Handle Results as a Team
People get nervous about handling positive results.
– Chief of Psychiatry and former Medical Director, Brookwood site
Handle Negative Results like Any Other
Negative HIV results can be handled just like any other negative labs.
Rapid results can be shared with the patient at the time of the test by the provider or support clinical staff once the provider has read the results. If the patient leaves before the results are available, a medical assistant can call the patient after getting provider approval. Think about whether this permission needs to be addressed in your policies and procedures.
Traditional lab results are shared by phone or mail. A medical assistant can handle the notification following approval by a provider. Either type of test result can be mailed to the patient if in-person notification was not possible, although we only did so for negative results and only with non-descript information such as “You labs came back normal.”
Handle Positive Results with Back-Up
Positive HIV results can cause a great deal of worry for staff and even providers. When staff are secure that help is available, they are much less likely to avoid testing in the first place.
Santa Rosa Community Health has a very strong HIV team called Team VIDA. They provided back-up for any positive result notifications, as well as linkage to care for positive patients. Here’s a sample workflow for in-house positive results:
- Let patient know the result is preliminary reactive but not confirmatory, and that an additional lab test is needed for confirmation.
- Order the lab test.
- If negative, patient returns for result and provider informs him/her.
- If positive, Team VIDA is called and is present to discuss results when patient arrives.
When a traditional lab test is positive, an RN calls the patient to let them know they need to come in to discuss their lab results, and to bring their partner if possible. Sometimes the provider or RN call Team VIDA before calling the patient so they can be best prepared to handle the notification well.
Don’t have a Team VIDA? Organizations without HIV specialists can still identify a champion, a provider who’s willing to notify patients or at least provide consultation to providers. Another consideration is special patient populations. For example, when addressing patients with mental health problems, it might be helpful to include a psychiatrist in the notification. The majority of all tests will result negative, but it is important to work with leadership and clinical staff onsite to ensure their comfort in who and how they provide results.
Regardless of who speaks with the patient, it’s important to work with local HIV care providers to ensure a successful linkage to care at the time results are given. Statistics show those who are linked to care at the initial meeting have a much higher medication adherence rate (resulting in lower viral load over time).
Be sure to update your written protocols and policies to reflect the additional steps, making site-level modifications as needed. Also include this information in your training content.
You’ll also need to train staff on the planned changes. See the Culture & Knowledge > Understand HIV Tests & Results section for more on staff training.
A Quick Clinic Story: Handling a Positive Result
A 31-year-old diabetic male came in for a routine visit. He had had sexually transmitted infections in the past year but no HIV tests had been run. Staff had been recently trained on opt-out testing. The medical assistant informed him, “As a part of your routine care, we screen all patients 15 and older for HIV. We would like to test you for HIV at this visit and can add it to your diabetes lab tests.” He agreed to testing and the confirmatory lab result was positive. Team VIDA was notified and triaged with the patient’s provider. During the subsequent HIV intake visit, the patient felt comfortable enough to share that he had been exposed through IDU (methamphetamines) and MSM encounters.
- Sample flier with contact info for staff handling preliminary positive results or providing care in high risk or exposure situations and sample 2-line script for explaining testing to patients (.pdf)
- Sample (draft) informational summary for staff about PrEP, nPEP and HIV treatments (.pdf)
- Summary of questions frequently asked by medical receptionists (.pdf)
- Reflex pathway for the HIV-1/2 Antigen and Antibodies, Fourth Generation, with Reflexes Assay (.doc)