be secure and confidential.

Record keeping

All areas should develop a record keeping system that will enable them to efficiently conduct the disease intervention outreach transmittal component of the interstate procedures. In most cases, the system will consist only of a file for field records or a log to record transmittal information. Simplicity is the key when record keeping systems are established by areas. For example, a system could be as simple as filing all incoming and outgoing forms together chronologically by "disposition due date." While the system should be specific to an area, each should have a method for keeping up with overdue follow-up requests. Overdue follow-up requests are those incoming and outgoing requests that have been open for more than 14 days, or that are beyond the "disposition due date." Investigating areas have the responsibility to call initiating areas and inform them of the status of the investigations if they are still open beyond the "disposition due date." Whenever an initiating area obtains new or clarifying information on individuals being followed out of jurisdiction, every effort should be made to inform the area.

International Transmission of STD Information

The CDC policy and procedure for the international and military transmission of non-HIV/STD information is currently under review and is expected to be revised. While this policy is being reviewed, program areas should continue to use current polices that have been established in their areas for handling international and military transmission of non-HIV/STD information. The CDC involvement in the transmission of international STD information is minimal and will be done only on a case-by-case basis. Since CDC has limited involvement in the transmission of other international STD information, program areas are encouraged to counsel patients to self-refer or notify their partners who reside in foreign countries and who may have been exposed to a disease.

 

Previous Page

Table of Contents

Next Page