Changes to HIV Testing Policy Aimed at Increased Awareness
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An amendment to Pennsylvania’s Confidentiality of HIV-Related Information Act, which took effect in September, advocates routine voluntary HIV screening as a normal part of medical practice for all people 13 – 64 years old, including pregnant women.
“Prior to Act 59, HIV screening required specific informed written consent from the patient and pre- and post-test counseling regardless of the result,” says Peg McKeon, director of Risk Management at Crozer-Chester Medical Center. “This was burdensome for both the patient and physician’s practice and created a barrier to testing. With the recent amendment, HIV screening becomes part of routine blood testing. The hope is that this will de-stigmatize and streamline the process involved in initial HIV testing so that it is more accepted by patients.”
With Act 59, there are three major changes of which healthcare providers must be aware.
- Pre-test counseling is no longer required. The pre-test 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.
- Informed documented consent replaces informed written consent. 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.” There is no requirement for a separate informed consent form. Rather, the provision of information about the HIV test, the consent or the “opt out” must be documented. This can be as simple as a note in the chart. CKHS consent forms have been updated for practitioners to include a section on documented consent for HIV testing.
- Negative test results no longer need to be given in person – with Act 59, in-person notification of negative HIV results is no longer necessary. However, positive results must still be given in person, if possible, and should include referral to an infectious disease specialist and other support based upon the patient’s needs.
McKeon emphasizes that the changes to the consent requirement for initial HIV testing laws do not apply to “source patient” testing in cases of accidental exposures. In those cases, the patient's permission for testing still needs to be requested.
“The hope is that these changes will promote early detection, education and treatment of HIV, with the ultimate goal being a reduction in the number of people who are unaware that they have HIV,” McKeon says.
Since 2010, Crozer-Chester Medical Center’s Emergency Department has offered free, optional HIV testing to all patients.
Patients are eligible for free testing if they are between the ages of 13 and 64 and are seeking emergency treatment, regardless of the medical reason. It is a simple saliva test and results are available within 20 minutes. Testing is voluntary and declining testing does not affect a patient’s rights or medical care. If a patient tests positive, a blood test is sent out for verification. Getting the results back takes approximately one week.