Conveying HIV Test Results
The process of conveying an HIV test result to the person who has been tested, irrespective of the specific result, is affected by the type of test performed, the setting of the consultation and testing, and the extent, if any, of additional testing required to determine the person’s true HIV status. Examples are provided for reference in Appendixes A and B. The site director and the person who requests the test are responsible for ensuring that appropriate mechanisms are in place for delivering the test result.
Community perceptions of HIV have changed over time as has the way people give and receive information. Nevertheless, even for those familiar with HIV, a positive diagnosis of a lifelong condition is a significant psychosocial event, in which some people display symptoms consistent with post-traumatic stress disorder (PTSD).26,27,28 For people visiting Australia and potentially returning to regions with poor access to treatment, a positive result may understandably be received as a traumatic and life-threatening diagnosis. Aboriginal and Torres Strait Islander people and those from culturally and linguistically diverse backgrounds may experience heightened difficulty in adjustment and linkage to services. [29,30,31,32]These populations continue to climb as a proportion of those diagnosed in Australia.15
Preferably a positive HIV test result should be given in person. However, current practice includes the provision of test results over the phone, by email or phone text message (SMS), or via apps such as Facetime, when it is considered appropriate. It is important for those performing the test to use professional judgment in deciding how results will be delivered. The decision should be based on the understanding of the person being tested. Counselling may be required by some individuals and should be offered to all receiving a positive diagnosis. Counselling should preferably be undertaken by doctors or nurses experienced in this area, or a trained allied health professional e.g. psychologist, social worker or counsellor. The National Standards for Psychological Support for Adults with HIV may be used as a guide.[viii] Operational guidance on conveying positive HIV test results, negative HIV test result, and a decision-making flow chart, are provided for reference in Appendixes B, C and D. Arrangements can be made between services that are not experienced in delivering HIV positive results (e.g. Emergency Departments) and sexual health services so that the sexual health service provides the result to the newly diagnosed person; this facilitates testing within inexperienced services.
Contact tracing and partner notification
It is the responsibility of the person conveying a positive HIV test result to ensure that the patient is aware of the legal obligations relevant to their jurisdiction and of the need for former partners to be advised that they may have been at risk of exposure to HIV.
Those conveying positive results are referred to the Australasian Contact Tracing Guidelines and state and territory policies on contact tracing. Practical assistance can be provided to the health-care provider and patients by ASHM, the local public health unit or sexual health clinics. The details of the source patient must be treated confidentially, and the contact must not be provided with the source patient’s name or details. It can be helpful for facilities performing contact tracing to create an information wall between the person who gets information from the source patient and the person speaking to the contact. Site-specific approaches to contact tracing should be included in standard operating procedures of facilities conducting HIV testing.
Confidentiality of HIV test results and testing data
Currently, pathology test results identified as sensitive are not sent to the Australian MyHealthRecord. Such tests include HIV tests and tests used to manage HIV infection (e.g. viral load, drug resistance); STIs; genomics tests; pregnancy-related tests in minors (under 16 years of age) drug and alcohol tests; ABO blood-typing paternity group; MCS (genital) tests and autopsy test results. HIV results from a pathology laboratory will only be released to the requesting medical practitioner or to the clinical service team responsible for the patient’s care and management. Confirmed HIV-positive results are also notified to the relevant jurisdictional health authority for the purpose of public health disease notification. However, some information that may be perceived as surrogate information about an individual’s serostatus, such as pharmacy prescriptions, may be transmitted to MyHealthRecord. Subject to the arrangement between the site and the reference laboratory, patient information may be shared between a specialist HIV physician, an s100 prescribing clinician or a sexual health service for the purpose of ensuring that a patient is informed of their test result. Part of the informed consent process should involve an explanation of how a patient can expect to receive their result.
Services are responsible for the security of HIV testing data and should develop mechanisms to restrict access to HIV pathology information in the same manner that other health information is protected. For example, there must be a security hierarchy within the information systems to restrict access to this information to those individuals directly involved with the care of the patient, noting that, with electronic medical record (EMR) systems it is not possible to restrict access to health information to those individuals directly involved with the treatment and care of an individual. This access is therefore managed by local codes of conduct, privacy and health record confidentiality legislation, and having EMR systems that include an audit trail, whereby a record is kept of every instance of access to a medical record, who accessed the record and the date and time of access.
It is reasonable to expect that pathology test results are available on a patient’s record and that all staff with a legitimate clinical reason have access to the patient’s HIV test information, including the range of non-HIV-related service staff who may be involved in the patient’s health care.
Any person involved in HIV testing must not disclose any personal or medical information about a patient to any other person, in accordance with privacy provisions.
Assistance to doctors new to diagnosing HIV
Some jurisdictions and ASHM provide assistance to doctors who are unfamiliar with diagnosing HIV. Assistance is most easily facilitated by the laboratory performing the HIV test. Services of this nature support the diagnosing doctor and improve the immediate management of the patient, including initiating contact tracing and assessment for treatment. These services can also facilitate the collection of routine surveillance data, and act to encourage the doctor to support the patient with access to ongoing HIV management; counselling on prevention; support for partner notification; psychosocial assessment and support; and linkage to other services.
Acknowledgement of Country