Clinical Advisory: Routine HIV Screening in Primary and Urgent Care Settings in Massachusetts, Massachusetts Department of Public Health, Bureau of Infectious Disease (2009)

The Massachusetts Department of Public Health (MDPH) issued this clinical advisory to encourage health care providers’ implementation of routine HIV screening. The subtext of the advisory is that routine offering of HIV testing in all health care settings, consistent with the primary goal of the U.S. Centers for Disease Control and Prevention(CDC) 2006 guidelines, can be accomplished without changing current Massachusetts law, which requires documented (i.e., patient-written), informed (i.e., pre-test communication with patients) consent, and post-test counseling for all who test regardless of the test result. The advisory provides a brief description of the CDC’s current HIV testing recommendations in health care settings, which call for routine opt-out HIV screening of all patients aged 13-64, with annual testing of those patients at “high risk.” The MDPH advisory acknowledges the importance of routine testing and ensuring that as many people as possible know their HIV status, while reassuring providers that it is possible to implement routine offers of testing and still comply with the state’s requirements by streamlining the consent process, condensing pre-test counseling, and decreasing paperwork. This is exactly the approach taken in New York State, which substantially increased testing rates without dispensing with patient protections. The state law approach described in the MDPH advisory serves as an example of how health care providers can easily and efficiently implement routine HIV testing into their practices without compromising patient protections that build trust in providers and encourage continued engagement in care.

Accompanying the advisory is a guidance document intended to assist providers with implementation of routinely-offered testing.