Selected Questions and Answers
Is domestic violence screening still required?
Yes. Screening for the risk of domestic violence is a required component of post-test counseling. A list of resources available on the NYSDOH website.
Does domestic violence screening need to be mentioned during pre-test counseling as is done currently?
Pre-test counseling offers an opportunity to introduce the issue of domestic violence screening. The new Informed Consent form indicates that if an individual tests positive a counselor or doctor will ask about the risk of domestic violence for each partner to be notified. When and how to raise this issue would be determined by the provider.
For patients who are already in care, must consent be secured before ordering CD4, viral load or resistance tests for treatment purposes?
It is not necessary to secure an additional signed informed consent form for individuals already in care who have consented previously. Part A of the revised consent form may be shared with individuals to assure awareness of the new tests that are now considered to be part of routine HIV testing.
The need to collect risk factor information was a barrier to some in terms of conducting efficient counseling and testing. With the new streamlined approach will risk-factor information no longer be collected?
Risk-factor information continues to be important for effective counseling and for identifying the need for prevention interventions. This information should continue to be collected, either while the individual is awaiting his/her test result, or during post-testing counseling.
Both the Informed Consent form (2556/2556i) and the Release of Medical Information form (2557) permit a "legal representative" to authorize the release of information. Can you describe who is authorized by law to consent for an HIV test for a minor?
In New York State the capacity to consent for an HIV test is determined without regard to age. Informed consent for minors varies, depending upon the minor's situation. A detailed discussion of this issue is available in the Regulations section of the web site.
In general, individuals who may consent for other medical procedures on behalf of a minor may also consent for an HIV test if the minor is unable to do so. More specifically, persons authorized to consent on a minor's behalf include a health care proxy, a parent or guardian. In certain cases a foster care agency, which has been designated by the courts to consent to the health care of a minor, may consent for an HIV test. It is important to remember that, under NYS law, a minor with capacity to understand the significance of an HIV test and its consequences may consent to the test.
Are there specific recommendations regarding frequency of training for staff involved in HIV counseling and testing?
There is no State requirement for initial or ongoing training to conduct HIV counseling and tests. However, agencies may have their own internal training recommendation or requirements. Staff should check with the appropriate person at their agency regarding agency-specific recommendations or requirements.
Staff conducting HIV counseling and testing should routinely review the Statewide Calendar of HIV/AIDS Training for sessions on emerging topics related to counseling and testing. Emerging topics in the field of HIV/AIDS prevention, care and treatment are covered in the training titled, "What's New in HIV/AIDS".
Changes in HIV testing policy or guidance to providers are communicated by NYSDOH through dear colleague letters, by posting information on the DOH website and through DOH sponsored trainings. Agencies should make an effort to ensure that whenever the DOH announces new guidance or policy (as was the case in June 2005) that staff have access to information and training regarding the new developments.
How will private physicians be made aware of these new forms and guidance?
Several approaches have been taken to reach out to physicians. Copies of the new Guidance were mailed to all individuals who participate in New York State's Enhanced Fees for Physicians Program and the information has been posted prominently on the State Health Department website. Training sessions will be available through the Clinical Education Initiative and other AIDS Institute sponsored programs. The Medical Society of the State of New York has highlighted the 2005 Guidance on its website. Future plans include a letter and "Tool Kit" that will be sent out under joint signature of the New York State Department of Health and the Medical Society of the State of New York.
Is there a way to prevent a single patient from signing multiple Release forms in instances where a patient is seeing more than one provider simultaneously?
No. Physicians are advised to have patients that they know to be under the care of more than one physician to complete a HIPAA Compliant Authorization for Release of Medical Information and Confidential HIV Related Information form so that the providers involved in any given patient's care can discuss that patient among and between themselves. This helps to assure that coordinated and comprehensive care is provided.
Why would a physician who is not now conducting in-office laboratory tests seek the appropriate authorizations to be able to conduct HIV testing?
Discussing and offering HIV testing as a routine part of care will help physicians to assure that patients with HIV infection learn their status, are provided timely access to care and treatment and are provided information to prevent the spread of new infections. The advent of rapid HIV testing provides additional options to physicians for collecting specimens and obtaining results. Rapid testing technology makes it easier to incorporate HIV into primary care as rapid tests are accurate, easy to use and can be accompanied by streamlined counseling.
Does the "Release of Confidential Medical Information" form have an expiration date? Is it only applicable for a defined time period?
The form itself requires that dates be specified for the release of the indicated general medical and/or HIV-related information. These dates must be specified in order for the form to be considered to be completed in full and valid.
Can copies of the new forms be ordered in bulk quantities?
The previous version of the HIV Informed Consent form included a statement indicating that hepatitis B and C tests would also be completed; the new form does not include similar language. Is there a separate consent form required for hepatitis testing?
No. There is no consent form required for hepatitis testing.