HIV Testing and Occupational Exposures

Yes. Written informed consent and pre- and post-test counseling are always required in VA in testing to diagnose HIV infection. (June 2005)

Immediately notify occupational (employee) health staff and discuss next steps, including post-exposure prophylaxis (PEP). Occupational health staff members are trained to counsel employees about the personal and professional ramifications of an occupational exposure. The occupational health staff is authorized to access the source patient's health records and to share any relevant information that will help the employee make informed decisions about his/her options. Occupational (employee) health staff will coordinate any request for further testing of the source patient and can advise the employee about the benefits and risks of PEP treatment. PEP is readily and frequently initiated before the source patients' status HIV status can be confirmed. (June 2005)

Asking a patient about his/her HIV status might be the provider's first impulse, especially if there is already an established relationship. Questioning the patient about HIV status is not prohibited. However, the exposed employee should always seek immediate assistance from occupational (employee) health staff familiar with the guidelines for occupational exposures and post-exposure evaluation and treatment, even if the patient is perceived to be at low risk or has previously tested negative for HIV. Any discussions about testing of a patient subsequent to a potential occupational exposure should be conducted by a health care professional other than the exposed employee. (June 2005)

As a part of the Federal Government, VA is subject to Federal laws, which may differ from State laws that govern the actions of other health care providers. In VA, all HIV testing of patients done for the purpose of establishing a diagnosis requires written, informed consent of the veteran patient and requires pre- and post-test counseling. (June 2005)

Since post-exposure prophylaxis (PEP) should be initiated as soon as possible after a potential occupational exposure, decisions frequently must be made without knowledge of the source patient's actual HIV status. PEP may be initiated based on the nature of the exposure and can be discontinued if the source if subsequently found to be HIV-negative. Provisions for testing of source patients who lack decision-making capacity are the same as those that would apply if the test were being performed for any other reason. If the patient is expected to regain decision-making capacity in a reasonable period of time, a request for testing after an occupational exposure should be deferred and the exposed employee should be counseled about post-exposure prophylaxis based on the nature of the exposure. If the patient is not expected to regain decision-making capacity in a reasonable period of time, a surrogate may provider consent in accordance with the procedures described in the Informed Consent Handbook (VHA Handbook 1004.1). There is no provision in Federal law or VA Regulations for involuntary testing. (June 2005)

No. There are no exceptions to the requirement that HIV testing be voluntary and with the informed consent of the person being tested or his/her surrogate. (June 2005)