Category: Clinical Services
Subject: HIV Testing and Results
Division: Community Health and Wellness
Policy Number: CA.72.01.402
Effective Date: October 26, 2017
All HIV testing will include pre and post-test counseling as per Ontario Guidelines for HIV Counselling and Testing, March 2008 (or most recent). No test will be done without pre-test counseling. Negative HIV test results can be provided over the phone, however, using nursing judgment, if a client is at high risk for HIV infection, a follow-up appointment may be booked to obtain test results. This can be communicated to the client as the nurse sees fit. If a client’s result returns positive, the nurse will have a discussion with the manager to determine a plan to communicate the diagnosis and complete appropriate follow-up.
Clients will be offered three variations of HIV testing; anonymous, non-nominal or nominal testing.
Anonymous HIV Testing
The name or identity of the person being tested is not requested, recorded or reported. The test is ordered using a code known only to the person being tested. Epidemiological information (i.e., age, sex, risk factor for HIV infection) is collected and reported.
Anonymous HIV testing is permitted in Ontario through an exemption to the Health Protection and Promotion Act (HPPA) Regulation 569, section 5.1. Only organizations designated as anonymous HIV testing sites under the HPPA can provide this service.
Photocopies of anonymous HIV test results are not given to clients. Client information related to anonymous testing is kept in an anonymous chart.
The practitioner orders the test using the person’s name. If the test is positive, the PHL is required to report the result to the local medical officer of health. Copies of the test result are available upon request by the client and must be stamped (stamp indicating that client has received lab results) and signed by the client.
WDGPH offers two formats of HIV tests (dependent on clinic location), both are available for anonymous; non-nominal and nominal testing:
Standard HIV testing is done at the PHL. Blood specimen is obtained by the nurse or client is given a lab requisition to have blood drawn at a local lab. Blood drawn in-house is forwarded to PHL for screen and confirmatory testing. Standard HIV testing is available to clients at all community, office and school clinical sites.
Point of Care (POC) testing is a rapid screening test only, it does not confirm HIV infection. Clients who test indeterminate or reactive will require a blood specimen to be drawn and sent to the PHL for confirmatory testing. However, the HPPA states that if a physician or nurse practitioner forms the opinion that a person is HIV positive, the case becomes reportable to public health. It may be determined that a reactive rapid result combined with information disclosed during counseling is sufficient to consider the client is infected with HIV. If a client who tests reactive or indeterminate declines confirmatory testing (standard non-nominal) HIV testing, the nurse must discuss the case with their manager to determine whether the POC test result should be reported to the Ministry of Health and Long-Term Care. The screening test is available only at designated office clinic sites by certified nurses.
As part of pre-test counselling, clients are informed of the sensitivity rate of point of care POC HIV testing (percentage of results that will be correctly positive) of 99.6%. They may also be informed that the specificity of POC HIV testing (the percentage of results that will be correctly negative) is 99.3%. Regardless of test results, the nurse must ensure that post-test counselling for non-reactive, indeterminate or reactive results as per Ontario Guidelines for HIV Counselling and Testing, March 2008 (or most recent) is provided to all clients.
This policy applies to all WDGPH nurses assigned to Clinical Services and student nurses working in these programs.
Anonymous HIV test – the name or identity of the person being tested is not requested, recorded or reported. The test is ordered using a code known only to the person being testing. Epidemiological information (age, sex, risk factor for HIV infection) is collected and reported.
Non-Nominal HIV test – the practitioner ordering the test knows the name or identity of the person being tested, but orders the test using a code. If the test is positive, the PHL is required to report the result to the local medical officer of health.
Nominal HIV test – The practitioner orders the test using the person’s name. If the test is positive, the PHL is require to report the result to the local medical officer of health.
Standard HIV test – done by the PHL using a two-part test. The first test, a screening test, is very sensitive. Any sample that tests reactive on the screening test is screened a second time. If the second screen is also reactive, then the sample is tested again using a confirmatory test (the Western Blot) that rules out everything except HIV. It takes up to two weeks to receive test results.
Point of care (POC) HIV test – done onsite at the time of testing and includes only a screening test. Results are available within a few minutes. When clients test reactive on the point-of-care test, then standard HIV testing must be ordered from the PHL to confirm the results.
REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES
Corresponding Procedure: N/A
Health Protection and Promotion Act (HPPA) Regulation 569, section 5.1
Ontario Guidelines for HIV Counselling and Testing, March 2008: http://www.ohsutp.ca/uploads/Ontario_HIV_Testing_guidelines.pdf
CONTACT FOR INQUIRIES
Manager, Clinical Services
Director, Community Health and Wellness