HIV Testing and Guidance
IHS Guidance
- The IHS HIV Program supports the CDC recommendations and (if possible given
resource constraints and potential jurisdictional issues) suggests each facility
attempt to move toward more routinized HIV testing.
- HIV prevalence has not been established in IHS or most AI/AN communities
and thus (given other co-existing risk factors and health disparities), IHS recommends
routine HIV testing.
- Although prenatal screening has improved IHS-wide, it still remains a priority. All pregnant
women should be screened for HIV during pregnancy. Women should be screened
a second time during their 3rd trimester if they are deemed at high risk, or
the community prevalence of HIV is above 1%. (For GPRA purposes, if a patient
visits a Service Unit 2 times or more during pregnancy, it is the Service Unites
responsibility to offer HIV screening, or enter into RPMS that a prenatal HIV
test has been offered in another health facility.)
- Any positive Sexually Transmitted Infection (STI) should be followed by an
STI/HIV screening panel, which is a newer Clinical Reporting System (CRS) measure
within the IHS.
- According to recent data collection, the IHS tests more women than men – due
in part to the priority of prenatal testing. However, the higher percentage of
seropositivity remains among men. This is consistent with the general US population. IHS
HIV Program recommends facilities to consider methods that will improve offering
HIV testing to men.
Tribal Efforts
- Support for expanded HIV testing has commenced in some locations and is assisting
healthcare facilities promote and raise awareness of this health maintenance
testing. In some locations, Tribes have championed these efforts and approved
Tribal resolutions supporting the revised CDC recommendations and IHS progression
toward more routine HIV testing.
- Tribal Policy / Resolution Projects on expanded HIV Testing: Example
Written consent for HIV testing
All patients require informed consent for HIV testing. However the
CDC revised recommendations for HIV testing of adults, adolescents in health
care settings do not require specific or separate written consent for HIV testing. Part
of the recommendations state that opt-out testing should be used whenever possible. Opt-out
means no specific or separate written consent is needed for HIV testing;
general consent for medical care should be considered sufficient documentation
of consent for HIV testing.
IHS Guidance
- IHS form 509, previously required by the IHS as a separate and specific patient
consent form for an HIV antibody test is no longer needed. The IHS supports
opt-out testing and recommends it in sites where State law does not prohibit
this streamlined method of HIV testing. Some States are consistent with CDC recommendations,
and it is our goal to remain as progressive as possible to improve the health
of the AI/AN population
State laws
Given the changing landscape of State laws and health policy on HIV testing,
the IHS defers to State laws on HIV testing. Please check with your individual
States to determine if their HIV testing laws are consistent with CDC and IHS
recommendations. There may be differences in State law on written consent, counseling
requirements, testing of minors, and other aspects of HIV testing. Each
Service Unit should check State laws prior to expanding HIV testing policy. However,
some Tribes have opted to issue Tribal resolutions to implement HIV testing guidelines
they find most suitable for their own community.
The
University of California, San Francisco offers a website to compare State
laws.
This site is very helpful; however please additionally contact each State individually
for the most current information. Laws and policy change frequently with regard
to HIV testing.
Counseling
requirements for HIV testing
The CDC counseling guidelines do not require prevention, pre- or post-test
counseling for routine HIV testing. However, just as with any other health
condition, counseling remains an important part of care. While providers
may deem some patients only need routine counseling, other patients may require
in-depth prevention counseling or discussions and referral to support services.
IHS Guidance
- The IHS supports CDC recommendations. Unless it is State law, no special
qualifications are now required for pre and post test counseling. However,
experience at some Service Units suggests:
- Nurses or other health care workers have latitude to decide how much time
counseling is needed for each patient
- Providing training to health care workers on offering an HIV test and counseling
so there is a basic and standardized offer of testing to patients
- Patient acceptance of HIV testing is improved by offering the test to all
patients in the appropriate age range, and bundling the HIV test with STI tests
as a general protocol.
- Have a clear notification of test results and return appointment protocol
in place for positive test results
- Have a set ‘go’ date where the expanded testing policy takes
effect for the entire Service Unit
Ensure that patients can be counseled and offered HIV testing in a setting
where other providers or patients cannot overhear the consultation. For
routine testing (not high-risk), more streamlined counseling is supported. As
stated, counseling remains critical given the opportunity or appropriate circumstances
and risk.
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