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Steps in Contact Tracing

All contact tracing should be undertaken whilst respecting the individual patient's sensitivities and needs and should not result in harm. The approach in contact tracing may vary depending on the population involved. Refer to the Special Populations section for additional information if required.

STEP 1.    Introduce the reasons for contact tracing

Patients should be informed about:
•    Asymptomatic infection. Sexual contacts that are infected are usually asymptomatic and unaware of their infection.
•    Possible serious complications for partners if partners are not tested and treated.
•    Risk of reinfection where relevant.

        
STEP 2.    Help identify who needs to be notified

•    Discuss mode of transmission and likely duration of infection.
•    Trace back contacts from the relevant time periods for the particular STI

Table 1 summarises how far back in time patients should be advised to contact partners. These are also shown for each individual in Conditions.

When taking a sexual history for the purposes of optimising contact tracing, a good starting place is the chronology of sex, starting with most recent contact and then working back from there. For example, ask 'When did you last have sex, and with whom?' and 'When did you last have sex with a different person before them?'. Then ask about details such as condom use, type of sex (e.g.: oral, vaginal or insertive or receptive anal) and drug use for each partner. It is helpful to ask about the patient’s relationship with the partner/s- were they regular, casual or anonymous, and did the sexual encounter occur locally, interstate or overseas? During a discussion of partners, the health care provider and the patient can discuss whether contacts are likely to be contactable and how the patient feels about contacting them and offer resources for contact tracing..

Considerations when taking the history:

  • It may not be necessary to exhaustively enquire about every detail for every partner; however, in the case of more serious infections, for example HIV, a more detailed partner history is warranted.
  • Index patient may have had casual or anonymous partners and not know their identities or contact details.
  • More detailed enquiry might include explicit information about the relationship with contacts, specific sexual practices, condom use and physical location, for example, brothel or sex on premises venues.
  • In the case of blood-borne infections,   ask about blood donation, receipt of blood products, and sharps exposure.

STEP 3.    Explain the methods available and proceed to contact trace

•    Contacts can be notified by Patient referral or Provider referral
•    Work with the patient to decide the most appropriate method for each of their contacts

Patient or Provider-initiated contact tracing 

Patient-initiated contact tracing

  • The index patient notifies their contact(s) either in person, anonymously or via an external resource.
  • Ensure that the index patient informs the contact(s) as to what condition or infection they have been diagnosed with.
  • The health care provider provides the information to be imparted by the index patient to the partner(s). They may do this in person or use an anonymous web-based service.

Advantages
Individuals usually prefer to notify contacts 
Quicker and easier

Disadvantages
Less or compromised confidentiality 
There is the chance that the index patients may not follow through and contact their partners 
They may not disclose the correct or all infections

Provider-initiated contact tracing

•    The health care provider directly advises the contact(s) or uses another agency (for example, sexual health service, public health unit or health department contact tracer) to ensure that contacts are notified.
•    The health care provider must have the consent of the index patient and ensure they do not divulge the index patient's details.

Advantages
Higher level of confidentiality for the index patient
Method of choice when an individual fears a violent or stigmatising reaction, and for certain situations and conditions (for example, blood transfusion-related infections, when contact will involve sex workers or a vulnerable person)
In certain situations, such as HIV infection, it is important the clinician follows up with the index patient as to how the contact tracing has gone and offers assistance and support if required

Disadvantages
More time- and resource-intensive 
The index patient may not disclose all their contacts to the clinician

STEP 4. Notification

Public health notification requirements differ between conditions. Most laboratories will automatically notify the public health unit when a notifiable condition is detected. Public health notification can also be clinician initiated.

More information around this can be sought from your Australian State or Territory Health Department website, or the New Zealand Ministry of Health website.

Consider local public health notification requirements such as databases for localized epidemics.

Ensure thorough completion of notification data, submitting all requested parameters where information is available.

 

 Page last updated April 2021

 

 

 

 

 

 

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