Section 693.40  Contact Interview and Investigation

a)         A Local Health Authority, Designated Agency or the Department, where applicable, shall initiate the contact interview and investigation process under any of the following circumstances:

1)         Upon receipt of an STD, AIDS or HIV report from a physician or laboratory;

2)         When the Local Health Authority, Designated Agency or the Department knows or has reason to know, based on medical or epidemiologic information, that a person within its jurisdiction may be infected with or have been exposed to an STD or HIV; or

3)         For reports of health care providers with AIDS received by the Department prior to October 4, 1991, the Department shall interview and investigate these cases in priority order established by the Department, and provide appropriate contact notification, in accordance with the provisions of subsections 693.40(b)(3)(B)(i) through (ix) of this Part.  The Department shall interview the health care provider or the provider's estate.  Coworkers, family members or others may be interviewed, if necessary, to determine the risk of transmission or to identify contacts.

b)         For cases of AIDS or HIV infection, the contact interview and investigation process shall include the following:

1)         Contact interview and investigation services shall be provided only by counselors who have completed a course of training that included instruction in the following:

A)        The etiology and transmission of HIV, including associated risk behavior and activities, and patient profiles of persons at significant risk of HIV infection;

B)        The natural history and progression of HIV infection;

C)        Methods for preventing transmission of HIV infection;

D)        Principles and techniques of counseling, including demonstration of interviewing and counseling skills needed for epidemiologic management of HIV infected persons, and critiqued role playing, psychologic assessment and crisis intervention;

E)         Principles and techniques of contact investigation and referral; and

F)         Principles of communicable diseases.

2)         For the interview and investigation process concerning sex and needle sharing contacts:

A)        All cases of AIDS or HIV infection identified to health authorities shall be offered the assistance of health professionals in locating and referring sex and needle-sharing contacts for counseling and testing, with the consent of the infected person.  All persons refusing such assistance shall be strongly encouraged to notify their previous sex and needle-sharing contacts of their possible exposure to HIV, and to refer these contacts for counseling and testing.

B)        Cases of AIDS or HIV infection shall be asked to identify their sex and needle-sharing contacts for the preceding twelve month period. The counselor shall discuss the specific nature of each contact with the client to determine the likelihood of HIV transmission based on the type of sexual or needle-sharing practice involved and the counselor's knowledge of risk factors.

C)        Those contacts determined to be at significant risk of infection, in the professional judgment of the counselor, based on the type of sexual or needle-sharing practice involved and the counselor's knowledge of risk factors, shall be investigated.  Investigation shall be conducted on contacts for whom sufficient information to identify the person is available, such as first and last name, street address or telephone number.

D)        The counselor may prioritize the order in which contacts are to be investigated.  The counselor shall provide first priority to those contacts who (based on the counselor's professional judgement), except for contact notification, may not have reason to suspect they may be infected because the counselor has no information that the contacts:  

i)          are aware of having engaged in behavior likely to result in exposure; and/or

ii)         are knowledgeable about the types of behavior carrying these risks.

E)         Persons choosing to self-refer their contacts shall receive intensive individualized instruction and counseling in methods to provide this notification and referral.

F)         Contacts to persons with HIV infection, identified through the contact interview and investigative process, shall be counseled, confidentially and in person, regarding the possibility of infection, methods to prevent the spread of the infection, and services available from public health agencies.  These persons shall also be offered testing to determine infection status.

G)        If the person is legally unable to agree to counseling due to age or legal incompetence, consent and participation in counseling shall be requested of the individual's parent or legal guardian.  If the person is legally able to agree to, but appears to be incapable of understanding and competently acting on such counseling, in the professional judgment of the counselor, participation in counseling shall be requested of a parent or other person chosen by the client.

3)         For the interview and investigation process concerning health care contacts:

A)        Patients

i)          All cases in which the individual has had invasive procedures performed on him or her shall be provided an explanation of the potential risks of HIV transmission to health care providers during the performance of invasive procedures, and the legal requirements for notification of the health care providers who have performed invasive procedures on that individual;

ii)         The individual shall be asked to identify the specific invasive procedures that had been performed on him or her along with the name of the facility or location at which the procedure was performed, and the name, address and telephone number of the health care provider who performed the procedure; and

iii)         The individual shall be offered the opportunity to self-notify those health care providers within 45 days, in accordance with the notification procedures described in Section 693.45 of this Part.  If the individual declines the opportunity to self-notify his or her health care providers, or fails to do so in accordance with the requirements of this Part, the case shall be referred to the Department for notification of contacts.  The Department's notification of contacts shall be conducted in a timely manner.

