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HIV Testing and Counseling

 

Department:     Harborview Medical Center

Policy Number:   80.11

Effective:     June 20, 1999

 

  • Inpatient HIV testing Procedures [click link]
  • Outpatient HIV testing - continue below

Summary of Updates 2007 [pdf]

POLICY:   All patients seen at HMC inpatient and outpatient settings should be evaluated, when feasible, for HIV risk. Patients may decline counseling and still be tested. Explicit verbal or written consent for HIV testing must be documented in the medical record.

 

TESTING PROCEDURES

 

  1. Pregnant women: All pregnant women should be made aware that HIV testing is routinely provided unless they request not to be tested. See Appendix B for HIV Counseling Standards for Pregnant Women.
  2. All other patients:
    Briefly evaluate, where feasible, all patients for behavioral and clinical risk factors:
    • Men who have sex with men - ever
    • Injection drug use – ever
    • Sex with injection drug user – ever
    • Immigrated from country with high rates of HIV infection
    • Recently treated for STD, hepatitis or tuberculosis
    • TB, acute retroviral syndrome (fever, fatigue, pharyngitis, lymphadenopathy) or opportunistic illnesses (esophageal candidiasis, kaposi’s sarcoma, Pneumocystis)
    • Fever or illness of unknown cause
  3. Offer information and an opportunity to ask questions (previously tested patients may decline information). See Appendix A for printed informational handout. Information should include:
    • Benefits of knowing HIV status Potential dangers of HIV disease
    • How HIV is transmitted and how to protect against transmission
    • What the results mean and the importance of receiving results.
    • The difference between and the availability of anonymous and confidential testing.
  4. Offer risk reduction counseling or a referral to counseling to those patients at increased risk for HIV or those who request counseling. Patients who decline counseling may still be tested. Patients who are referred for counseling can be tested pending their counseling session.

    A. Patients can be referred to the STD Clinic in HMC for test counseling.

    B. Counseling should be based on the patient’s unique risk factors, circumstances and ability/readiness to change. The goal is to identify ways to reduce HIV risk.

  5. Obtain informed consent explicit for HIV.

    A.   Verbal consent must be documented in the medical record, e.g. “Patient given required information and consented to HIV test. Patient has had an opportunity to ask questions and had them answered to their satisfaction.”

    B.    Form UH2224 “Special Consent for Medical Care” may be used when written consent is preferred, such as when using substitute decision makers or when there is concern that a patient may not recall giving consent.

  6. Confirm plan for patients to learn their test results.
    • Ideally, patients should learn test results from the same person who provided the initial screening and information, especially if the result is a confirmed positive.
    • Ideally, patients should receive their results in person. However, both non-reactive and confirmed positive results may be given by phone.
    • When giving results by phone, it is important to verify the patients’ identity by asking them to provide personal information such as birth date, date of test, provider name or other.
    • When giving results in person or by phone ensure confidentiality by noting who else is in the room and asking the patient if it is alright to discuss test results at this time.
    • When giving results, be cognizant of the psychological impact of the results, both positive and non-reactive, and to ensure that patients have a plan to access adequate support and information.
    • All patients should be offered risk reduction counseling or a referral to counseling at the time the results are disclosed.

VII. Ensure notification and follow-up for patients testing HIV positive

    • Ideally, positive results should be given in person.
    • Provide or arrange for at least one in-person counseling session consistent with section III. Counseling (above). Post-test counseling for patients testing positive can be arranged through Public Health’s One-on-One program. Call the HIV/STD Hotline at 205-7837 to schedule.
    • If the patient does not plan to return to HMC, results may be given by phone after verifying the patient’s identity.
    • Inform the individual that their identity will be confidentially reported to the local health department.
    • Inform the individual that the local health department may contact them to ensure that their partners are notified.

VIII. HIV+ Patients Who Fail to Obtain Test Results

A. Information about HIV+ patients who are lost to follow-up before learning of their results should be sent to the HMC HIV Test Counseling Coordinator at 744-3809.

SOURCE PATIENT TESTING FOR OCCUPATIONAL EXPOSURES

A. For counseling and testing of occupationally exposed HMC employees and source patients, contact Employee health service at HMC, Extension 3081.

1. Source patient testing records are maintained separately by Employee Health and source patients are not billed for this test.

B. Occupationally exposed non-HMC health care workers, police and fire fighters must first contact their employer to determine:

1. The employer’s policies and procedures for soliciting testing of source patients.

2. These individuals may also contact Public Health Disease Intervention Specialist at 744-4277 for advice and assistance.

3. The company’s policies and procedures for providing follow-up for the exposed worker.

C. If no internal policy exists, the company and/or the employee can contact the HIV/AIDS Program at Public Health – Seattle & King County at 206-205-7192.

1. Good Samaritans can contact the HIV/AIDS program at Public Health – Seattle & King County at 206-205-7192.

2. Employee Health counsels occupationally exposed health care workers at Harborview.

RAPID HIV TEST CONSIDERATIONS

D. Rapid testing is available and appropriate for:

1. When results will change management of acute illness
2. Patient is unlikely to be found for follow-up.

E. Persons testing reactive on the Rapid HIV test may be informed of the result provided it is interpreted as preliminarily reactive and the patient is told that:

1. Further testing is necessary to confirm the result

    a. Inpatients – send confirmatory test
    b. Clinic or ED – refer to Madison Clinic for confirmatory testing: 744-5100

2. The meaning of reactive screening test result is explained in simple terms, avoiding technical jargon.

3. The importance of confirmatory testing is emphasized and a return visit for confirmatory test results is scheduled; and

4. The importance of taking precautions to prevent transmitting infection to others while awaiting results of confirmatory testing is stressed. 

Click on links to view appendices:

APPENDIX A

APPENDIX B

APPENDIX C

 

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