Partner Notification Guidelines
As part of WP7-Objective 2, a mapping of partner notification/contact tracing of the four disease areas has been executed. This process demonstrates the official and unofficial experience of partner notification/contact tracing in EU countries. The information collected, along with official documents, guideline and laws, gives an understanding of the current situation and will help form the foundation for the future training and improvement. This material has been collected and translated from all JA partner countries.
The information per country is presented below:
The General Data Protection Regulation 2016/679 is a regulation in EU law on data protection and privacy for all individuals within the European Union and the European Economic Area. It also addresses the export of personal data outside the EU and EEA areas. You can find information and a PDF version of the GDPR here: https://gdpr-info.eu/
Article 9 of the GDPR specifically addresses health data (see below).
Processing of special categories of personal data
1. Processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation shall be prohibited. The GDPR prohibition on health data, does not apply under certain conditions, such as the following:
2. Paragraph 1 shall not apply if one of the following applies:
(a) the data subject has given explicit consent to the processing of those personal data for one or more specified purposes, except where Union or Member State law provide that the prohibition referred to in paragraph 1 may not be lifted by the data subject;
(h) processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3; (i) processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy.
It is important to remember that patient referral, where the patients notify their partners themselves, is legal under GDPR. Healthcare providers (HCPs)/ trained staff can still inform patients of multiple methods available for their use in PN, including phone calls, emails, ICT tools and other resources. Assisted partner notification is also legal under GDPR IF 1) it is in line with the specifications set out in Article 9 (2) and 2) it is legal in the country where it is being performed.
In Croatia, there are not specific guidelines as separate documents for each disease area.
The guidelines are for a group of STIs, including HIV. Guidelines for partner notification is included in law and bylaws for the prevention of infectious diseases. All activities, interventions and recommendations, including partner notification, for prevention and control of HIV and STIs is within the control and prevention measures for all infectious diseases that is under surveillance in Croatia which is based and regulated by Act on the Protection of the Population against Communicable Diseases (OG 79/2007, 113/2008 and 43/2009, 130/2017) (see ‘LEGAL’).
There are no specific documents for partner notification of viral hepatitis. All activities, interventions and recommendations, including partner notification, for prevention and control of hep B and C is within the control and prevention measures for all infectious diseases that is under surveillance in Croatia which is based and regulated by Act on the Protection of the Population against Communicable Diseases (OG 79/2007, 113/2008 and 43/2009, 130/2017)
Download "Law on the Protection of People from Contagious Diseases" (English)
Epidemiologists are responsible for TB contact tracing. Public health institutes are involved in surveillance system and partner notification. In terms of surveillance of communicable diseases, Croatia is divided into 112 epidemiologic districts covered by epidemiology services (teams). Epidemiological interventions are acting on three levels: primary, field level (Community level); intermediate (County) level and the national (state) level all of which are supportive. The TB reporting system is mandatory and integrated with the surveillance of other infectious diseases. TB data collection, as well as the overall surveillance of communicable diseases in Croatia, is regulated by law - Act on the protection of the population from infectious diseases and its Regulations - (reports/notifications of infectious disease/death), Naputak za sprečavanje i suzbijanje tuberkuloze (Guidance on the prevention and control of tuberculosis.
Download "Guidance on the Prevention and Control of Tuberculosis" (English)
Download "Naputak za sprečavanje i suzbijanje tuberkuloze" (Croatian)
Legislation outlining partner notification for HIV, STIs and viral hepatitis is included in: ‘Act on the Protection of the Population against Communicable Diseases’ (OG 79/2007, 113/2008 and 43/2009) and the ‘List of communicable diseases the control and prevention of which is of interest to Croatia’ (OG 60/2014). Additionally, healthcare providers must adhere to patient confidentiality laws, found in the ‘Law of the Protection of Patients’ Rights (Official Gazette 169/04 and 37/08).
