Table 3.
Example of field services priorities, approaches to investigation+ and goals
| Population in order of priority | Approach | Goals* |
|---|---|---|
| Tier 1 | ||
| Syphilis in pregnant women | High intensity PS** | Index patient (IP) and partner treatment, Prevention congenital syphilis |
| Acute HIV infection | High intensity PS | Partner testing, Partner PrEP or PEP, Immediate initiation antiretroviral therapy (ART) (<48 hours) |
| Bacterial STI in HIV+ unsuppressed persons | High intensity PS | Relinkage to care/initiation antiretroviral therapy (ART), Partner testing and PrEP |
| Tier 2 | ||
| New HIV infection | Intermediate intensity PS** | Linkage to care (goal <7 days), Partner testing Partner PrEP |
| Investigation of HIV+ persons known to be in-jurisdiction and not virally suppressed | Intermediate intensity PS | Relinkage to HIV care, Partner HIV testing and PrEP |
| Complicated syphilis++ | Care coordination (as needed) – intermediate intensity PS | Treatment – prevent long-term sequelae, PrEP (HIV−), ART (HIV+), partner testing, treatment and possible PrEP |
| Tier 3 | ||
| Antimicrobial resistant gonorrhea (GC) | Intermediate intensity PS** | Treatment of IP and partners |
| Early syphilis in women and men who have sex with women only (MSW) | Intermediate intensity PS | Treatment of IP and partners, Identification of pregnant women with syphilis, Long acting contraception (LARC) promotion, HIV testing, PrEP referral (depends on local epidemiology) |
| GC or chlamydia (CT) in untreated pregnant women++ | Intermediate intensity PS | Treatment of IP and partners |
| Early syphilis in MSM and transgender persons who have sex with men | Lower intensity PS** (consider follow-up to ensure PrEP linkage) | HIV testing, Screening for complicated syphilis, Treatment of IP and partners, PrEP promotion |
| Surveillance-based investigation of HIV+ persons who are not virally suppressed | Intermediate intensity PS | Relinkage to HIV care, Partner HIV testing and PrEP |
| Tier 4 | ||
| Random sample heterosexual GC/CT*** | Lower intensity PS | Evaluation of EPT uptake, Partner treatment (EPT), LARC promotion |
| GC in MSM and transgender persons | Lower intensity PS (Intermediate intensity to promote PrEP in rectal GC) | HIV testing, Treatment of case and partners, PrEP promotion |
| GC in women and MSW only | Lower intensity PS | EPT, LARC promotion, PrEP promotion (depends on local epidemiology) |
| Tier 5 | ||
| CT in MSM and transgender persons | Lower intensity PS | HIV testing, Treatment of case and partners, PrEP promotion |
| CT in women and MSW only | Lower intensity PS | EPT, LARC promotion |
High intensity PS involve early initiation of field investigations. Intermediate intensity PS includes initial efforts to contact IPs by telephone or text message, with field investigation limited to cases that cannot be reached via telephone or text message. Lower intensity PS involves efforts to reach IPs and partners only via telephone and text message.
Referral for assistance obtaining insurance is a potential goal in all populations.
Neuro, ocular or otosyphilis
High intensity PS should be used in cases with elevated minimum inhibitory concentrations to ceftriaxone. Selected jurisdictions are using high-intensity PS for infections with Neisseria gonorrhoeae with decreased susceptibility to cefixime or azithromycin.
Prioritization of untreated persons with gonorrhea or chlamydial infection should not necessarily prompt programs to allocate resources to define the treatment status of all reported cases.
Undertaken to evaluate chlamydial control programs, particularly the use of expedited partner therapy11.