4.1 Preparing the PCRS Provider
Program managers
and supervisors
must ensure that
each PCRS provider
has the appropriate
training and skills to
effectively serve HIV infected
clients and
their partners. |
In large part, the manner in which PCRS is provided to and perceived by
the affected communities determines how successful HIV prevention programs will
be (see Section 4.5). Therefore, program managers and supervisors should ensure
that PCRS staff -
- are skilled and competent in providing
PCRS;
- are culturally competent and demonstrate respect for the community to be served;
- are knowledgeable about HIV infection, transmission, and treatment;
- are knowledgeable in local, state, and
federal laws regarding HIV and other
relevant issues of providing health
care, especially the right to privacy
and confidentiality;
- receive updated information and periodic
retraining as appropriate;
- have standards, objectives, and specific
guidelines for performance;
- are appropriately supervised and given
written and oral feedback about their
performance on a regular basis; and
- have appropriate problem-solving skills
to deal with situations that might be
encountered in a field setting, e.g., personal
safety, violence to others.
In addition to receiving formal training, such
as CDC’s training course on PCRS, an inexperienced
PCRS provider should complete an
internship by being teamed with a more
experienced provider for a period of time
before conducting PCRS alone (see Section
6.1). Another way to enhance a provider's
performance is through routine peer review
of selected cases.
Providers of successful PCRS programs regularly
go outside the clinic or office setting to
reach partners. The inexperienced provider
will need training in deciding when to deliver
PCRS outside the office or clinic and when to
postpone PCRS. Benefits of delivering PCRS
in a partner's home might include providing
the partner with a familiar environment and
helping the provider better understand the
personal circumstances of that partner.
Whether or not to do PCRS outside the clinic
or office, or whether it is best postponed until
an adverse situation can be resolved, must be
decided on a case-by-case basis. In addition,
training in avoiding confrontations, diffusing
anger, and mediating disputes will better
prepare any provider for handling potentially
violent situations.
4.2 Setting Activities in Motion
Locating and
notifying activities
must begin
promptly once the
PCRS plan has
been formulated
and the priorities
set for reaching
partners. |
For those
partners the provider
will be
contacting, the
first step the
provider should
take is to verify
the identifying and
locating information
given by the HIV-infected client. Locating
and notifying partners should begin as soon as
possible after the provider and HIV-infected
client have decided on the best approach to use
for each partner and priorities have been set
for reaching partners. If the client will be
informing partners, the client should be well-coached
on how to do so and should be provided
opportunities to obtain additional
counseling, assistance, or other support during
the process.
4.3 Maintaining Confidentiality
While conducting
PCRS
activities in the
community,
providers must
continue to
maintain confidentiality
for
all HIV-infected
clients and their
partners. |
Confidentiality
for all persons involved
in PCRS must
continue to be maintained.
All attempts to
make contact with a
sex or needlesharing
partner should be
confidential. This is
often difficult because
other community
members might ask the purpose of the
provider's visit and why he or she is attempting
to make contact. Nevertheless, providers
should not, for example, reveal to others why
they are trying to find a particular person.
Likewise, providers should never leave a note
or message that mentions HIV exposure as the
reason for attempting to make contact. In
addition, no other information should be
revealed that might lead to others learning the
reason for the contact or that might otherwise
lead to disclosure of sensitive information or
to a breach of confidentiality. As each partner
is located, he or she should be informed privately
and face-to-face, if at all possible. However,
if the person refuses to meet with the
provider, informing a partner by telephone
might become necessary. In such situations,
only limited information should be provided
to the partner, and the goal still should be to
arrange a face-to-face meeting if at all possible.
Informing a partner by telephone should only
be done as determined by state and local
jurisdictions and after every step has been
taken to ensure that the correct person has
been located, is on the telephone, and others
are not listening. Further attempts should be
made to arrange a meeting in person.
The original HIV-infected client will sometimes
inquire about the results of the PCRS
provider's activities regarding his or her partners.