Download "Law on Protection of Patients Rights" (English)
Download "BESPLATNI KODOVI" (Croatian)
In Denmark, the ‘Recommendations on prevention, diagnosis and treatment of sexually transmitted infections’, 2015 (The Danish Health Authority) recommend that contact
tracing should be part of any consultation for patients diagnosed with an STI (in primary care and hospitals). Partner notification can be done according to 2 principles: 1)The patient inform the partners or 2)Health care personnel inform named partners. Most patients choose to inform partners themselves. IT is important that the index patient is thoroughly informed about the infection and the purpose of contact tracing. In cases where the patients do not want to inform contacts themselves partner notification can be done the doctor using a standard letter (Appendix 1 p. 58 ). It recommends that the diagnosing doctor should be the one who initiates contact tracing.Clinics for sexually transmitted diseases in the larger cities can assist with contact tracing / partner notification. Patients can be referred to one of these clinics for examination, treatment or exclusively contact tracing.
With HIV, the ‘Health promoting and infection prevention counselling of people diagnosed with HIV’, 2007 outlines contact tracing (p 18- 27). Partner notification can be done in 3 ways: 1)The index person informs partners, 2)HIV counselor, nurse or doctor inform named partners, or 3) The index person and the HIV counsellor/nurse/doctor inform partners together. Contact tracing is collaboration between the patient and the counselor and should build on trust, confidence and voluntariness. If the patient does not trust the health care personnel meaningful contact tracing cannot be performed. Partner notification performed by health care personnel is anonymous. If the patient does not wish to meet face to face with a former partner a letter can be send. The letter should be sent in a plain envelope. Language and culture can be other barriers for the contact tracing procedure.
Download "Health promoting and infection prevention counselling of people diagnosed with HIV" (English)
There are no specific guidelines for contact tracing for viral hepatitis in Denmark.
The ‘Guidelines for prevention of TB’, 2015 (Danish Health Authority) outline the contact tracing protocol for TB. When a person is diagnosed with TB all household contacts (person sharing bedroom, living room, kitchen and bath with the infected individual) and close contacts (partner not living in the same house or people often visiting the house of the infected individual) should be offered screening for TB. The guidelines include contact tracing recommendations for different environments, such as schools, workplaces, hospitals, and close contacts.
Download "Guidelines for prevention of TB_Chapter 5" (English)
Download "VEJLEDNING OM FOREBYGGELSE AF TUBERKULOSE" (Danish)
There are no specific laws on contact tracing, but there is a law on reporting of infectious diseases to health authorities, ‘Statutory Order on Physicians' Notification of Infectious Diseases No 277 of 14 April 2000’.
There are no specific documents for STIs in Greece. Concerning HIV, Greece uses translated WHO guidelines for PN.
Download "Prevention of sexual transmission of human immunodeficiency virus" (English)
Download "Guidelines for counselling about HIV infection and disease" (English)
Download "Συμβουλευτική για τη HIV-λοίμωξη και νόσο" (Greek)
Additionally, there are parts of official HIV specific documents that provide supplementary guidance. The “HIV-AIDS. Public Health and Human Rights" acts as recent version (2002) of the “Fundamental Principles for the Protection of Human Rights and Civil Liberties” that HCDPC published in 1995 (see Legal).
Download "HIV-AIDS. Public Health and Human Rights"(English)
Download "HIV/AIDS-ΔΗΜΟΣΙΑ ΥΓΕΙΑ ΚΑΙ ΑΝΘΡΩΠΙΝΑ ΔΙΚΑΙΩΜΑΤΑ" (Greek)
Download "Αντιμετώπιση ασυμπτωματικών ασθενών με διαταραχές των ηπατικών ενζύμων" (Greek)
Download "HCVHBV" (English)
The ‘Tuberculosis Case Investigation Protocol’ describes CT protocol for Greece, as well as the parliamentary decree 144/1963 (see Legal).
In Greece, the patient is protected against mandatory or unvoluntary PN. The “Fundamental Principles for the Protection of Human Rights and Civil Liberties” that HCDPC published in 1995 contained 150 articles for the protection of human rights and civil liberties with regard to Epidemiology, Migrants, Refugees, Family, Housing, Rental Residence, Employment, Education, Military Forces, Prisons, Health Care, Privacy and Confidentiality, Health Care Personnel, Social Security and Welfare, Protection from Un-Orthodox Treatments and Misleading Advertising and Social Life. These principles enacted as Circular of Ministry of Health (Y1/3239/4 of July 2000) and are still in force. According to Article 103 and 104, only the patient has the right to disclose their health condition, unless a physician is granted permission as referred in.
