Reporting and Notification Requirements
In July of 1998, the New York State Legislature passed legislation that required the Department of Health to develop regulations to implement a system of HIV/AIDS surveillance and enhance efforts at partner/spousal notification. After an extensive process of developing the regulations, publishing them for public comment and making revisions, the Health Department has established an implementation date of June 1, 2000. This Question and Answer Sheet outlines the responsibilities of physicians, nurse practitioners, physician assistants and nurse midwives under these regulations. More detailed information is available on the new version of the Department of Health’s Guide to HIV Pre-Test and Post-Test Counseling Reference Card.
What are health care provider responsibilities for reporting cases of HIV infection, HIV-related illness and AIDS as of June 1, 2000?
Beginning June 1, 2000, the New York State Department of Health will establish an integrated HIV/AIDS surveillance system to monitor cases of HIV infection, HIV-related illness and AIDS. Under the new regulations, health care providers will report initial (newly diagnosed) cases of HIV infection, HIV-related illness and AIDS.
Reporting of HIV infection: Physicians, nurse practitioners (NPs), physician assistants (PAs) and nurse midwives will be responsible for reporting to the Health Department all persons they newly diagnose with HIV infection. Providers should report cases of HIV infection by completing the Medical Provider HIV/AIDS and Partner/Contact Form within 21 days of the diagnosis. In New York City, health care providers will call the New York City DOH Office of AIDS Surveillance at the phone number listed on the form and arrange for pick-up of the reports. For the rest of the state, providers will mail reports to the New York State Department of Health Bureau of HIV/AIDS Epidemiology at the address listed on the form. Laboratories will report all positive antibody tests to the NYSDOH Bureau of HIV/AIDS Epidemiology.
Reporting of HIV-related illness: Health care providers may complete a report form for new diagnosis of HIV-related illness; this will also be tracked through laboratory reporting of all positive viral load tests, CD4 counts less than 500 and CD4/CD8 ratios below 29%. The Health Department will follow-up with the provider to confirm the case, gather epidemiological information and to offer partner notification assistance services.
Reporting of AIDS: Providers should continue to report all new diagnoses of AIDS to the Department of Health using the new reporting form.
Delegating reporting responsibilities: Physicians, NPs, PAs and nurse midwives may delegate specific tasks associated with reporting to other supervised members of the care team. However, it is the responsibility of the diagnosing physician, NP, PA or nurse midwife to be sure that reporting of new cases of HIV infection and AIDS takes place and that all reporting forms are appropriately signed.
What are health care provider responsibilities regarding HIV partner/spousal notification?
The new program requires providers to:
- Report to the Health Department the names of all known sexual and needle-sharing partners, including spouses, as well as the names of any partners the patient wishes to have notified.
- Report information about partner notification plans and the results of screening for domestic violence of each reported partner on the Medical Provider HIV/AIDS and Partner/Contact Form.
The law states that there is no penalty if the patient chooses not to name partners or engage in partner notification assistance activities. Public health staff may follow-up with providers on the status of their patient’s HIV partner notification following a case report. The responsible local public health officer will determine which cases merit partner notification by public health staff. Upon initial diagnosis of HIV infection, providers must discuss in posttest counseling the importance of partner/spousal notification and work with the patient to develop a plan for notifying exposed partners. Providers should explain the three options for partner notification: (1) notification of the partner by the NYSDOH Partner Assistance Program (PNAP) or the NYCDOH Contact Notification Assistance Program (CNAP); (2) assisted notification of the partner in which the patient notifies the partner with the assistance of a willing provider or a public health counselor from PNAP/CNAP; (3) self-notification in which the patient notifies the partner him/herself. When self-notification is chosen for a known or named partner, a confirmation plan will be worked out between PNAP/CNAP staff and the provider. If PNAP/CNAP cannot sufficiently verify the self-notification, PNAP/CNAP staff may also follow-up with the patient and/or the known partner to confirm the self-notification. (Self-notification is particularly an option if the patient does not wish to disclose the partner’s name to the provider.) PNAP/CNAP counselors never reveal the name or any information about the HIV positive patient (index case) to the partner(s) during partner notification. Since HIV infection is life-long, providers should routinely discuss with patients the importance of partner notification. These discussions should focus on the importance of avoiding transmission to new partners and may include referring the patient for primary and secondary prevention services at a community-based organization that provides such services.
What are the new counseling messages that should be provided during HIV pre-test counseling?
