Sexually Transmitted Infections (STI) in Adolescents — Consent for HIV Testing, Communicating Test Results — Clinical Pathway: Emergency and Primary Care

Sexually Transmitted Infections (STI) in Adolescents Clinical Pathway — Emergency Department and Primary Care

Consent for HIV Testing, Communicating Test Results

Consent Guidance for HIV

Providers should be familiar with their state and local consent and confidentiality laws. Written consent for HIV testing is not required in PA. Guidance below is specific to PA.

  • Explanation of test, including its purpose, limitations and meaning of its results
  • Obtain verbal consent of the patient/personal representative
  • Confirm consent in the Epic HIV test order
  • Provide information for HIV prevention, including condoms, pre-exposure prophylaxis (PrEP), abstinence

Limited Exceptions

In the case of medical emergencies, when the patient/personal representative is unable to grant/withhold consent and the test is medically necessary for diagnostic purpose to provide appropriate emergency care to the patient, the Pretest Counseling and Consent provisions need not be followed

Note

  • A competent minor, regardless of age, is permitted under PA law to consent to HIV testing and/or treatment.
  • This is documented in EPIC when you order the test automatically.
  • Parental consent is not required.

Sharing Test Result and Post-test Counseling

The clinician (or designee) who ordered the test informs the patient about the test results.

HIV Negative Test
  • Provide results to the individual who consented to the testing immediately.
  • Adolescents have the right to receive the results confidentially.
  • Counsel teens who have ongoing risk for infection about prevention measures condom use and pre-exposure prophylaxis (PrEP).
HIV Positive Test
  • Positive HIV test results cannot be delivered by phone. The patient should be instructed to come in to clinic or schedule a telehealth follow-up as soon as possible. Refer patient to Adolescent Initiative for Case Management who should be available to attend the visit. At the visit, provide presumptively positive HIV test results to the individual who consented to the testing.
  • Explain need for immediate follow-up testing and/or treatment.
  • A positive test result may not be revealed w/o affording the individual who consented to the test with the immediate opportunity for individual, face-to-face counseling including:
    • Significance of the test result.
    • Immediate link to care to start antiretroviral therapy, ART.
    • Emphasize many patients on ART live for HIV live long and healthy lives.
    • Measures for preventing HIV transmission including ART, condom use and referring partners for PrEP.

Linking HIV Positive Patients to Care with the CHOP Adolescent Initiative

During Business Hours
  • Call clinic at 215-590-3626. If unable to reach anyone, do not leave a message.
  • If unable to reach staff member using clinic line, call AI social worker at 215-279-4384 or 215-221-4156.
  • If unable to reach social workers, call program manager at 215-764-9425.
After Hours or on Weekend Adolescent Medicine Fellow in Epic On-Call Finder.

Sharing HIV Test Results to ED Patients

HIV Results Available While Patient is in ED HIV Negative
Provider informs patient of test result before discharge
HIV Positive: M-F 8:30 a.m. – 5 p.m.
  • Provider:
    • Contacts Adolescent Initiative (AI)
    • AI SW and/or provider
    • Come to ED to support ED provider in sharing positive HIV test results
    • Helps connect teen to care
HIV Positive: Weekends or After Hours
  • Provider:
    • Contacts ED SW for support sharing positive test results
    • Contacts the Adolescent on-call fellow to connect patient with care
    • ED SW
    • Meet with teen to discuss the results, provide support
    • Tell the patient that AI will call them the next business day
HIV Results Return After a Patient Leaves ED and HIV Test is NEGATIVE ED APP will contact the patient by phone to inform share results
HIV Results Return After a Patient Leaves ED and HIV Test is POSITIVE Patients Without Other Positive STI Testing
  • ED APP:
    • Contact AI
    • Contacts patient to arrange follow up with the Adolescent Initiative
    • Do not disclose HIV diagnosis over the phone
Patients With Other Positive STI Test
  • ED APP:
    • Contacts AI, arranges time that they can come to the ED to see
      the patient
    • Contacts the patient to return to the ED for STI treatment
  • AI SW and/or provider:
    • Comes to the ED to share HIV positive results and connect teen to care.