HIV and HCV Testing
In California, the majority of HIV testing takes place in medical care settings, and the majority of new cases of HIV are identified in physician's offices, community clinics and other health care settings. To encourage additional routine testing in health care settings, the California Department of Public Health (CDPH), Office of AIDS (OA) allows HIV prevention funds to be used by funded health departments for routine opt-out HIV testing in medical care settings including hospital emergency departments, community clinics and county jails. The goal of routine, opt-out testing is to identify and link to care those individuals who, for whatever reason, are not aware of their risk for HIV or who do not fall into the at-risk categories for targeted testing.
The California Department of Public Health, Office of AIDS (OA) also funds targeted HIV testing to reach individuals who are at high risk for acquiring HIV but who may not receive HIV testing as part of routine medical care. OA funds local health departments in the jurisdictions with the highest burden of HIV to provide confidential and anonymous rapid HIV testing in a variety of non-healthcare, community-based settings. The goal of these efforts is to identify people who are unaware of their HIV-positive status and link them into either HIV care and treatment services, or HIV prevention services. Some jurisdictions also provide rapid hepatitis C testing and link people with reactive test results to further testing and medical care.
How to find a provider
To find an HIV, HCV or STD test provider in your community go the CDC's Get Tested website.
HIV Test Counselor Training
California Health and Safety Code allows non-medical personnel to conduct rapid HIV and HCV tests provided they are trained through an OA-sponsored training provider. Limited slots are available for the five day Basic Counselor Skills Training. For more information, contact OA.Prevention.Training@cdph.ca.gov.
OraQuick Rapid HIV Testing Guidelines (PDF): This document contains policies, procedures, forms and quality assurance guidelines related to the implementation of rapid HIV testing in California Department of Public Health, Office of AIDS settings.
Hepatitis C Virus Screening in Non-Healthcare Settings
The OraQuick rapid hepatitis C virus (HCV) antibody test is a simple-to-use device that delivers HCV antibody tests results in 20-40 minutes using a single drop of whole blood. California law allows non-medical personnel that have trained as HIV test counselors and meet the specific requirements to perform these tests. This technology enables HIV test counselors to integrate rapid HCV testing into existing HIV rapid testing processes and helps to ensure that more people will receive their test results, along with result-specific counseling and referrals.
HIV Testing in Health Care Settings – California Law
In California, changes to HIV testing law have supported the effort to bring "opt-out" (routine offering with the option to decline to take an HIV test) HIV testing to the state's health care facilities.
As of January 1, 2008, Assembly Bill (AB) 682 (Berg, Chapter 550, Statutes of 2007), added California Health and Safety (H&S) Code Section 120990, which eliminated the requirement for written consent for an HIV test when ordered by a medical care provider.
Medical care providers ordering HIV tests under H&S Code Section 120990(a) are not required to obtain written consent for an HIV test, nor are laboratories processing HIV tests ordered by medical care providers under H&S Code Section 120990(a) required to obtain either written or oral consent to process the ordered test. Furthermore:
Continued requirements for written consent under H&S Code Section 120990(c) refer to HIV testing provided and/or processed in non-medical settings (such as OA-funded confidential HIV test sites).
Instead of required written consent, H&S Code Section 120990(a) requires medical care providers to do the following before they order an HIV test:
1) Inform the patient that an HIV test is planned;
2) Provide information about the HIV test;
3) Inform the patient that there are numerous treatment options available for a patient who tests positive for HIV and that a person who tests negative for HIV should continue to be routinely tested;
4) Advise the patient that he or she has the right to decline the HIV test; and
5) If the patient declines the HIV test, document that fact in the patient's medical file.
AB 682 also amended H&S Code Section 125090, which eliminated the requirement for written consent for HIV testing for pregnant women. H&S Code Section 125090 states that if a woman does not have an HIV test documented in her prenatal record during prenatal care or at the time of labor and delivery, the physician and surgeon or other person engaged in the prenatal care or attending the woman shall ensure that the woman is informed about the:
1) Intent to perform an HIV test,
2) Routine nature of the test,
3) Purpose of the test,
4) Risks and benefits of the test,
5) Risk of transmission of HIV, that approved treatments are known to decrease the risk of perinatal transmission of HIV, and
6) Right to decline HIV testing.
If the woman verbally accepts testing, she must then receive an HIV test "by a method that will ensure the earliest possible results." Currently, there are several HIV tests available that can provide preliminary results within 20 minutes; therefore, hospitals should be able to provide rapid HIV testing in labor and delivery. If a woman receives appropriate HIV treatment during labor and delivery, she can decrease the chances of transmitting HIV to her infant by approximately one-half.
As of January 1, 2009, AB 1894 (Krekorian, Chapter 631, Statutes of 2008) added H&S Code Section 1367.46 and Insurance Code Section 10123.91 to require individual and group health care service plans and health insurers to provide coverage for testing for HIV in medical care settings regardless of whether the testing is related to the primary diagnosis. Insurance Code Section 10123.91 further states that reimbursement shall be provided according to the respective principles and policies of the health insurer. This statute does not cover reimbursement through all public funding.
Perinatal HIV Information
Pregnant women should
be tested for HIV at their earliest prenatal appointment or, if there is not
evidence of prenatal HIV test, at labor and delivery. See the policy letter
below. The information sheets (in several languages) provide the information pregnant
women must receive prior to their healthcare provider ordering an HIV test. For additional information:
- The Pacific AIDS Education and Training Center, based at the University of California, San Francisco can provide free training and technical assistance to health care facilities on implementation of CDC's HIV testing recommendations. Based in medical schools and community-based organizations, the faculty of nurses, physicians, and program managers can help you address implementation challenges, train your staff, and develop necessary policies and procedures.
- The California STD/HIV Prevention Training Center (CA PTC) is funded by CDC and is a joint project of CDPH's Sexually Transmitted Disease (STD) Control Branch; University of California, Berkeley, School of Public Health; and UCSF School of Medicine. CA PTC offers capacity building, consultation and training free of charge to medical providers and health professionals.