HIV Information For Healthcare Professions

Prevention

The Department of Health uses CDC recommendations to focus HIV prevention efforts. The CDC has developed guidance to help healthcare providers plan, implement, and evaluate HIV prevention case management.

Testing

The evolution and management of HIV disease has changed over the years, as has public perception, to mirror many chronic diseases. The CDC and other experts recommend that HIV testing and screening be included as a routine test, particularly during pregnancy. Therefore, Rhode Island has revised its laws and regulations to consider HIV testing as a routine prenatal test. 

The Abbott 4th Generation HIV test is an antigen/antibody combo test that simultaneously detects the presence of HIV p24 antigen and antibodies to HIV-1 and HIV-2 in serum and plasma. The test detects the presence of p24 antigen as early as 7 days post-infection, at least a week earlier than the 3rd generation test, which was only able to detect HIV-1 and HIV-2 antibodies. For this reason, this 4th generation HIV test is ideal, especially for testing high-risk individuals and partners of known HIV infected individuals.

Effective October 2016, The Rhode Island State Health Laboratory will begin using the Geenius HIV-1/2 Supplemental Assay (Geenius) for the confirmation and differentiation of individual antibodies to HIV-1 and HIV-2. The Geenius HIV-1/2 Supplemental Assay replaces the Multispot HIV-1/2 Rapid Test (Multispot). Review the Updated State Laboratory HIV Testing Algorithm for specific details.

Counseling and Referral

The CDC has developed guidelines with policy makers and service providers to guide the provision of HIV counseling, testing, and referral services. Click here to review CDC guidelines for HIV.

For Partners

The Rhode Island Department of Health has developed a policy to help healthcare providers counsel patients on partner notification. This policy allows healthcare providers to inform a partner that he or she may be exposed to HIV if the patient refuses to notify him or her. The Department of Health's Partner Counseling and Referral Service (PCRS) can also contact partners on behalf of interested patients and let them know that they may have been exposed to HIV. 

For HIV Patients Out of Care

The Rhode Island Department of Health has been funded by the Centers for Disease Control and Prevention to improve the health of persons with HIV by increasing access to HIV medical care and retaining patients in care long-term. Healthcare providers should complete the Out of Care Referral Form for HIV Patients for all HIV patients who have not been seen within the last 12 months or longer since their last appointment, or who have not had a lab test for more than 12 months since their last lab test.

Case Reporting

Laboratories are required to report any positive laboratory result indicative of HIV. All HIV viral loads and CD4 tests are reportable for individuals diagnosed with HIV.  Licensed healthcare providers are required to report newly identified cases of HIV and HIV Stage 3 (AIDS) disease to the Department of Health’s Center for HIV, Hepatitis, STDs, and TB Epidemiology. This may include new diagnoses residing in Rhode Island as well as known cases of HIV migrating to Rhode Island from other jurisdictions. Providers should report using the appropriate reporting form listed below:

• Adult HIV Case Report Form
• HIV Transfer of Care Report Form
• Pediatric HIV Case Report Form
• Perinatal HIV Exposure Report Form

HIV Qualified Professional Test Counselors (QPTC) Certification

Training courses integrate viral hepatitis, sexually transmitted diseases, and partner counseling and notification into statewide HIV testing. For information about becoming certified as a Qualified Professional Test Counselor, call (401) 222-2577.

PEP and PrEP

HIV Post-Exposure Prophylaxis (PEP) is a secondary preventive method that may reduce the incidence of HIV infections. HIV PEP is divided into two types: occupational and non-occupational. Occupational PEP is available through employers for nurses, emergency medical technicians, doctors, or other professionals who may have been exposed to HIV at work. Non-occupational PEP is typically employed after sexual assault, consensual sex, or needle stick injuries to at-risk patients who are not healthcare professionals.

HIV Pre-Exposure Prophylaxis (PrEP) should be delivered as part of a comprehensive package of prevention services, including HIV testing, discussing sexual health to reduce risk behavior, access to condoms, and management of other sexually transmitted infections.

Recommendations:

• Identify adult men who have sex with men (MSM) and heterosexually-active men and women who are eligible for PrEP.
• Consult the CDC’s fact sheet PrEP: A New Tool for HIV Prevention and interim guidelines for clinicians.
• Consider pre-exposure prophylaxis for those at high risk for HIV acquisition through sex:
  • People with partners who have known HIV infections
  • People who have frequent unprotected sex and abuse drugs and/or alcohol
  • People who have sex in exchange for money
  • People with frequent sexually transmitted diseases
• For higher risk patients as described above who receive PrEP, test each person for HIV at baseline, and repeat testing every two to three months. Click here for more information about HIV PrEP guidance.

Bloodborne Pathogens: Standard Universal Precautions

The following sites provide information for agencies on bloodborne pathogens, including universal precautions and staff training standards:

• Bloodborne Infectious Diseases Risk Factors
• Healthcare-Associated Infections
• Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States Recommendations

The most effective means of preventing HIV infection is preventing exposure. The provision of antiretroviral drugs to prevent HIV infection after unanticipated sexual or injection-drug use exposure might be beneficial.