There are different methods by which contacts can be informed by the index case themselves or a health care provider:
- in person
- telephone
- SMS
- social Media
- email
- letter
- referral to a specialist agency.
Online resources available to support both patients and health care providers to undertake partner notification include:
Patient (index case) referral
The index case personally notifies his or her contacts. This requires specific instructions including advice on which contacts to inform and what information to be communicated, including appropriate agencies for assessment and counselling. Patient referral is recommended for well-informed, motivated and confident index cases. Discussion of various scenarios and how they can inform contacts may be helpful. If the index case fears embarrassment or reprisal from contacts e.g. intimate partner violence (IPV), seek assistance from the public health unit (Healthy WA) to undertake contact tracing in a way that minimises risk to the index case’s safety. For further guidance on how to support a patient who may be at risk of IPV, see section Intimate Partner Violence and STIs. It is important to use follow-up consultations to confirm that the contacts have been notified and assessed adequately.
A
sample letter (PDF 16KB) for your patient's contact to pass on to their own GP is provided. The letter explains:
- that they have been in contact with a person diagnosed with an STI/BBV and may have contracted an STI/BBV
- the importance and need for examination and testing, and empirical treatment of chlamydia, gonorrhoea and syphilis.
Provider referral
Provider referral may be selected either at the index case's request, or at the recommendation of the index case’s health care provider. In such cases the provider may undertake to notify contacts directly, or seek assistance from the local public health unit. Provider referral requires the explicit approval of, and offers greater anonymity to, the index case.
Approaches to contact tracing by health professionals
Approaches by phone
Advantages:
- Quick and low cost.
- Opportunity to provide immediate information to the contact and allay their anxiety.
- Opportunity for the health care provider to assess immediately the contact’s willingness to participate in contact tracing, allows an appointment to be made immediately.
- Confidential (provided that the source of the call is only revealed to the contact).
Disadvantages:
- Provides only verbal/auditory information.
- Contact may be uncomfortable disclosing information over the phone to a health care provider they do not know/trust.
- Confidentiality may be compromised as phone conversions can be intercepted/overheard by other people.
- Not practical for the hearing impaired.
Approaches by letter
Advantages:
- Confidentiality can be assured if registered mail is used.
- Cost effective.
Disadvantages:
- May create anxiety, especially if read when services are closed.
- Inappropriate for disclosing details.
- Difficult for people with literacy problems or for the visually impaired.
A
sample letter (PDF 16KB) for patients to pass on to contacts is included. The health care provider should consider the appropriateness of using such a letter.
Approaches in person/Home Visit
Advantages:
- Face to face contact gives the health care provider opportunity to manage the contact’s responses.
- Opportunity for health care provider to assess the index case’s home/social situation.
- Depending on the circumstances and the health care provider's training, immediate testing, empirical treatment, support and referral to appropriate services can be offered if appropriate.
- Informal approaches in small communities can minimise confidentiality risks.
Disadvantages:
- Risk to the health care provider, especially if undertaking this task by themselves.
- Presence of a health care provider with the index case outside a clinic setting can be sufficient to breach the index case’s confidentiality and negatively influence their willingness to participate in contact tracing.
- Human resource and time intensive.
Referral to another agency
For common bacterial STIs such as chlamydia and gonorrhoea, it is preferable that the index case’s contacts be identified, examined, tested, counselled and treated by the health care provider or clinic that treated the index case. However, structural, geographical or other factors may make it necessary for contacts to be referred to a public health unit or specialist sexual health service.
Advantages:
- Opportunity for the index case’s health care provider to limit their involvement to that of their patient, i.e. the index case.
- Opportunity to access to specialist knowledge of contact tracing and public health management.
- Allows the index case’s confidentiality to be maintained if information that could identify them is not included in the referral.
Disadvantages:
- Break in continuity of care.
- Complication of involving another party.
- Delay in contact tracing.
- Perception of breach in confidentiality.