Delivering Results: 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.

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