Download Άρθρο 8 - Νόμος 3418/2005 (English)
Partner notification is expected to be the responsibility of the patient, except for syphilis and gonorrhea. Infectologists will try to convince patients about the importance of PN and patients are free to give out names and phone numbers to healthcare personnel for assistance with contacting partners, but they can only ask patients. For data privacy reasons, current guidelines don't discuss this topic, but there's the Ministry of Welfare Decree 18/1998 (VI.3) (see ‘Legal’) on the actions to prevent epidemics explicitly require the patient to provide names of contacts in a specified set of STDs (syphilis, gonorrhea, lymphogranuloma venerum, chlamydia). Yet there are no countermeasures if the patient does not comply.
Download "Szexuális úton terjedő betegségek kivizsgálása és kezelése" (Hungarian)
There are no specific guidelines in Hungary for viral hepatitis.
There is mandatory reporting mechanism for TB in Hungary. Contact tracing is carried out by pulmonology, by interviewing the TB patient. The guideline distinguishes close and distant contacts of Tuberculosis cases. Close contacts are people living in the same household as the patient, colleagues at the workplace, inmates in prisons living in the same cell, patients in the same ward if the TB patient is an inpatient, classmates if the patient is going to school, healthcare workers, etc. Distant contacts are frequently visited based on a risk assessment, and for close contacts, screening is mandatory. The notification of contacts is done by the TB patient asking contacts to get tested at a screening site, public health departments are not involved.
Protection of patient data and privacy is of upmost importance. Currently, the rights of the patient for anonymity restricts efficient partner notification, as current laws do not bind the patients who test positive for any of the diseases to give out their contacts. ‘18/1998. (VI.3) NM Regulation the epidemiological measures needed to prevent infectious diseases and epidemics’ explicitly require the patient to provide names of contacts in a specified set of STDs (syphilis, gonorrhea, lymphogranuloma venerum, chlamydia).
Ireland uses the BASHH guidelines for partner notification of STIs and HIV. There are no official guidelines for PN in Ireland, and each local department of health will conduct PN as best suits.
Download "BASHH Statement on Partner Notification for Sexually Transmissible Infection" (English)
The ‘Hepatitis C Screening National Clinical Guideline’ outlines contact tracing for hepatitis C in Ireland.
Download "Hepatitis C Screening National Clinical Guideline" (English)
The ‘Guidelines on the Prevention and Control of Tuberculosis in Ireland 2020’ from the Health Protection Surveillance Centre outline the contact tracing protocol that should be used in Ireland.
Download "GUIDELINES ON THE PREVENTION AND CONTROL OF TUBERCULOSIS IN IRELAND" (English)
There are no partner notification guidelines for HIV or STIs in Italy.
There are no contact tracing or partner notification guidelines for viral hepatitis in Italy
There is a regional guideline for TB contact tracing in Lombardi
HIV testing activities must be carried out in compliance with the rules set forth in the consent document on "Policies and methodologies regulating HIV testing in Italy“ (Rep. N. 134/CSR 27 Jul 2011) (11A11001) (G.U. Serie Generale n. 191 8 Aug 2011, http://www.gazzettaufficiale.biz/atti/2011/20110191/11A11001.htm ) Art. 5 c. 1 of Law 135/90 ensures anonymity and non-discrimination to all PLHIV. Art. 10 of the present CdM specifies that: "clinician must keep the secrecy/confidentiality on all the information that they get to know during their professional activities…disclosure is allowed if motivated by a just cause, represented by the fulfillment of an obligation established by law (report to the Judicial Authority, health complaints, notifications of infectious diseases, mandatory certifications) or from the provisions of subsequent articles 11 (Confidentiality of personal data) and 12 (Processing of personal data).” This means that physicians can only disclose patient status in rare cases that will allow it “to be considered exempt to the extent to which facing the risk of contagion deriving from a rare venereal disease, they consider as prevalent the interest of the patients partners’ health or the community health” possibly after being granted authorization by the Privacy Guarantor.
