/ CHHS15/061

Canberra Hospital and Health Services

Clinical Procedure

Blood Borne Virus (BBV) Testing in Adult Patients

Contents

Contents

Introduction

Key Objectives

Section 1 – Consent

Section 2 – Pre-Test Discussion

Section 3 – Results and Post-Test Discussion

Section 4 – Management of HIV False Positive and Indeterminate Results

Implementation

Related Policies, Procedures, Guidelines and Legislation

References

Search Terms

Introduction

The purpose of this document is to provide guidance related to blood borne virus (BBV) (HIV, hepatitis B and C) testing.

This document is applicable to:

  • All Medical Officers at CHHS
  • All nurses and midwives at CHHS who are working within their scope of practice

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Key Objectives

Testing is performed with the patient receiving adequate information and that they fully understand the implications of the test

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Section 1 – Consent

Informed consent has been obtained if all of the following elements have been satisfied:

  • patient is competent to give consent
  • full information on risks, benefits and alternatives has been provided
  • consent is freely given; and
  • consent is specific to the procedure

Where it has been identified that an adult consumer does not have the decision-making capacity to provide consent to treatment or procedures themselves the following substitute decision makers can provide consent:

  • Health Attorney
  • The Attorney, under an Enduring Power of Attorney
  • Guardian, if approved
  • Public Advocate of the ACT if appointed guardian, and the
  • Chief Psychiatrist or Community Care Coordinator (where there are issues relating to mental health or mental dysfunction and the consumer is under a Mental Health Order).

Note:Accredited interpreters must be used as appropriate for people who have English as a second language for consent to be valid

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Section 2 –Pre-Test Discussion

Procedure

Obtain informed consent for testing during pre-test discussion.

Pre-test discussion needs to be tailored to the individual patient and will differ according to their level of knowledge and risk of positivity. At a minimum, the following should be addressed:

  1. Reason for testing
  2. If the patient is unsure about testing, outline the benefits of early diagnosis and risks of delayed diagnosis; explore concerns, discuss alternatives
  3. Approximate date of most recent possible exposure (e.g. sexual contact, shared injecting drug equipment, sharps injury) and clarification of window periods
  4. Information on confidentiality and privacy
  5. Contact tracing if positive result
  6. Information about the testing process including:
  7. How results are to be obtained
  8. Indeterminate results
  9. Follow-up testing if patient is within window period
  10. Specific advice on prevention of transmission to others whilst results are pending, and during window periods
  11. For testing in individuals with perceived or actual higher risk of BBV infection, assessment of support mechanisms while waiting for the test result and/or if the result is positive

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Section 3 – Results and Post-Test Discussion

Procedure

Conveying a positive result

  1. Positive results should be provided to the patient as soon as possible
  2. Staff conveying a positive result should consider seeking specialist advice and support prior to giving a positive diagnosis
  3. A positive result should always be provided in person, except in extenuating circumstances eg. the person cannot return for results within a reasonable timeframe
  4. Give the test result in a manner that is appropriate to the gender, culture and language of the person tested by a clinician with sufficient knowledge of the BBV
  5. Provide information and assess support mechanisms relevant to the diagnosis such as referral to local agencies including AIDS ACTion Council of the ACT and ACT Hepatitis Resource Centre
  6. Provide information regarding treatment options
  7. If the patient is pregnant provide information on management of the baby post-delivery
  8. Discuss contact tracing and partner notification (refer to CHHS Sexually Transmitted Infection Assessment and Management Procedure)
  9. Discuss legal obligations relevant to disclosure of the diagnosis
  10. Inform on the transmission of the BBV and how onward transmission may be prevented

It may be necessary to cover these issues over a period of time, in which case a subsequent consultation should be arranged at the time of the initial post-test discussion consultation

Conveying a negative result

  1. Explain the result and determine the need for post window period re-testing according to recent risk behaviours; and
  2. Reinforce reduction of risk-taking behaviours and provide information as appropriate

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Section 4 – Management of HIV False Positive and Indeterminate Results

Procedure

Pre-test discussion

  1. Discuss the possibility of an indeterminate result as part of routine discussion

Laboratory notification of positive or indeterminate HIV results

  1. A medical officer must be informed of all positive or indeterminate HIV results
  2. The patient’s clinical history and result is reviewed by a medical officer and a plan for informing the patient is made

Informing patient of indeterminate results

  1. When possible, indeterminate HIV results should be given to the patient in person
  2. Indeterminate results can cause significant patient distress and anxiety
  • If the patient phones for results, request that the patient attends in person to discuss some of the results
  • If possible, telephone calls to contact a patient about HIV test results should be made in the morning with the option for the patient to attend that day
  1. When the patient attends, explain result verbally and provide written information
  2. Review the history with the patient and assess for a possible exposure to HIV that has not previously been disclosed

Further testing

  1. A medical officer is to arrange for retesting at an appropriate interval according to the most recent possible exposure allowing for window periods. Consider Infectious Diseases or Sexual Health Physician consultation regarding pro-viral DNA and viral load testing
  2. Advise the patient to protect their partners during window periods and avoid blood or tissue donation
  3. Discuss the need for emotional support and offer follow-up appointment and counselling referral if required
  4. Clarify the patients understanding of test results and management

Complete retesting

  1. Review clinical history to exclude further exposures which will require future testing
  2. Review understanding of the long-term false positive and stable indeterminate results
  3. Ask the patient to attend in person to receive any subsequent results
  4. Offer a written letter of explanation of indeterminate results for the patient and their GP

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Implementation

This guideline will be circulated to the following for implementation of all relevant staff:

  • Medical Executive
  • Strategic Executive
  • Nursing Executive

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Related Policies, Procedures, Guidelines and Legislation

Policies

ACT Health, Consent to Treatment Policy

ACT Health, Nursing and Midwifery Continuing Competence Policy

Procedures

ACT Health, Consent to Treatment Procedure

CHHS Sexually Transmitted Infection Assessment and Management Procedure

Guidelines

2011 National HIV Testing Policy, Commonwealth of Australia

Further information on testing

Legislation

Public Health Act 1997

Health Act 1993

Human Rights Act 2004Back to Table of Contents

References

Australasian Society of HIV Medicine (ASHM), 2014. ASHM Testing Portal. Accessed August 2014 from

Commonwealth of Australia, 2011. National HIV Testing Policy v1.1. Accessed September 2012 from

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Search Terms

HIVHIV-Infected PatientsHIV Seropositvity

HIV SeronegativityHIV-AIDS NursingHIV-AIDS

HIV InfectionsHIV EducationHIV 1

HIV Rapid TestingELISAHIV Indeterminate

Proviral DNAHepatitis Hepatitis B

Hepatitis C

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Disclaimer: This document has been developed by Health Directorate, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS15/061 / 1 / 10/03/2015 / 19/02/2020 / Medicine - CSHC / 1 of 6
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register