There are significant public health and clinical benefits when an individual learns of his/her HIV infection status as soon as possible. In April of 2009, the New York State Department of Health:
- clarified that public health regulations allow for the release of preliminary positive HIV test results;
- outlined settings and specific circumstances where release of a preliminary positive HIV test result may be warranted; and,
- provided guidance regarding counseling in cases where a preliminary positive HIV testing results is released to a patient.
What are the benefits of reporting a preliminary positive result for a standard HIV test?
Standard HIV testing typically involves use of a highly sensitive screening test such as the ELISA test. Sensitive screening test are effective at identifying all possible cases of HIV infection but will also include a very small number of false positive tests. In order to rule out a false positive test result, a highly specific confirmatory test called the Western Blot test is performed. However, since it takes time to perform the confirmatory test, there is typically a delay in providing the confirmed test result to the patient.
There are many circumstances when even a short delay in learning a test result can have serious implications. Some of these circumstances include:
- A hospital inpatient will be discharged before completion of the confirmatory test result;
- An inmate will be released from jail or prison prior to completion of the confirmatory test result;
- It is likely to be difficult to reach the patient for follow-up;
- An individual was involved in an occupational exposure and the test result will have implications for initiation of prophylaxis;
- The patient has travel or other plans that will make it difficult or impossible to get the test result in a timely manner; and,
- A person newly infected with HIV, is likely to have a very high viral load and continues to engage in high risk sexual or substance using practices.
Learning a preliminary positive test result in these cases can play an important role in limiting subsequent transmission. Provision of preliminary positive test results can be an important step in clinical and public health practice to ensure that individuals do not miss opportunities to learn of their potential HIV infection status as early as possible and take steps to avoid passing the virus to others.
Are there other circumstances where a patient might receive an HIV test result that is preliminary positive?
In New York State providers already share preliminary positive test results with patients in two specific situations. With the advent of rapid HIV testing, providers across the state have been giving preliminary positive test results to patients. If a patient tests positive on a rapid HIV test, he or she is told that additional testing is needed to confirm the result and arrangements are made for confirmatory testing. In addition, since 1999, it has been standard practice to share preliminary positive test results in the labor and delivery setting. This practice has played an important role in reducing the rate of maternal-child transmission and allowing for the early initiation of treatment to prevent mother-child transmission.
Are there any circumstances where a preliminary positive test result can not be reported?
State regulation prohibits giving preliminary positive HIV test results to blood, organ or tissue donors. It also prohibits giving preliminary positive HIV test results to the next of kin of a deceased person. In these cases, the test result can only be provided upon completion of the confirmatory test.
What must a provider do to obtain preliminary positive HIV test results for standard HIV tests?
A facility or provider may request reporting of preliminary positive HIV test results on a case by case basis or by establishing standing orders for release of preliminary positive test results. Providers who would like to request preliminary positive test results should contact the laboratory directly to discuss the process and requirements for obtaining these results. Each laboratory is required to establish written policies and procedures for the provision of preliminary positive HIV antibody screening tests. These policies must address:
- storage and retrieval of written authorization to release preliminary positive test results,
- how laboratory staff will be trained to ensure release of results in accordance with the limits of public health law and,
- quality improvement activities to ensure timely release of results.
What are the key counseling messages that should be provided when delivering a preliminary positive test result?
When providing a preliminary positive test result, the provider should review the following key points with the patient:
- Explain that the test result is preliminary and that a follow-up test is needed to tell for sure whether the patient has HIV;
- Inform the patient when the confirmatory result will be available and emphasize the importance of learning the final result;
- Explain that if infected, the patient could pass HIV to his/her sexual or needle sharing partners;
- Emphasize the importance of avoiding behaviors that could pass the virus to others;
- Conduct a risk assessment to gain a better understand of the likelihood that the test result is a true positive; and,
- Based on the results of the risk assessment, help the client understand the likelihood that the preliminary positive test result is a true positive;
- If the patient has a history of high risk behaviors or if acute infection is suspected, consider contacting Partner Services and initiating a referral to an HIV specialist for care.