In addition to the standard HIV pre-test counseling requirements outlined in Public Health Law Article 27-F, the following new counseling points should be covered during all HIV pretest counseling sessions:
- Explain that all cases of HIV infection will be reported to the Health Department;
- Anonymous testing is still an option and anonymous test results will not be reported to the Health Department;
- Explain that the information collected in HIV-reporting and partner notification is confidential and used only for epidemiological and partner notification purposes;
- Explain that if a patient tests HIV antibody positive, he/she will be asked to cooperate with his/her doctor or PNAP/CNAP counselor to plan the best ways to notify partners who may be at risk of infection;
- Explain the benefits of partner notification;
- Explain that if the health care provider ordering the HIV antibody test is aware of any known sexual or needle-sharing partners (e.g., spouse) of the patient, the provider is required to report the names of these partners to the DOH; and
- Begin domestic violence risk assessment (recommended if not handled at another point in patient intake or care, not required during pre-test counseling).
What counseling points should be covered when providing post-test counseling to a patient with a positive HIV antibody test result?
In addition to standard post-test counseling messages which educate patients about advances in HIV treatment, the importance of health care, and the confidentiality of HIVrelated information, providers should:
- Review the benefits of partner notification, including: it allows the partner to learn he/she was exposed to HIV and would benefit from HIV testing; if infected, the partner can take advantage of new treatments which may slow or stop progression of HIV; if uninfected, the partner can learn how to stay that way.
- Explain that the provider will work with the patient to develop a plan for notifying sex and needle-sharing partners, including spouses, who have been exposed to HIV;
- Explain that partner notification is voluntary and that there are no penalties for choosing not to provide the names of partners;
- Inform the patient that the provider will ask questions about the risk of domestic violence in relation to each partner before proceeding with any partner notification activities;
- Ask the patient if there are any partners’ names he/she would like to provide at this time and work with the patient to select an option for notification for each partner: PNAP/CNAP notification, assisted notification, self-notification;
- Discuss any partners already known to the provider and explain the provider’s responsibility to report all known partners, such as spouses, to the Health Department; and
- Conduct domestic violence screening for each partner that is under consideration to be notified and report the results of the screening to the Health Department.
How does the domestic violence screening protocol work?
The Department of Health has developed a domestic violence screening protocol for use in all HIV-positive post-test counseling sessions. This domestic violence screening must be conducted prior to any partner notification being conducted. The purpose of this seven-step protocol is to identify any cases in which notification of a partner could lead to physical harm or some other severe threat to the health and safety of the index patient or someone close to him/her, such as a child. The screening should be conducted with all patients, male or female. The core of the domestic violence screening is a simple straightforward question: What response would you anticipate from your partner if he/she were notified of possible exposure to HIV? If the patient identifies concerns about the partner’s reaction, a series of follow-up questions would be asked, such as;
- Have you ever felt afraid of your partner?
- Has your partner ever pushed, grabbed, slapped, choked or kicked you?
- Based on what you have told me, do you think that notification of this partner will have a severe negative effect on your physical health and safety or that of your children or someone close to you?
If there is risk of any form of domestic violence, the provider should refer the patient for domestic violence services and the notification may be deferred. In the event of a deferral, public health staff would follow-up with the provider in 30-120 days to determine if the situation has been resolved and whether it is now safe to proceed with the notification. A decision to proceed with partner notification would be made by the responsible public health officer in consultation with the provider. In some cases, a deferral may be extended. For information about domestic violence services programs call:
- NYS Domestic Violence Hotline: 1-800-942-6906
- NYC Domestic Violence Hotline: 1-800-621-HOPE
- NYC Gay and Lesbian Anti-Violence Project: 1-212-714-1141
How will the state’s partner notification assistance programs (PNAP & CNAP) assist providers and patients?
PNAP and CNAP are public health programs that have many years of experience working with the partners of HIV positive clients. PNAP/CNAP staff can assist health care providers in the following areas:
- Working collaboratively to address the partner notification needs of patients.
- Providing consultation to health care providers who are coaching patients through self-notification.
- Reviewing good practices for conducting a provider-assisted notification.
- Clarifying questions about HIV confidentiality and partner notification.
- Providing information about accessing HIV counseling and testing services.
- Providing information about the specific conditions under which a physician, PA or NP may notify a partner of exposure to HIV without the patient’s consent.
PNAP/CNAP counselors can meet with HIV positive clients to assist with the following services:
- Providing assistance with partner notification.
- Conducting assisted notification of partners, where the PNAP/CNAP counselor meets with the client and partner.
- Conducting notification of partners without revealing the client’s name or any identifying information.
- Preparing clients for self-notification of partners.
- Assisting patients with arranging for notification of partners who are out of the state.
Information about these programs is available at the following numbers:
- PNAP (Statewide, outside NYC) 1-800-541-2437 (available 9 am-5 pm weekdays)
- CNAP (New York City) 1-212-693-1419 (available 9 am-5 pm weekdays)
Where can I obtain training about these regulations and how can I obtain DOH patient education materials?
The Department of Health has many training and informational resources available for health care providers and the general public. To view a number of these resources visit the DOH web site at www.nyhealth.gov. For more information about training programs or to order a catalog of materials for providers or the general public, call the Health Department at 1-518-474-9866.