PCRSPCRSPartner Counseling and Partner Counseling and

Referral ServicesReferral Services

Tereé JeromeTereé JeromeFern OrensteinFern Orenstein

CaliforniaCaliforniaPCRS ProgramPCRS Program

HIV Partner Counseling & Referral HIV Partner Counseling & Referral Services (PCRS)Services (PCRS)

Array of Voluntary & Confidential services available to HIV positive persons and their sex and/or needle-sharing partners

Integral part of a comprehensive HIV prevention program… 

Prevention With Positives

PCRSPCRS

For the HIV+ client :For the HIV+ client : support andsupport and professional assistance with the notification professional assistance with the notification of HIV exposure to all relevant partnersof HIV exposure to all relevant partners

  • For the partners :For the partners : services include: services include:

• notification of HIV exposurenotification of HIV exposure• HIV counseling and testing options,HIV counseling and testing options,• referrals for other services: PCM, referrals for other services: PCM,

support groups, drug tx, STD evaluation, support groups, drug tx, STD evaluation, housing, domestic violence resources, housing, domestic violence resources, legal assistance, etc...legal assistance, etc...

PCRS PCRS Guiding PrinciplesGuiding Principles

VoluntaryVoluntary ConfidentialConfidential Client CenteredClient Centered On-goingOn-going Support Services and ReferralsSupport Services and Referrals Universal accessUniversal access

Disclosure Options Disclosure Options

Self Disclosure Self Disclosure Dual Disclosure Dual Disclosure Provider Disclosure (Anonymous 3Provider Disclosure (Anonymous 3rdrd

Party Disclosure )Party Disclosure )

Dispelling Myths about PCRSDispelling Myths about PCRS

Clients don’t want it Clients don’t want it Clients are too overwhelmedClients are too overwhelmed Not “client centered”Not “client centered” Not voluntaryNot voluntary Not confidentialNot confidential Cannot be done in anonymous Cannot be done in anonymous

settingssettings

GIVE MENAMES

NAMESNAMES

The Clinic

What People Think

Role of ProvidersRole of Providers

Check in with clients about partners Check in with clients about partners Support clients in deciding whether Support clients in deciding whether

or not to disclose their statusor not to disclose their status Help client explore which option, if Help client explore which option, if

any, is best any, is best – Self, Dual, or Provider (Anonymous)Self, Dual, or Provider (Anonymous)

Assess safety, Partner/Domestic Assess safety, Partner/Domestic Violence Violence

CDC 2004 Prevention PlanCDC 2004 Prevention Plan

Approx ¼ of persons w/HIV (950K) are not Approx ¼ of persons w/HIV (950K) are not aware of their infection and their risk for aware of their infection and their risk for transmitting HIV. transmitting HIV.

Prevent new infections by working w/HIV + persons and partners: – Voluntary PCRS– Rapid Testing (new models for DX HIV)– Linking positive persons into care and

treatment earlier

Prevent vertical transmission, mother to child, 180 cases last year

Benefits & ConcernsBenefits & Concerns

Break into three groups: Break into three groups:

Client, Partner & ProviderClient, Partner & Provider Brainstorm the benefits & concerns Brainstorm the benefits & concerns

around PCRS, for the group you around PCRS, for the group you representrepresent

You need:You need: 1) Recorder1) Recorder

2) Reporter2) Reporter

*15 minutes**15 minutes*

Utilization of Voluntary HIV Utilization of Voluntary HIV Partner Counseling and Partner Counseling and

Referral Services (PCRS)Referral Services (PCRS)

California Office of California Office of AIDS & STD Control AIDS & STD Control

BranchBranch

PCRS Program DataPCRS Program Data

5 Demonstration Projects5 Demonstration Projects– 14 Local Health Jurisdictions (LHJs)14 Local Health Jurisdictions (LHJs)

March 1999 – December 2002March 1999 – December 2002 1783 clients offered PCRS1783 clients offered PCRS

How HIV + Clients are Responding to PCRS (N=1783)

Did not refer partner

75%

Referred at least one partner

25%Prepared by California Department of Health Services: Office of AIDS and STD Control Branch

Partner ReferralsPartner Referrals

• 450 HIV+ clients went on to refer partner

• 802 total partners referred

• Average partners referred per client: 1.8

• Range: 1-21 partners

• 71% designated only 1 partner

• 42% of partners referred to Provider, Dual or Contract services

Number Number of OCs of OCs choosinchoosing each g each typetype

Percent Percent of of

referring referring OCs*OCs*

Number Number of total of total

partnerpartners s

elicited elicited

Percent Percent of all of all

partnerpartners s

elicitedelicited

Avg # Avg # of of

partners partners elicited elicited

per per client:client:

Range of Range of partners partners elicited elicited

per per client:client:

ClientClient 306306 68%68% 469469 58%58% 1.51.5 1-191-19

ProviderProvider 143143 32%32% 275275 34%34% 1.91.9 1-191-19

DualDual 4040 9%9% 4646 <6%<6% 1.11.1 1-51-5

ContracContractt

88 <2%<2% 1212 <2%<2% 1.51.5 1-51-5

Partner Referrals

*percentages do not necessarily add to 100% as OCs can choose multiple referral choice for different partnersPrepared by California Department of Health Services: Office of AIDS and STD Control Branch

Not tested25%

(n=41)

Refused contact6%

(n=9)

No prev test, new neg

42%(n=38)

Already known HIV positive

13%(n=21)

No prev test, new pos

16%(n=14)

161 partners (85%) were located

90 (56%) of the located partners were tested

&

Follow-up was initiated on 189 partners

Prepared by California Department of Health Services: Office of AIDS and STD Control Branch

Tested56%

(n=90)

Prev neg, still neg

40%(n=36)

Prev neg,new pos

2%(n=2)

Partner Follow-up 189 partners followed-up 161 located (85%)

• 13% already HIV +• 10% new positives of those located (16/161)

90 tested (56%)• 18% new positives of those tested (16/90)

• 1.3% state OA-funded positivity rate• 4%- 7.5% ‘HIV+ partner’ high risk group

• Over half (58%) of those testing were 1st time testers (n=52)

Supporting Materials from PCRS Supporting Materials from PCRS ProgramProgram

Customized TrainingCustomized Training BrochuresBrochures Palm Cards Palm Cards Standards and RecommendationsStandards and Recommendations Data collection tools and technical Data collection tools and technical

assistance assistance PCRS Toolkit (under construction)PCRS Toolkit (under construction)

Contact usContact us

Fern OrensteinFern Orenstein

PCRS Program PCRS Program DirectorDirector

State of California State of California

510-883-6638510-883-6638forenste@dhs.ca.govforenste@dhs.ca.gov

Tereé JeromeTereé Jerome

PCRS Regional PCRS Regional CoordinatorCoordinator

Bay AreaBay Area

510-540-2907510-540-2907

tjerome@dhs.ca.govtjerome@dhs.ca.gov. .