The Australasian Contact Tracing Guidelines 2022 provide a framework for a consistent approach to undertaking effective contact tracing. It provides practical guidance for healthcare providers undertaking contact tracing, and includes guidance and case studies, and patient handouts on HIV, viral hepatitis and other sexually transmissible infections (STIs).
Contacting tracing:
- aims to identify individuals who may be unaware of their HIV-positive status, so they may benefit from treatment and be provided support to take reasonable precautions against the risk transmitting HIV
- must not be associated with blaming the HIV-positive person, and the identity of the positive person must remain confidential, unless there is a legal requirement for breach of confidentiality
- is a delicate task and if undertaken inexpertly or insensitively can alienate individuals (and communities) and cause additional anxiety and distress
- will differ in every case, so each instance must include assessment of the biological, social, ethical and legal implications of the particular case
- is only one facet of HIV prevention and plays a limited role when considered against other prevention measures, including preventive education campaigns, voluntary HIV testing, distribution of condoms and safe drug-injecting equipment, pre-exposure prophylaxis (PrEP), treatment as prevention, post-exposure prophylaxis (PEP) and community-led education
- must not undermine the constructive partnerships between communities at risk, healthcare professionals, government agencies and research bodies, which have proven invaluable in minimising HIV transmission in Australia.
In all jurisdictions, medical practitioners (and sometimes other healthcare professionals) are tasked with identifying whether a patient is placing others at risk of acquiring HIV, and raising the importance of contact tracing. Patients and healthcare providers then discuss the most appropriate way to make contact with current and previous sexual partners.
Permission to contact previous partners must involve patient consent, except in limited circumstances authorised by law. Generally, contact tracing may be conducted by the patient or healthcare worker; delegation is recommended to specialised contact tracing officers in certain circumstances where these resources are available, including instances when the healthcare worker is unable to undertake contact tracing due to time restrictions (see the sections below for an overview of contact tracing state-based laws and guidelines). For more details about considerations for selecting the most appropriate method of contact tracing, check the Australasian Contact Tracing Guidelines 2022.
Overview of contact tracing laws and guidelines #
The capacity of healthcare providers to carry out contact tracing is affected by a range of laws; however, information in this section focuses solely on laws and regulations that specifically reference contact tracing provisions. This information should be read and understood in conjunction with laws on privacy and confidentiality (Privacy and confidentiality), policies on managing people who put others at risk of HIV (Management of people with HIV who place others at risk) and Duty of care to third parties and civil liability).
Court rulings #
In BT v Oei [1999] NSWSC 1082, the defendant medical practitioner was found to have a duty of care to a patient’s sexual partner, even though the partner was not, themselves, a patient of the medical practitioner.
The case arose in New South Wales and involved a man (AT) who reported a flu-like illness in late 1991 and developed acute hepatitis B in early 1992. A woman (BT) subsequently formed a sexual relationship with AT and acquired HIV. BT sued the medical practitioner, claiming that his failure to diagnose AT’s HIV-positive status was negligent.
The following considerations were important to the finding of negligence:
- • BT asserted, and the court agreed, that the medical practitioner should have advised AT to have an HIV test when AT first presented, having reasonably assumed AT may have also been exposed to HIV.
- • The provisions of the Public Health Act 1991 (NSW) (as the law then was) required a medical practitioner who believed a patient was living with HIV, to inform that patient of the risk to others and to advise of the measures they should take to protect others from transmission.
Having failed in these respects, the medical practitioner was found to have been negligent in the exercise of the duty of care owed to his patient’s partner.