HIV Testing in Health Care Settings- Amendment to Pennsylvania’s Confidentiality of HIV-Related Information Act (Act 148) - Crozer-Keystone Health System - PA

Published on November 14, 2011

HIV Testing in Healthcare Settings -

Amendment to Pennsylvania’s Confidentiality of HIV-Related Information Act (Act 148)

OBJECTIVE: The learner will be able to identify the changes in HIV consent process under Pennsylvania’s ACT 59 and the rationale behind those changes.

As of September 6, 2011, Act 59, an amendment to Pennsylvania’s Confidentiality of HIV-Related Information Act (commonly known as Act 148) took effect. The legislation promotes early detection, education and treatment of HIV. The law is aimed at reducing barriers to HIV testing in the Healthcare setting.

The provisions of Act 59 align Pennsylvania’s HIV law with the 2006 Center for Disease Control and Prevention (CDC) Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Healthcare Settings. Those CDC recommendations advocated routine voluntary HIV screening as a normal part of medical practice for all people 13 to 64 years old, including pregnant women. This general screening is similar to screening for other treatable conditions. The ultimate goal being to reduce the number of persons who are not aware they are HIV positive.

The PA DOH advisory #0208-2011 specifically recognized that often, persons with HIV infection visit health settings years before receiving a diagnosis, but are not tested for HIV. This Advisory reports that since the 1980’s, the demographics of the HIV/AIDS epidemic in the US has changed; and as a result, the effectiveness of using risk based testing to identify HIV infected persons has diminished. Increasing proportions of infected persons are less than 20 years old, are women, are members of ethnic and racial minority populations, are persons who reside outside of metropolitan areas and are heterosexual men and women who are frequently unaware they are at risk for HIV.

Prior to Act 59, HIV testing required specific informed written consent of the patient, and both pre and post test counseling, whether or not there was a positive result. Compliance with this requirement created a strain on the physician’s practice resources as well as adding burdensome procedural steps for both the physician and patient.

The basic premise of Act 59 is that HIV testing should be routinely offered to increase number of people tested. Routine testing de-stigmatizes the test. The belief is that more patients accept HIV testing when it is offered to everyone. People may not perceive themselves to be at risk or do not disclose risky behavior to their providers, so this population will accept screening when it is a routine test versus risk assessment testing.

What Act 59 means to your practice:

There are three major changes that physicians need to be aware of and adjust their internal processes to comply with the new legislation. This is one time that the requirements are actually designed to decrease documentation and demands on the physician’s time. 

1.   Informed written consent has been replaced by informed documented consent of the subject, as a requirement for the performance of an HIV test. This informed consent can be oral or written. 

Now, it is only required that a healthcare provider document the provision of informed consent, including the purpose, possible uses, limitations and meaning of the HIV test result, and whether the subject declined the offer of HIV testing or “OPTED OUT”. The new language states that the healthcare provider may offer opt-out HIV testing wherein the subject would be informed that he/she will be tested for HIV unless he/she refuses. There is not a requirement for a consent form, but the discussion and the consent must be documented. This documentation can be as simple as a note in the chart. If the patient chooses to “opt out” of testing, this should be documented also. For those practitioners that use the CKHS HIV consent form for testing, those forms have been updated to comply with this documented consent/opt-out requirement.

2.   Pre-test counseling is no longer required.

However, the pretest information requirement of identifying the potential uses, limitations and the meaning of its results remains. This information can be provided in an information sheet similar to that provided with vaccines.

3.   Negative test results no longer need to be given in person, face to face.

The Pa DOH advisory group noted that post test counseling requirement for HIV negative test results is probably the single largest deterrent to the routine integration of HIV testing in healthcare. Act 59 removes that barrier by removing the requirement for in person notification of negative test results.

However, positive results must still be given in person, if possible, and should include referral to an infectious disease specialist and other support based on your patient’s needs.

While Act 59 tries to streamline, expedite and de-stigmatize the process involved in initial HIV testing, it is silent on frequency of follow up testing, and notably any mandates on funding for the testing. As implementation of ACT 59 is in its infancy, those issues will be hot topics of discussion for all healthcare providers. Further, Act 59 does not change the requirement of obtaining a source patient’s permission in cases of where testing is requested following potential exposure in the workplace.

HIV Testing in Healthcare Settings -Amendment to Pennsylvania’s Confidentiality of HIV-Related Information Act (Act 148) Questions/ Answers

HIV Testing in Healthcare Settings -Amendment to Pennsylvania’s Confidentiality of HIV-Related Information Act (Act 148) Questions/ Answers

 

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