Needs Assessment
Our team conducted a series of key informant interviews to better understand the specific needs of and challenges faced by STI/HIV Partner Services. We spoke to a range of Partner Services stakeholders, including disease investigators, STI/HIV program directors, IT staff, and Partner Services clients.
In order to gain a broad understanding, we spoke to individuals across the country, representing at least six public health departments. An outcome of this work was our needs assessment report, summarized below.
Logistical Issues
HIV/STI Partner Services programming is underfunded and lacks essential resources required to meet the demands of conducting the intervention with local populations. Staffing, in number and experience, is often inadequate due to high attrition, expertise required, and funding challenges. Technology, devices, internet connectivity, and data systems are often siloed, outdated, and dysfunctional.
Recommendations
Invest time and resources in strengthening technological infrastructure, staff training, and staff retention.
Technology is often deployed to promote efficiency, resources need to be put in place to not just implement new solutions but to strengthen and maintain existing systems. Technology isn’t a band-aid for broken core infrastructure.
Ethical Issues
Ethical concerns were found to be common among our interviewees. Fourteen (47%) key informants highlighted the importance of building a trusting relationship, and thirteen (43%) pointed to the importance of secure data systems and a culture of confidentiality.
Recommendations
With the implementation of data capture tools in a Partner Services interview, contextualization of interview questions, assurance of data security and confidentiality, and communication that responses are optional is crucial to building rapport, trust and obtaining reliable data.
While data security and confidentiality measures are important, efforts by DIS to build and maintain client trust (which may include confirmation of confidentiality) represent the most salient ethical issues facing Partner Services programming.
Interface Reconfiguration
DIS expressed wanting flexibility from a data capture tool, including a desire for the ability to pause, add notes, skip questions, and/or return to skipped questions. Interviewers want a data tool that allows for protocols and questions to be internally modified.
Building strong rapport and keeping the interview conversational are priorities for DIS. Clients may be hesitant to disclose information due to mistrust or discomfort speaking to health professionals. Modifying interview protocols to meet changing needs has often required substantial cost and time.
Recommendations
Ensure data collection protocols are easily configurable by Partner Services staff members - who might have low technological expertise or immense time pressures.
Utilize tools that support a conversational approach to interviewing (i.e., tools which allow DIS to easily navigate across questions in a nonlinear order to follow the flow of the conversations with clients).
Tools designed for public health need to accommodate contact tracing across different diseases
Well designed software interfaces can promote comfort and trust.
Deployment Reconfiguration
Many key informants stressed the importance of and value in remote options for interviewing and partner notification, whether self-administered, online, or app-based.
Factors such as long transportation times to clients’ homes, remote work configurations for staff brought about by the COVID-19 pandemic, and an increasing trend toward remote solutions for Partner Services administration, even prior to COVID-19, all contributed to a widely held desire for remote functionality within any new tools.
Recommendations
Optimize tools for remote deployment to ensure continuation of Partner Services outreach even when in-person interviewing is infeasible (e.g., during a pandemic) and when staff resources are low (e.g., insufficient time for locating clients in person).
Remote deployment methods need to be designed in such a way that they not only increase efficiency for Partner Services, but also promote client trust necessary for disclosure.
Data Reconfiguration
There is clear and pressing need for connection between data systems, and significant barriers exist in interoperability and format of data with regards to import and export. Existing data systems are siloed, often including disconnected federal, state, and department level health systems.
DIS have limited time to interview clients, and are burdened by data entry taking a substantial amount of their time, so efficiency of these interviews is important. There is increasing movement toward “efficiency” and the building of electronic systems, but these systems often do not integrate with each other and DIS are faced with doing the hard work of moving data between systems.
Recommendations
Any new Partner Services data system must be integrated with existing data systems to avoid creating another silo.
Invest in connecting existing data systems together to simplify reporting processes and more effectively and efficiently utilize limited resources.
Ensure that the data captured aligns with what is useful practically and/or analytically (i.e., avoid collection of data that will not ultimately be utilized).