for Health Care Providers
Delivering HIV Test Results
Q: What should I discuss with the patient when delivering HIV test results?
Delivering an HIV test result involves more than just telling the patient about the result. It should include time to make sure the patient understands the meaning of the result and making appropriate plans based on the results. The specific elements of the discussion will vary based on the test result and also on the needs of the particular patient. When delivering a negative test result, information should be given about the validity of the test result, especially if the patient has engaged in high risk behavior within 6 months of the test, as well as the need for possible retesting. It is also important to talk with the patient about how to decrease his or her risk for HIV. If the patient's risk factors for HIV infection include a substance use disorder, then he or she should be referred to appropriate treatment resources. Similarly, providers should discuss safer sex practices that decrease the risk of HIV infection.
When delivering a positive HIV test result, it is important to provide a referral for HIV care, to inform the patient about the importance of informing his or her spouse, and/or sexual or drug use partners, and provide information about how to avoid transmitting HIV to others. It is important to document the information provided to the patient, including: the results of the test; information about the patient's comprehension of and reaction to the results; and, information about follow-up referrals or services arranged. (August 2009)
Q: Do I have to deliver the HIV test results in a face-to-face meeting with the patient? Sometimes our patients may not have another clinic visit scheduled in the immediate future and they may live several hours away from our medical center. Coming in for just the HIV test result may be a hardship for some while others do not show up for appointments that were scheduled to deliver the test results.
VHA practice has always been to deliver HIV test results in a face-to-face visit with the patient whenever possible. This is even more important when the test result is positive as it is critical to make sure that the patient has all the information that he or she needs to answer any questions about HIV and to offer much needed support. It is also important to help get the patient into care for their HIV as soon as possible and to provide them with the information about how to prevent transmission to others.
However, there are times when it may be difficult or impossible after multiple attempts to get a patient in to discuss positive test results. At those times, it is appropriate to try to reach the patient by phone and speak with him or her directly. This is more easily done over the phone when the provider is someone who already has a relationship with the patient. The information provided over the telephone should be similar to that which would be given in a face-to-face visit, and documented in the patient's electronic health record. The patient should be encouraged to come see the provider or the HIV clinic to which they are being referred for care as soon as possible.
In patients with negative results, contacting the patient by phone may be acceptable if it would represent an undue burden for the patient to return for a visit just to receive the test results. However, the same information on risk reduction that would be provided in a face-to-face visit should be given to the patient, and documented in the patient's electronic health record. In addition, appropriate referrals for risk reduction and other needed services should be made and discussed with the patient. It is important to make sure that the patient's confidentiality is protected. If you need to leave a message with someone on the phone, please make sure that the reason for the call is not disclosed. It is not appropriate to leave a message on results on an answering machine or to inform a patient by email, as these are not secure means of communication. (August 2009)