Delivering Results

What happens once you have the test results?

Once the test has been administered, patients will need to be informed of their results and, if necessary, linked to follow-up treatment and care. On the following pages, we list basic steps that take place when a patient has a negative test result or a preliminary positive test result. Consult Staffing and Operational Flow to help you identify who will disclose results and where.

When a Test Is Negative

• Patients may be given their result and informed that no further testing is required at that time.
• Patients should be advised that if they are at high risk for HIV, they should have an HIV test at least once a year. Patients likely to be at high risk include injection-drug users and their sex partners, persons who exchange sex for money or drugs, sex partners of HIV-infected persons, men who have sex with men (MSM), and heterosexual persons who themselves or whose sex partners have had more than one sex partner since their most recent HIV test. At the time the negative test result is given, providers may decide to provide or refer patients to intensive prevention counseling.
• Advise patients that if they suspect they have been exposed to HIV in the past three months, it may be too soon to detect it. Providers should refer patients to their primary care provider or a community-based testing site for retesting in three months.

When a Test Is Reactive

When a Test is Reactive (Preliminary Positive)

1. Disclosure: Preliminary positive results should be communicated confidentially in person by a clinician, nurse, mid-level practitioner, counselor, or other skilled and previously trained staff. When disclosing results in the ED, patients should be in a private area. Because of the risk of stigma and discrimination, family or friends should not be used as interpreters to disclose HIV-positive test results to patients with limited English proficiency. Providers should have easy access to HIV counselors or mental health providers for support in counseling patients.
   
   
2. Follow-up appointment: Patients should be able to set an appointment time with the infectious disease clinic or HIV clinic at the time their results are disclosed. See Linking to Care for more information on how the ED can facilitate this process.
   
   
3. Confirmatory test: Patients should be advised that a second test will be performed to confirm their positive HIV test result. Patients should be told how they will be informed about the results of this confirmatory test (e.g., at their first follow-up appointment, via telephone, or some other way).
   
   

   Standard practice and working relationships in your area will determine whether specimens will be sent to the public health laboratory or the hospital laboratory for confirmatory testing. Protocol should establish that specimens are flagged so the lab will know that a positive rapid HIV test result has already been received.

   Laboratories are encouraged to progress directly to the Western Blot or IFA to confirm a rapid test result. If confirmatory testing yields negative or indeterminate results, follow-up testing should be performed on a blood specimen collected four weeks after the initial reactive rapid test result.

   If the patient receives their test result in the ED, the confirmatory test specimen could be drawn before the patient leaves and the results sent to the referral clinic. The patient will require blood draws for CD4 counts and viral loads to determine their stage of illness. This lab work may be ordered at that time, or it may take place at the initial follow-up appointment.
   

4. Surveillance and reporting: If the Western Blot or IFA test results confirm HIV infection, the facility must follow all applicable local and state requirements regarding the reporting of HIV infection or AIDS. If personnel are uncertain about the HIV/AIDS reporting requirements in their area, they should contact their state health department HIV/AIDS surveillance unit.

Providers should be aware that the Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits use or disclosure of a patient's health information, including HIV status, without the patient's permission.  Some states may have laws or regulations regarding the disclosure if a patient's HIV status.  Consult with your health department for more information.

Resources

• Off-Hours Pack: (from the University Hospital in Cincinnati's HIV Early Intervention Program) 
  • Clinical lab requisition
  • Informed consent to test for HIV form
  • Early intervention program questionnaire
  • Nurse/physician off-hour instruction sheet
  • Take-home packet:
    • Informed consent to test for HIV form
    • Early intervention program overview on HIV
    • Emergency phone number for the program on a card
    • Male and female condoms, dental dam, and instructions
    • Pocket guide of HIV testing sites in the region
    • Pamphlets on STDs and HIV
• Doctor's Preliminary Positive Procedures Pack (from Highland General Hospital)
  • Flow chart instructions for a preliminary postive test
  • Patient intake form for preliminary positive patients
  • Preliminary positive HIV test overview sheet in English and Spanish for patients
  • Lab order for initial rapid HIV test
  • Appointment card for patient
• ED Nurse's Preliminary Positive Procedures Pack (from Highland General Hospital)
  • Flow chart instructions for a preliminary positive test
  • Specimen bag A for confirmatory HIV test with instructions
    • Lab order form
    • Note to lab staff on sending instructions
  • Specimen bag B for additional HIV labs
• Policy and Procedure Mini-Manual (PDF)
  New York City Health and Hospitals Corporation
• Result Reporting Procedures (PDF)
  New Jersey Rapid HIV Testing Support Program
• Preliminary Positive Result Form (PDF)
  New Jersey Rapid HIV Testing Support Program
• Preliminary Positive Follow-Up Procedures (PDF)
  New Jersey Rapid HIV Testing Support Program
• Script for Negative HIV Test Result (DOC) 
  Highland General Hospital
• Qraquick Rapid HIV 1&2 Antibody Test and Western Blot Lab Order Form (DOC) 
  University of Medicine & Dentistry of New Jersey
• Social Work Procedures for HIV Positive Test Results in the ED (PDF) 
  Denver Health Medical Center
• Protocols for Confirmation of Reactive Rapid HIV Tests
  Morbidity and Mortality Weekly Report