Written consent for HIV testing

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 Guidance

• 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

State laws

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 University of California, San Francisco offers a website to compare State laws. This site is very helpful; however please additionally contact each State individually for the most current information. Laws and policy change frequently with regard to HIV testing.

Counseling requirements for 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.

IHS Guidance

• 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 ‘go’ 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.