Dallas County Health and Dallas County Health and

HumanHuman

Dallas County Health and Dallas County Health and Human ServicesHuman Services

Dallas County Health and Dallas County Health and Human ServicesHuman Services

Public Health Follow-Up for Public Health Follow-Up for Acute HIV InfectionAcute HIV Infection

La Shonda WortheyLa Shonda WortheySTD/HIV Program ManagerSTD/HIV Program Manager

Dallas County Health and Human ServicesDallas County Health and Human Services

AHI Protocol

Laboratory Director or Assistant is notified immediately

Assistant STD/HIV Program Manager is notified immediately

Program Manager notified if Assistant Manager is not available

Surveillance Administrative Support Staff enters case

immediately

Field Record is created immediately

Case is assigned to a DIS immediately

DIS Successfully Interviews Case within 72 hours of test result

Field Operations Manager receives copy of record

DIS Unsuccessful in interviewing case within 72 hours

Immediate Enrollment into Early Intervention Clinic (within 24

hours)

Medical clinic appointment made for case to outside provider

Field Operations Manager notifies Assistant Program Manager

AHI patient is seen by area medical provider within 21 days

of testing date

Field Operations Manager Attempts to interview case

Review of cases where AHI patient is not seen by medical provider within 21 days of test date by Medical Directors

Enhanced Partner Notification

Notification Protocol for AHI Cases

Assistant Program Manager documents unsuccessful interview

Enhanced Partner Notification

DIS elicits names of high risk contacts of AHI cases

High risk contacts are interviewed within 72 hours

High risk contact has had unprotected sex and/or shared needles with AHI case* within

the last 72 hours

Perform Rapid HIV test either in the field or in the STD Clinic

High risk contact has had unprotected sex and/or shared needles with AHI case* within 72

hours – 4 weeks

High risk contact has had unprotected sex and/or shared needles with AHI case* > 4

weeks

Partner r Notification Protocol for AHI Cases

Rapid HIV test +

Rapid HIV test -

Refer to Early Intervention as a presumptive positive

Perform HIV testing

Notify Medical Director for potential referral for possible PEP

Perform HIV testing

Perform Rapid HIV test either in the field or in the STD Clinic

Rapid test +

Refer to Early Intervention as a presumptive positive

Rapid test -

Recommend retesting in 1 month if negative

Perform Rapid HIV test either in the field or in the STD Clinic

Rapid test +

Refer to Early Intervention as a presumptive positive

Perform HIV testing

Perform HIV testing

Rapid test -

Perform HIV testing

Perform HIV testing

* Note: because identifying the AHI individual by name to the contact violates confidentiality, contacts who mention unprotected sex or sharing needles with any individual in listed timeframes should follow above.

Public Health Follow-up for NAAT Public Health Follow-up for NAAT July 2009-May 2010July 2009-May 2010

26 Positive NAAT Test 26 Positive NAAT Test 2 from San Antonio and 24 in Dallas2 from San Antonio and 24 in Dallas 23 Cases interviewed (2 Cases Still 23 Cases interviewed (2 Cases Still

Open)Open) 40 contacts initiated and 25 suspects 40 contacts initiated and 25 suspects

initiated initiated

Public Health Follow-up Public Health Follow-up Dispositions for Partners NamedDispositions for Partners Named

40 Partners Named40 Partners Named 14 Previous Positive14 Previous Positive 13 Negative13 Negative 11 closed as unable to locate and 11 closed as unable to locate and

refused testing (H and J)refused testing (H and J) 2 New HIV cases found 2 New HIV cases found

Public Health Follow-Up Public Health Follow-Up Dispositions for Suspects NamedDispositions for Suspects Named

25 Suspects Named25 Suspects Named 18 tested negative18 tested negative 2 Previously Positive for HIV2 Previously Positive for HIV 5 Unable to locate (H)5 Unable to locate (H)

Case Management Activity Case Management Activity Case #1Case #1

592 interviewed patient X who was a 592 interviewed patient X who was a volunteer to the STD clinic with volunteer to the STD clinic with palmer/plantar rash. Patient X tested palmer/plantar rash. Patient X tested positive for syphilis and NAAT and was positive for syphilis and NAAT and was linked to Early Intervention Serviceslinked to Early Intervention Services

Patient X named 6 contacts and 1 suspectPatient X named 6 contacts and 1 suspect One partner from patient X could not be One partner from patient X could not be

found by 592 and was closed as unable to found by 592 and was closed as unable to locatelocate

593 continued public health follow-up on 593 continued public health follow-up on the contact who was located and tested the contact who was located and tested for syphilis and HIV.for syphilis and HIV.

Case Management OutcomeCase Management Outcome

The contact was negative for syphilis The contact was negative for syphilis and a new NAAT positiveand a new NAAT positive

This contacts Rapid HIV Test was This contacts Rapid HIV Test was negative on 4/28/10 and positive for negative on 4/28/10 and positive for NAAT on 4/28/10NAAT on 4/28/10

Patient was linked to Early Patient was linked to Early Intervention ServicesIntervention Services

Case Management ActivityCase Management ActivityCase #2Case #2

579 tested an inmate in the jail, NAAT test was positive579 tested an inmate in the jail, NAAT test was positive Inmate tested because of IV drug use, girlfriend a prostitute Inmate tested because of IV drug use, girlfriend a prostitute

and two brothers that he shared needles with.and two brothers that he shared needles with. 579 conducted a screening to locate to two brothers and 579 conducted a screening to locate to two brothers and

was unsuccessful.was unsuccessful. 579 found a new NAAT positive that was not case related 579 found a new NAAT positive that was not case related

from the screening.from the screening. Another screening was conducted a month later at the Another screening was conducted a month later at the

same site and the girlfriend was located and tested. She same site and the girlfriend was located and tested. She was a previous positive but had not received an interview.was a previous positive but had not received an interview.

The inmate tested negative for HIV 5 months prior to the The inmate tested negative for HIV 5 months prior to the positive NAATpositive NAAT