B)        Health Care Providers

i)          All cases in which the individual is a health care provider or has worked as a health care provider shall be interviewed to determine whether the type of health care practiced by the individual involves the performance of invasive procedures, and whether the individual has or is likely to have performed invasive procedures;

ii)         If the individual's type of health care practice involves the performance of invasive procedures but the individual has not or is not likely to have performed invasive procedures, he or she shall be provided with written information concerning the use of universal precautions and the recommendations of the Centers for Disease Control and Prevention concerning the prevention of HIV transmission in the health care setting.  The individual shall also be advised to refrain from performing exposure-prone invasive procedures, except in accordance with the recommendations of an expert review panel that has been convened pursuant to the Centers for Disease Control and Prevention's "Recommendations for Preventing Transmission of HIV and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures" (see Section 693.15(c)(5) of this Part);

iii)         If the individual has or is likely to have performed invasive procedures the Local Health Authority shall refer the case to the Department for risk assessment and follow-up;

iv)        The Department shall interview the health care provider or the provider's estate to complete the investigation and assess the potential risk of HIV transmission from the provider to his or her patients, based on the provider's practice and the types and frequencies of invasive procedures performed.  Others may be interviewed as necessary to complete the investigation and assess the potential risk of HIV transmission from the provider to his or her patients;

v)         The Department shall provide the health care provider with an explanation of the potential risks of HIV transmission to patients during the performance of invasive procedures, and the legal requirements for notification of patients whom the Department determines may have been at risk of HIV transmission from the health care provider;

vi)        If the invasive procedures performed by the health care provider were not exposure-prone invasive procedures, and no other potential risk of transmission was identified by the Department, the entity performing the investigation process shall provide the health care provider with information concerning the use of universal precautions and the recommendations of the Centers for Disease Control and Prevention concerning the prevention of HIV transmission in the health care setting.  The health care provider shall also be advised to refrain from any future performance of exposure-prone invasive procedures, except in accordance with the recommendations of an expert review panel convened pursuant to the Centers for Disease Control and Prevention's "Recommendations for Preventing Transmission of HIV and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures" (see Section 693.15(c)(5) of this Part);

vii)        If any of the invasive procedures performed by the health care provider were exposure-prone invasive procedures, or the Department identifies any other potential risk of transmission to patients, the Department shall advise the health care provider that these patients must be notified of their potential risk of exposure to HIV.  The health care provider shall be given the opportunity to submit any information and comments to the Department concerning the notification, and shall be offered the opportunity to self-notify his or her patients within 45 days, in accordance with the notification procedures described in Section 693.45 of this Part;

viii)       If the health care provider declines the opportunity to self-notify his or her patients, or fails to do so in accordance with the requirements of this Part, he or she shall provide the Department with complete and immediate access to any records that identify or may lead to the identification of his or her patients and the actual health care that was rendered. The Department shall review but shall not copy or seize the provider's records.  The Department shall identify and notify in a timely manner all patients who received exposure-prone invasive procedures or have otherwise been determined by the Department to have been at risk for HIV transmission; and

ix)        The health care provider shall also be advised to discontinue performance of exposure-prone invasive procedures except in accordance with the recommendations of an expert review panel convened pursuant to the Centers for Disease Control and Prevention's "Recommendations for Preventing Transmission of HIV and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures" (see Section 693.15(c)(5) of this Part).

c)         For cases of syphilis, gonorrhea, chlamydia, chancroid, or opthalmia neonatorum,  the contact interview and investigation process shall include the following:

1)         Contact interview and investigation services shall be provided only by counselors who have completed a course of training which included instruction in the following:

A)        The etiology and transmission of STDs;

B)        The natural history and progression of STD infection;

C)        High or increased risk behavior and activities, including patient profiles of persons at significant risk for acquiring STDs;

D)        Methods for preventing and treating STD infection;

E)         Principles and techniques of counseling, including demonstration of interviewing and counseling skills needed for epidemiologic management of STD patients, and critiqued role playing; and

F)         Principles and techniques of contact investigation and referral.

2)         All persons diagnosed with early syphilis or antibiotic-resistant gonorrhea or chlamydia or any person treated for gonorrhea or chlamydia at a clinic of the Local Health Department shall be interviewed by the Local Health Authority, Designated Agency or the Department, where applicable.  "Early syphilis" means primary, secondary or early latent syphilis of less than one year's duration.

3)         All persons diagnosed with chlamydia and/or gonorrhea in the private medical sector shall be interviewed as resources permit and within the discretion of the Local Health Authority, Designated Agency or Department, where applicable.

4)         All cases interviewed shall be asked to provide the names and any available identifying information regarding their sex contacts. Persons refusing to name their sex contacts shall be strongly encouraged to self-refer such contacts for testing and treatment, if necessary.

5)         Those contacts determined by the counselor to be at significant risk of infection, based on high or increased risk behavior and activities, shall be investigated.

6)         Interviewing and counseling of STD cases and contacts shall be conducted in person, in a private manner, and shall be documented on epidemiologic records furnished by the Department.

7)         Counselors shall follow the guidelines and standards described in Section 697.300 of the AIDS Confidentiality and Testing Code (77 Ill. Adm. Code 697).

8)         All records regarding cases of STDs, contacts to cases of STDs and all information collected in investigations and interviews pursuant to this Section shall be confidential, and shall at all times be maintained in the same manner as those maintained for reported cases of STDs.

(Source:  Amended at 25 Ill. Reg. 3916, effective April 1, 2001)