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HIV Testing in the Oral Health Care Setting 

Posted October 2015
 

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. For more information, see HIV Testing in the Dental Chair: Technical Assistance Manual and HIV Testing in the Dental Chair Algorithm. Additional resources are listed in Appendix A.

 

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.1 In 2010, the Amended HIV Testing Law2 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 2012.3 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,4 highlighting the dental setting as a key opportunity for routine HIV testing.
 

RECOMMENDATIONS:
Oral health care settings that can support an HIV testing program should offer testing to all dental patients. Diagnostic HIV tests must be performed in full compliance with the New York State Public Health Law; written consent is no longer required for HIV testing under most circumstances.

When oral health care settings provide testing, providers must:

Whenever there is a reactive result on an HIV screening test, the oral health care provider or a representative must:

  • Explain the result to the patient, including the requirements for follow-up diagnostic testing and consultation with an HIV provider (see Testing Toolkit: Resources to Support Routine HIV Testing for Adults and Teens)
  • Immediately collect a blood specimen (i.e., finger stick or venipuncture) for follow-up diagnostic testing
  • Schedule an appointment for follow-up HIV medical care for the patient (see the NYSDOH HIV Patient Resources Directory for an interactive map of HIV care providers in New York State)
  • Ensure that the diagnostic test results are forwarded to the medical facility where the appointment has been made

Oral health care providers should develop referral agreements for timely appointments with medical providers who have experience with HIV treatment, management, and counseling.

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. For more information about implementing routine HIV testing in the oral health setting, see HIV Testing in the Dental Chair: Technical Assistance Manual.

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.5 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 HIV Uninsured Programs.

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 in Appendix A.

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 www.health.ny.gov/diseases/aids/providers/testing.

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REFERENCES

1. New York State Department of Health. HIV Testing: Public Health Law 2014 Amendments. Available at: www.health.ny.gov/diseases/aids/providers/testing

2. 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

3. 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

4. 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]

5. 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. Available at: www.nynjaetc.org/Testing.html

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APPENDIX A. ONLINE RESOURCES

HIV Testing Resources

Provider Directories

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.
  • NYSDOH AIDS Institute’s Oral Health Regional Resource Center (NY/NJ AIDS Education & Training Center)
    Telephone: 315-477-8479
    www.nynjaetc.org/oralhealthprogram.html and
    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.
    www.health.ny.gov/diseases/aids/providers/training/nonclinical.htm
  • HIV Clinical Resource
    Provides recommendations for the management of patients with HIV, quality of care information, clinical educational materials, and resource materials.
    www.hivguidelines.org

Patient Materials for Providers

Online Resources for Patients

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