There are no nationally agreed laws or guidelines on the diagnosis, treatment and tracing of contacts of patients with HIV. There is, however, general agreement as to the purpose and priorities of contact tracing as it relates to HIV.
- aims to identify individuals who may be unaware of their HIV infection, so they may benefit from treatment and be provided support to affect sustained behaviour change thereby mitigating ongoing transmission of HIV.
- must not be associated with blaming the index case, and indeed, the identity of the index case must in most instances remain confidential.
- is a delicate task and if undertaken inexpertly or insensitively can alienate individuals (and communities) and cause additional anxiety and distress.
- will differ in every case, so each instance must include assessment of the biological, social, ethical and legal implications of the particular case.
- is only one facet of HIV prevention mechanisms, and plays a limited role when considered against other prevention measures including preventive education campaigns, voluntary HIV testing, distribution of condoms and safe drug injecting equipment, and the myriad laws and policies which support these and other preventive measures.
- must not undermine the constructive partnerships between communities at risk, health care professionals, government agencies and research bodies that have proven invaluable in minimising HIV transmission in Australia.
For further information about managing contact tracing responsibilities see ASHM’s The Australasian Contact Tracing Manual1 (2006), which is endorsed by the Royal Australasian College of Physicians. It provides practical guidance for health care providers undertaking contact tracing, and includes guidance, case studies and patient handouts on HIV, viral hepatitis, other sexually transmissible infections (STIs) and HIV-related tuberculosis.
In all jurisdictions, medical practitioners (and sometimes other health care professionals) are tasked with identifying patients’ risk episodes and raising the importance of contact tracing. Patient and health care providers then discuss the most appropriate way to make contact with current and previous sexual partners. Generally, contact tracing may be conducted by the patient or health care worker, with delegation recommended to specialised contact tracing officers in certain circumstances, including instances when the health care worker is unable to undertake contact tracing due to time restrictions (see overview of contact tracing state based laws and guidelines below).
Those wishing to access expert assistance should contact their applicable health department in the first instance.
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Choosing a method of advising contacts
The method of advising and counselling contacts about their exposure to HIV is chosen after taking into account the risk history, condition, sexual or social environment and motivation of the index case. The following strategies are available:
Patient (index case) referral
Specific instructions: The health care provider presents the index case with specific advice regarding which contacts to advise and the information to be imparted, including appropriate agencies for assessment and counselling. The index case personally notifies his/her contact(s). Many services provide contact letters (sample included in The Australasian Contact Tracing Manual) detailing the index case’s diagnosis and treatment, that the contact can take to the doctor of his/her choice.
Imparting skills: Patient referral requires a well-informed, motivated and self-confident index patient. If the index case fears embarrassment or reprisal by his/her contact(s), it may be helpful for a skilled counsellor to rehearse the notification with the index case. The advantages of role-playing are that information to be imparted can be confirmed and the index case can be taught to anticipate and respond to reactions by contacts. General counselling support can also be provided. If relying on patient referral, it is important to use follow-up consultations to confirm that the contacts have been advised and assessed adequately.
Either at the index patient’s request or at the suggestion of the health care provider, the provider may advise the contact(s) directly or recruit another agency (e.g. sexual health service, public health unit) to ensure that the contact(s) are assessed. To do so, the health care provider should have the explicit approval of the index case (check confidentiality requirements).
Provider referral may have the advantage of offering the index case a higher level of confidentiality. However, provider referral is more time- and resource-intensive. It is the contact tracing method of choice for certain situations and conditions, e.g. where patient referral has failed or when the index case fears a violent reaction. A combination of patient and provider referral is often used for the different contacts of one index case.
Based on extract from The Australasian Contact Tracing Manual, 3rd Edition1 (2006)
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Overview of contact tracing laws and guidelines
The capacity of health care providers to carry out contact tracing is affected by a range of laws, however, the following information focuses solely on laws and regulation which specifically reference contact tracing provisions. These outlines should be read and understood in conjunction with laws on privacy and confidentiality (Privacy and Confidentiality) and policies on managing people who put others at risk of HIV infection (Management of People with HIV Who Place Others at Risk).
State based contact tracing laws and guidelines are listed below.
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State Based Information
1Australasian Society for HIV Medicine (ASHM). The Australasian Contact Tracing Manual. A practical handbook for health care providers managing people with HIV, viral hepatitis, other sexually transmissible infections (STIs) and HIV-related tuberculosis. Canberra: Commonwealth of Australia; 2010. Available at: http://ctm.ashm.org.au (last accessed November 2012.
Australasian Society for HIV Medicine (ASHM). The Australasian Contact Tracing Manual. A practical handbook for health care providers managing people with HIV, viral hepatitis, other sexually transmissible infections (STIs) and HIV-related tuberculosis. Canberra: Commonwealth of Australia; 2010. Available at: http://ctm.ashm.org.au
(last accessed November 2012.