As Italian law does not allow healthcare providers or trained staff to notify a patient’s partner (unless in the case of TB), the GDPR does not affect the process of partner notification. It is important to remember that healthcare providers (HCPs)/ trained staff can still inform patients of multiple methods available for their use in PN, including phone calls, emails, ICT tools and other resources. Patients are legally allowed to utilize any of these methods in patient referral, where they notify their partners without the involvement of HCPs.
HIV and STI PN guidelines are combined in the same document found at: https://www.e-tar.lt/portal/en/legalAct/TAR.4DE3590B55F8 .
Download "STI, HIV CARRYING AND HIV DISEASE EPIDEMIOLOGICAL SURVEILLANCE PROCEDURE" (English)
Lithuanian documents for viral hepatitis found at: https://www.e-tar.lt/portal/en/legalAct/TAR.733DC244327C .
Download "THE PROCEDURE FOR THE MANDATORY RECORDING OF EPIDEMIOLOGICAL OBJECTS" (English)
In Lithuania, TB is mainly carried out voluntarily by patient referrals. When formally conducted, it is through contract referral by public heath centre, family doctor and public health institution.
TB documents found at: https://www.e-tar.lt/portal/en/legalAct/31481da0442411e6bd3bfefc575ccac4 .
The mandatory reporting mechanism in place functions only formally.
Download "PROCEDURE FOR THE IDENTIFICATION OF PERSONS WITH TUBERCULOSIS AND CASE MANAGEMENT" (English)
Download "DĖL TUBERKULIOZE SERGANČIŲ ASMENŲ IŠAIŠKINIMO IR ATVEJO VALDYMO TVARKOS APRAŠO PATVIRTINIMO" (Lithuanian)
There are no laws that prohibit or mandate PN in Lithuania
Chapter 54.3 from ‘Polish AIDS Society Recommendations’, which has been prepared by specialized lawyer, summarizes law requirements regarding HIV and STI notification and partner notification. The law states that doctor needs to inform the patients and that person suspected or diagnosed with infectious disease is obliged to inform his/hers contacts. There is no formal contact tracing in Poland and no related law.
Download "Polish AIDS Society Recommendations 2017" (English)
Download "ZASADY OPIEKI NAD OSOBAMI ZAKAŻONYMI HIV" (Polish)
There are recommendations for the treatment of HCV and HBV, although no official guidelines.
Download "HBV" (Polish)
Download "HCV" (Polish)
TB in Poland is under supervision of the pulmonological institute who monitors reporting and referral laboratory. TB is reported according to the same law as HIV and STIs, but there is currently no active, structured contact tracing in place.
Download "National Programme for Prevention, Surveillance and Control of Tuberculosis" (English)
There are no laws that prohibit or mandate contact tracing efforts.
Current diagnostic/screening recommendations do guide health professionals to screen sexual partners of those recently diagnosed, as a mere indication, but do not offer any PN/CT recommendations on how to find them. It is up to an individual decision of index cases with help (or not) of their health professionals how to conduct PN. After any HIV, HAV, HBV, HCV, TB, NG, CT/LGV and syphilis diagnosis, physicians must fill an online mandatory declaration of communicable diseases. Here they are asked if they do know or did notify any contacts of the case index, if case-index did notify contacts on its own and/or if the case-index allows the public health team to call them back for contact tracing
Download "PROGRAMUL NATIONAL DE PREVENIRE SUPRAVEGHERE SI CONTROL AL TUBERCULOZEI" (Romanian)
All activities and interventions, including partner notification, for prevention and control of HIV infection and other STIs are within the prevention and control measures for all infectious diseases that is under mandatory surveillance in Serbia which is based and regulated by the Law on the Protection of the Population against Communicable Diseases (OG 15/2016). There are specific guidelines with Recommendations/ Guidelines for Diagnosis, Treatment and Prevention of Syphilis.
