Table 1.

Expanded field services outcomes and changes in public health infrastructure, policy and procedures that may be required to institute change

Field Services Outcomes	Potential Areas for change in procedures	Potential changes in policy, training and infrastructure
Partner notification, testing and treatment	Greater use of telephone interviewing Greater use of text messaging, geospatial networking applications (GSN apps), and phone/internet enabled technology (e.g. face-time, skype) for partner services Alter disposition codes to include patient reported and verified outcomes, and to better define when outcomes occur relative to DIS intervention Triaging of persons with syphilis to different intensities of intervention based on HIV status (including viral suppression) Promotion of targeted partner services for persons with gonorrhea and/or chlamydia Integrate expedited partner therapy into partner services for heterosexuals with gonorrhea or chlamydial infection	Changes in DIS policy and performance standards related to telephone interviewing Development of protocols for text messaging and the use of apps that meet privacy compliance standards Changes in partner services databases Refinement of criteria for which persons with gonorrhea or chlamydia receive partner services. Candidate populations include: HIV-infected persons who are out of care or who have a detectable viral load; MSM with rectal gonorrhea; young and/or minority MSM; persons with untreated infections.
HIV testing and retesting of index cases with STIs and high-risk partners of persons with HIV/STI	Promote HIV testing among index patients and partners of persons receiving STI partner services Promote serial retesting of persons receiving STI partner services	Changes in DIS protocols, data collection, and databases to include HIV testing outcomes among index cases and partner (particularly MSM) receiving partner services for STIs Changes in DIS protocols, data collection and databases to consistently define a retesting reminder plan for each patient Development of automated text message reminders systems, or procurement of existing systems for use by public health staff Development of text messaging protocols that meet privacy compliance standards Integration of home HIV testing kit distribution into partner services to use when HIV testing cannot otherwise occur
Increase condom use	Integrate condom distribution and improved access to condoms into partner services	Changes in DIS protocols, data collection and databases to consistently offer condoms to patients and partners. Development of increased and improved options to access free condoms
Referral for PrEP	Referral of high-risk index cases and partners for PrEP (directly or via PrEP navigators)	Development of local guidelines prioritizing PrEP referrals Integration of PrEP referrals into DIS protocols, including local information on PrEP resources Development of PrEP clinical infrastructure in STD clinics and other clinical venues Change field services databases to collect PrEP outcomes
Linkage to HIV care	Integrate linkage to care into HIV partner services for persons with newly diagnosed HIV	Development of local protocols that include jurisdiction specific steps for linking patients to care Changes in field services records and databases to allow monitoring of linkage to care Development of monitoring and quality improvement procedures for real-time evaluation of linkage Development of national trainings for DIS
Relinkage to HIV care	Integration of relinkage to HIV care into STI partner services New programs that use surveillance data to identify persons who are out of care or not virologically suppressed (Data-to-Care).	Integration of STI and HIV databases to identify which persons with STIs are HIV positive and are out of care or not virologically suppressed Change DIS procedures, data collection instruments, and databases to ascertain care status in HIV infected persons receiving partner services Ensure DIS have access to HIV surveillance data, particularly data on HIV viral suppression Development of DIS protocols for relinkage to care Development of DIS trainings in care relinkage, including training in how to use local resources to relink patients to care
Increase use of effective contraception	Integrate effective referral for long-acting contraception into partner services	Change DIS procedures and data collection instruments to ascertain contraception use and pregnancy intention Develop collaborations with local family planning providers to streamline referrals for contraceptive services DIS training in contraception referral, including development of local resource inventories of sources of family planning services
Referral for health insurance	Integrate effective referral for health insurance, including Medicaid, into partner services for STI.	Develop effective insurance navigation systems Changes in DIS procedures and data collection instruments to define the insurance status of partner services recipients and their partners Develop and train DIS in how to refer patients for assistance obtaining insurance