Dental Standards of Care Committee, October 2015
Rationale and Recommendations
Purpose of this guideline: This document provides key recommendations for implementing an HIV testing program in the oral health care setting. A more detailed guide to implementing HIV testing programs in oral health care settings has been developed by the New York State Department of Health AIDS Institute in collaboration with the New York/New Jersey AIDS Education and Training Center (AETC) Oral Health Regional Resource Center and includes an algorithm that can be used as a planning tool. Additional resources are listed below.
Increasing HIV testing in New York State: In April 2014, sections of the New York State Public Health Law relating to HIV testing and confidentiality of HIV reports were amended to increase HIV testing in New York and promote linkage and retention in care for HIV-infected persons . In 2010, the Amended HIV Testing Law  required healthcare providers to offer HIV testing as a routine part of healthcare to all persons aged 13-64 years (and others depending on risk). The 2014 Amended HIV Testing Law streamlines the testing process by no longer requiring written patient consent under most circumstances.
An estimated 12.8% of HIV-infected individuals in the United States were living with undiagnosed HIV infection in 2012 . Routine HIV testing at the point of care is intended to identify more undiagnosed HIV-infected people, provide the benefit of earlier access to treatment, and reduce the risk of HIV transmission. In 2013, 61.7% of adults 18 to 64 years of age visited a dentist , highlighting the dental setting as a key opportunity for routine HIV testing.
Screening patients for HIV infection can be performed in oral health care settings. Factors to consider for implementing an HIV testing program include physical space that affords patient confidentiality, laboratory quality assurance, and staff training.
HIV testing is voluntary. Like all healthcare settings that offer HIV testing, oral health care settings must notify patients prior to testing that an HIV test will be conducted and must document every HIV test in the patient’s dental record. Written consent is no longer required for HIV testing under most circumstances; written informed consent is still required when HIV testing is performed in state and local prisons or jails. The oral health care team can easily perform HIV tests as part of routine care.
If an HIV screening test indicates a reactive result, the test is considered a preliminary positive result. Whenever there is a reactive result on an HIV screening test, regardless of whether it is an oral fluid test or blood test, the oral health care provider, or a representative of the provider, who performed the HIV screening must collect a blood specimen for diagnostic testing and submit the specimen to a certified laboratory for analysis. Finger stick blood specimens should be sent to the Wadsworth Center, NYS Public Health Laboratory, for analysis. For information about the Wadsworth Center, call (518) 474-4177.
Oral health care providers must make an appointment for patients with a preliminary positive result to be seen, preferably within 48 hours, by a medical provider who has experience with HIV treatment . Oral health care providers must ensure that the diagnostic test results are forwarded to the medical facility where the patient has been referred. Patients who express concern about their ability to afford HIV care may obtain information about financial assistance by visiting NYSDOH HIV Uninsured Care Programs Summary.
The New York State Department of Health provides resources to promote HIV testing as part of routine healthcare. One such resource, Testing Toolkit: Resources to Support Routine HIV Testing for Adults and Teens, presents information about the healthcare settings and healthcare professionals who are affected by the law. A broad range of topics is covered, including confidentiality, informed consent, communicating in a language that the patient can understand, key points that patients must be provided before HIV testing is performed, and follow-up for patients with confirmed positive test results. Additional online HIV testing resources are provided below.
Confidentiality laws regarding testing extend to physicians, physician assistants, oral health care providers, nurses, and other healthcare professionals. Oral health care clinics that provide HIV testing are subject to the same requirements as all healthcare settings and personnel who perform HIV testing. HIV testing must be conducted in accordance with applicable New York State public health laws and regulations.
Information about the HIV testing Public Health Law, consent forms, and counseling can be found at NYSDOH HIV Testing.
- New York State Department of Health HIV Testing: Provides a “portal” to all AIDS Institute materials on HIV testing.
- NYSDOH Consent Forms: Written consent is no longer required in New York State before performing HIV testing in most circumstances. If your agency chooses to continue to use written consent, model HIV Consent forms are available in English, Spanish, Haitian, Italian, French, Russian, Korean, and Chinese
- Frequently Asked Questions Regarding New York State’s HIV Testing Law
- HIV Testing
- Dental Resource Directory to Improve Access to Dental Care for People Living with HIV/AIDS: There are many dentists/dental clinics in NYS that provide care for free or at low cost. The Dental Resource Directory is provided to make it easier for people living with HIV/AIDS to find dental clinics in their area and receive dental care.
- Listing of Designated AIDS Care Centers Throughout New York State
- AIDS Institute Voluntary HIV Provider Directory: Provides contact information for HIV care providers licensed to practice medicine in New York State. Providers in this directory are categorized by geographic region, and organized by adult, pediatric, and adolescent patient populations.
HIV Education and Training
- NYSDOH/AIDS Institute’s Clinical Education Initiative (CEI): Offers clinically relevant education and training on HIV, HCV, STIs, PEP, and PrEP. Also available is the CEI Line (866-637-2342), which offers clinicians the opportunity to discuss clinical management issues and guidelines on these topics with experienced clinicians.
- HIV Testing in Dental Clinics: Video Resource
- Non-Clinical Provider Education and Training: Provides education and training on various HIV-related topics to a range of community providers.
Patient Materials for Providers
- Say Yes to the HIV Test. We’re Asking Everyone. It’s the Law
Available in English, Spanish, Chinese, French, Haitian Creole, Korean, Russian, and Vietnamese: Brochure | Poster
- Oral Health and HIV
- Good Oral Health Is Important (in Spanish)
- Oral Health Is Important: A Guide for Caregivers of Children with HIV Infection: English | Spanish
Online Resources for Patients
- Information for Patients Who Test Negative for HIV
- AIDS Institute HIV Patient Resources Directory: Provides a list of organizations funded by the New York State Department of Health AIDS Institute to provide HIV/AIDS services. This directory is arranged by region, with each organization listed under the region it serves and then by the type of service it provides.
- HIV Uninsured Care Programs: These four programs, established by the New York State Department of Health’s AIDS Institute, provide access to free health care (HIV Drugs, Primary Care, Home Care, and APIC) for New York State residents with HIV infection who are uninsured or underinsured.
- New York State Department of Health. HIV Testing: Public Health Law 2014 Amendments. Available at: www.health.ny.gov/diseases/aids/providers/testing
- New York State Department of Health. HIV Testing: Public Health Law: Chapter 308 of the Laws of 2010, HIV Testing Law, Mandated Report, August 2012. Available at: www.health.ny.gov/
diseases/ aids/ regulations
- Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2013. HIV Surveillance Supplemental Report 2015;20(No. 2). Published July 2015. Available at: www.cdc.gov/hiv/library/reports/surveillance
- Strauss SM, Alfano MC, Shelley D, et al. Identifying unaddressed systemic health conditions at dental visits: Patients who visited dental practices but not general health care providers in 2008. Am J Public Health 2012;102:253-255. [PubMed]
- New York State Department of Health AIDS Institute’s Oral Health Regional Resource Center (NY/NJ AETC). HIV testing in the dental chair: Technical assistance manual.