All activities and interventions, including partner notification, for prevention and control of viral hepatitis B and C are within the prevention and control measures for all infectious diseases that is under mandatory surveillance in Serbia which is based and regulated by the Law on the Protection of the Population against Communicable Diseases (OG 15/2016).
There are no specific guidelines for PN/CT of viral hepatitis in Serbia.
Within National Tuberculosis Program in Serbia Guidelines of contact tracing, latent TB infection (LTBI) and chemoprophylaxis was developed. Guidelines covered the topics related to definition of contacts, probability and risk of TB transmission, contact investigation methods, detecting and prioritizing contacts, contact investigation in congregate settings, public information as well and summary table of the type of contact investigation in relation to type of index case as well as type of contact.
Download "Guidelines for TB" (English)
Additionally, National recommendations for the TB prevention in patients undergoing biological treatment was developed in 2016 since this topic was not covered by the previous one.
In 2019 the last update in the area of TB was prepared based on the latest WHO consolidated guidelines for LTBI (2018).
Download "Smernice za dijagnostiku latentne tuberkuloze sa primerima iz kliničke prakse" (Serbian)
Legislation outlining partner notification for HIV, STIs, viral hepatitis and TB is included in the Law on the Protection of the Population against Communicable Diseases (OG 15/2016). Additionally, healthcare providers must adhere to patient and health status data confidentiality issues, found in the Law of the Protection of Patients’ Rights (OG 45/2013, 25/2019).
Moreover, in the Criminal Code (OG 85/2005, 88/2005, 107/2005, 72/2009, 111/2009, 121/2012, 104/2013, 108/2014, 94/2016 and 35/2019) article 249 is related to transmitting infectious diseases to others while article 250 is related specifically to HIV transmission (Part Criminal acts against human health).
Download "LAW ON PROTECTION OF POPULATION AGAINST COMMUNICABLE DISEASES" (English)
Download "Transmitting Contagious Disease" (English)
Download "Cover page HIV in the Legislation of Serbia, 2010" (English)
Download "Criminal responsibility for HIV transmission Serbia" (English)
Download "Protection of privacy part 1 Serbia" (English)
All rules concerning HIV/AIDS prevention are officially embodied within the ‘Expert Guideline for Providing HIV Prevention in Slovakia’ from the Slovak Ministry of Health. Despite the guidelines including a declaration to be made by the HIV positive person, this declaration is not routinely completed, nor is there any means to enforce this.
Download "Odborné usmernenie - prevencia HIV infekcie" (Slovakian)
There are no specific guidelines for viral hepatitis PN.
There are no specific guidelines for TB CT.
According to article 9 of ‘Act no. 20/1966 Coll. On Care of the People’s Health’ and article 25 of Decree no. 103/1984 ‘Coll on Measures Against Transmitted Diseases’, individuals with HVI are required to inform sexual partners about their health condition.
Download "Criminal Code" (English)
Downolad "HIV_informacia a vyhlásenie" (Slovakian)
The British Association for Sexual Health and HIV (BASHH) guidelines for partner notification, as well as the Society of Sexual Health Advisers (SSHA) ‘HIV partner notification for adults’ are the guidelines used for partner notification in the UK.
Download "HIV partner notification for adults, definitions, outcomes and standards" (English)
Download "BASHH Statement on Partner Notification for Sexually Transmissible Infection" (English)
The Health Protection Agency published ‘Standards for Local Surveillance and Follow-up of Hepatitis B and C’ which outlines surveillance methods but does not denote how contact tracing should take place or who is responsible for follow-up.
Download "STANDARDS FOR LOCAL SURVEILLANCE AND FOLLOW UP OF HEPATITIS B AND C" (English)
Public Health England set out the ‘Collaborative Tuberculosis Strategy for England: 2015 to 2020’. This notes that there is considerable variation in how contact tracing for TB is undertaken, and recommends improving contact tracing pathways and mechanisms.
Download "Collaborative Tuberculosis Strategy for England" (English)
The WHO guidelines on partner notification can be found here.
The European Centre for Disease Prevention and Control information on partner notification can be found here.
Please contact INTEGRATE partner Shannon Glaspy at email@example.com with any corrections, updates or questions.