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Partner Counseling and Referral Services

Allison C. Morrill, JD, PhD, Evaluator

Funded by Centers for Disease Control and Prevention    
      via the Massachusetts Department of Public Health

Purpose. From March through September, 2007, the Massachusetts Department of Public Health (MDPH) HIV/AIDS Bureau (HAB) conducted the second phase of a pilot project to offer Partner Counseling and Referral Services (PCRS) to persons living with HIV. Six HIV Counseling, Testing and Referral (CTR) sites throughout the Commonwealth implemented the pilot. This is an evaluation of the second phase of the pilot, to assess (a) the staff training, (b) the process of implementation, and (c) the impact of the pilot.

Methods. Twenty staff from six CTR sites attended both days of the two-day training. After the training they completed a written survey concerning knowledge, skills, attitudes and beliefs before and after the training, as well as their assessment of the training. They completed as similar survey on the web 6 weeks later. Nine front-line staff from six sites were interviewed in person 6 weeks after implementation about their early experiences implementing the pilot. Finally, during the week after the pilot ended, twelve staff from five sites attended one of two focus groups and gave feedback on client responses and acceptance, successes, challenges and suggested improvements. Eleven of these counselors completed a final web-based survey similar to the previous one approximately one week later.

Findings. The training achieved its goals of increasing participants' knowledge and skills relating to PCRS, and the counselors rated it favorably. From early on, counselors reported regularly offering PCRS at pre-test counseling session, but only inconsistently at the post-test session, when many clients seemed emotionally unprepared to consider PCRS and some counselors felt it was not in the client's interest to broach the topic. Greater enrollment was reported at sites with more field experience and with inter-department cooperation that allowed counselors continuing access to clients after they entered care. Among clients who enrolled, typically their main concern was notification of their current main partner; for this, most preferred self-notification or assisted notification. Clients who identified other (past or non-main) partners seemed motivated by their rapport with the counselor, and preferred provider notification. While grateful, clients did not later ask about completion of notification except when there was a safety concern. Counselors were decidedly mixed in their willingness to undertake field notification, citing limited training as well as personal aversion. Implementation was limited by small number of new HIV+ diagnoses. Counselors had numerous creative ideas for outreach; they strongly supported involvement of case managers (CM), and perhaps a dedicated PCRS staff person who would work closely with both CTR and CM. Benefits to the agencies included thoughtful formulation of a new service and its integration with other services for clients living with HIV.

Recommendations. Based upon the findings, the report recommends that DPH do the following:

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