The provider, when requested, can reveal
whether a particular partner has been informed
of his or her exposure to HIV, but
must not reveal any confidential information
about that partner, including whether the
partner decided to be tested or whether he or
she is HIV-infected.
Of equal importance is not revealing any
identifying information about the original
client to the partner, including the person's
sex, name or physical description, or time,
type, or frequency of exposure. Although the
PCRS provider will need to document the
results of his or her activities in a thorough,
concise, and timely manner, confidentiality
must still be maintained for all persons involved.
Information that identifies partners
should be kept locked in a secure location.
Client and partner information, other than the
official record (as determined by state practice),
should be destroyed when current PCRS activities
are concluded.
State or local areas should establish PCRS
record-keeping policies and procedures, and
client and partner information should be
maintained in accordance with these policies.
Many public health programs have developed
policies and procedures to safeguard sensitive
client or partner information. One example
can be found in CDC’s Guidelines for HIV/AIDS Surveillance, Appendix C, Security and
Confidentiality (as revised October 1998). In
developing their policies, PCRS managers can
choose to review and adapt the policies and
procedures in this document or those of other
public health programs.
4.4 Helping Partners Access Services
The PCRS
provider must be
well prepared to
handle the initial
reactions of the
person who is being
informed of possible
exposure to
HIV. That person
will undoubtedly
need immediate
counseling, followed
by referral to
additional HIV
prevention counseling.
The provider
must be prepared
to answer the questions and concerns of
each partner without revealing any identifying
information about the original HIV-infected
client.
As described earlier, referring partners to
needed prevention, treatment, and other
relevant services is a goal of PCRS. Testing is a
very important issue to persons who have just
learned of possible exposure. The provider
must be prepared to, at a minimum, refer them
to counseling and testing services. For many
years, providers have taken blood specimens of
those who consent at the time of notification,
which requires specialized training. With the
current availability of oral fluid and urine
collection kits, and rapid testing systems,
program managers are encouraged to consider
providing on-the-spot collection of specimens
for HIV testing as each partner is informed. If
the partner has previously been tested, and
those results were negative, the PCRS provider
should stress the need to follow up with
another test if exposure history indicates
it is warranted.
However, many partners will need referrals
for other kinds of social and medical support
services beyond counseling and testing. The
PCRS provider should already have agreements
in place and an up-to-date resource
guide so that immediate referrals can be made
to services such as substance abuse treatment,
family planning assistance, other STD treatment,
domestic violence prevention, mental
health counseling, or housing assistance (CDC,
1993). Having agreements in place for collaboration
between PCRS providers and referral
sources will help ensure that those services can
be successfully accessed. PCRS providers
should then follow up with each partner
contacted to ensure that test results and other
referral services have in fact been received. If
providers in another health jurisdiction have
been asked to contact a partner, health departments
should follow up with that provider to
determine that services have been received.
4.5 Addressing Community Concerns
The potential exists for PCRS to have a
negative impact on HIV-infected individuals,
their partners, or affected communities (Rothenberg
and Paskey, 1995; West and Stark,
1997). Some community leaders view these
kinds of activities with suspicion and are
apprehensive about such issues as -
- whether disclosure of partner names is
done voluntarily;
- possible denial of health care or other
services if the HIV-infected client refuses
to reveal partner names or otherwise
refuses to cooperate with the provider;
- unintended effects on personal
relationships, such as partnership
breakup or violence;
- potential for invasion of privacy or
loss of confidentiality for HIV-infected
clients and their partners; and
- possible discrimination if confidential information
held by government agencies is
ever released, either accidentally or by law.
Although PCRS providers cannot always
resolve these issues, they can strive to build
relationships of trust between themselves and
those they serve, including the leaders of
affected communities. Working with HIV
prevention community planning groups and
others when determining and evaluating
priorities, policies, and procedures for PCRS
will help increase community support and
acceptance. PCRS providers should be prepared,
whenever an opportunity arises, to
address legitimate concerns and dispel misconceptions
about policies and practices
(West and Stark, 1997).
Go to Section 5.0 |