New HIV Testing Requirements What Physicians Need to Know

Rules Changes  North Carolina law requires that, except under certain circumstances, patients must consent to be tested for HIV infection.  UNC Health Care System has required a written consent from patients for HIV tests. The HIV testing rules have been revised and, as a result, after January 1, 2008, a separate written consent for HIV testing will not be required. Our General Consent for Treatment contains a consent for routine laboratory testing that encompasses HIV testing.

Rules Changes  NOTE: Patients must still be notified in advance that the test will be performed and, with exceptions below, patients must still consent to the testing. This notification and consent may be done orally, but the physician must document in the patient’s medical record.  Pre-test counseling is no longer required for HIV testing.

Consent for Testing  Except as discussed below, a patient may refuse HIV testing. If necessary to protect public health, the physician of a patient who refuses may notify the local health director of the potential risk. The local health director may require testing. If necessary to protect public health, the physician of a patient who refuses may notify the local health director of the potential risk. The local health director may require testing. An unemancipated minor may be tested for HIV infection without the consent of the parent/guardian when An unemancipated minor may be tested for HIV infection without the consent of the parent/guardian when the parent/guardian has refused to consent andthe parent/guardian has refused to consent and there is reasonable suspicion that the minor has AIDS or HIV infection or that the minor has been sexually abused.there is reasonable suspicion that the minor has AIDS or HIV infection or that the minor has been sexually abused.

Pregnant Women Physicians must offer every pregnant woman HIV testing at her first prenatal visit and in the third trimester and the physician will test the pregnant woman at those times unless she refuses to consent. Physicians must offer every pregnant woman HIV testing at her first prenatal visit and in the third trimester and the physician will test the pregnant woman at those times unless she refuses to consent. When a pregnant woman presents to Labor and Delivery: if there is no record of an HIV test result during the current pregnancy, the physician When a pregnant woman presents to Labor and Delivery: if there is no record of an HIV test result during the current pregnancy, the physician notifies the woman that an HIV test will be performednotifies the woman that an HIV test will be performed explains the reasons for testingexplains the reasons for testing tests the woman without consent using a rapid HIV test unless it appears that the test cannot be performed without endangering the safety of the pregnant woman or the person administering the test.tests the woman without consent using a rapid HIV test unless it appears that the test cannot be performed without endangering the safety of the pregnant woman or the person administering the test.

Pregnant Women If the pregnant woman cannot be tested, an existing specimen, if one exists that was collected within the last 24 hours, will be tested using a rapid HIV test. If the pregnant woman cannot be tested, an existing specimen, if one exists that was collected within the last 24 hours, will be tested using a rapid HIV test. If the woman cannot be tested for HIV at Labor and Delivery and has no HIV test result during this pregnancy, the newborn will be tested for HIV without consent of the mother. A newborn born in the 12 hours prior to the drawing of the blood for the HIV test will be tested using a rapid HIV test. If the woman cannot be tested for HIV at Labor and Delivery and has no HIV test result during this pregnancy, the newborn will be tested for HIV without consent of the mother. A newborn born in the 12 hours prior to the drawing of the blood for the HIV test will be tested using a rapid HIV test.

Other Exposures  When a needlestick injury or other exposure to blood or body fluids occurs that would pose a significant risk of HIV transmission if the source were infected: If the source is known, the physician of the exposed person notifies the physician of the source that an exposure has occurred. If the source is known, the physician of the exposed person notifies the physician of the source that an exposure has occurred. The physician for the source discusses the exposure with the source and, unless the source is already known to be infected, tests the source for HIV infection without consent, unless it appears that the test cannot be performed without endangering the safety of the source or the person administering the test. The physician for the source discusses the exposure with the source and, unless the source is already known to be infected, tests the source for HIV infection without consent, unless it appears that the test cannot be performed without endangering the safety of the source or the person administering the test. If the source cannot be tested, an existing specimen, if one exists, will be tested. The physician of the exposed person will be notified of the infection status of the source. If the source cannot be tested, an existing specimen, if one exists, will be tested. The physician of the exposed person will be notified of the infection status of the source.

Other Exposures The physician of the exposed person will notify the exposed person about the infection status of the source and will offer testing for HIV infection as soon as possible after exposure and at reasonable intervals for the next year to determine whether transmission occurred. If the source was infected with HIV, the physician of the exposed person will give the exposed person the required control measures, and will instruct the exposed person regarding the necessity for protecting confidentiality. The physician of the exposed person will notify the exposed person about the infection status of the source and will offer testing for HIV infection as soon as possible after exposure and at reasonable intervals for the next year to determine whether transmission occurred. If the source was infected with HIV, the physician of the exposed person will give the exposed person the required control measures, and will instruct the exposed person regarding the necessity for protecting confidentiality. If the source is unknown, the physician of the exposed person will notify the exposed person of the risk of transmission and offer testing for HIV infection as soon as possible after exposure and at reasonable intervals for the next year to determine whether transmission occurred. If the source is unknown, the physician of the exposed person will notify the exposed person of the risk of transmission and offer testing for HIV infection as soon as possible after exposure and at reasonable intervals for the next year to determine whether transmission occurred. UNC HCS may release the name of the physician of the source upon request of the physician of the exposed person. UNC HCS may release the name of the physician of the source upon request of the physician of the exposed person.

Post-Test Counseling  State law requires that a patient be given post-test counseling if the patient is infected with HIV.  Post-test counseling must be documented in the patient's chart.  Post-test counseling is not required for patients who test HIV negative.