Clinical Information HIV Testing and 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. The IHS HIV Program recommends facilities consider methods that will improve offering HIV testing to men.
- 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 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
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 CDC website has a section devoted to State HIV Laws, including HIV testing consent and counseling requirements and laboratory reporting laws. HIV Laws and policy change frequently, so please consult your state government sites for the most recent information. with regard to 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.
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 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.