Current through Register Vol. 48, No. 12, March 22, 2024
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 chlamydia or gonorrhea by a health care professional other than
a local health department shall be counseled and offered partner services 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.
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. 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.
g)
For the interview and investigation process concerning health care contacts:
1) Patients
A) An individual who has had exposure-prone
invasive procedures performed on him or her 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 him or her, 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 his or her 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
A) An individual who is a health care
professional or has worked as a health care professional shall be interviewed
to determine whether the type of health care practiced by the individual
involves the performance of invasive procedures, and whether the individual has
or is likely to have performed invasive procedures;
B) If the individual's type of health care
practice involves the performance of invasive procedures but the individual has
not or is not likely to have performed invasive procedures, he or she shall be
provided with written information concerning the use of universal precautions
and the recommendations of the Centers for Disease Control and Prevention
concerning the prevention of HIV transmission in the health care setting. The
individual shall also be advised to refrain from performing exposure-prone
invasive procedures, except in accordance with the recommendations of an expert
review panel that has been 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);
C) 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;
D) The Department will
interview the health care professional or the professional's estate to complete
the investigation and assess the potential risk of HIV transmission from the
professional to his or her 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 professional to his or her
patients;
E) 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;
F) If the invasive
procedures performed by the health care professional were not exposure-prone
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 in the
health care setting. The health care professional shall also be advised to
refrain from any future performance of exposure-prone 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);
G) If any of the
invasive procedures performed by the health care professional were
exposure-prone 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 his or her patients within 45 days, in accordance with the
notification procedures described in Section
693.45 of this Part;
H) If the health care professional declines
the opportunity to self-notify his or her 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 his or her 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 exposure-prone invasive procedures or have
otherwise been determined by the Department to have been at risk for HIV
transmission; and
I) The health
care professional shall also be advised to discontinue performance of
exposure-prone 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).