Content Information
A. Isolation and Quarantine Requirements
None.
B. Protection of Contacts of a Case
To protect future contacts, all cases receive education on prevention of further spread.
The Iowa Department of Public Health will initiate the voluntary partner notification program for all persons who are newly diagnosed with HIV infection. Healthcare providers can facilitate this process by describing the program to the patient, providing the patient with the department’s brochure entitled, “Partner/Spousal Notification for HIV/AIDS,” and encouraging the patient to meet with the department’s disease prevention specialist assigned to his or her region.
Patients’ names and times of exposures are not used in the notification of partners. HIV testing is offered to all partners free of charge and appropriate referrals to other services are provided during the partner counseling sessions. Partner notification brochures are available in English and Spanish from the Clearinghouse at (319) 398-5133.
Physicians may assist the disease prevention specialists with the collection of partner notification information. In such cases, the physician should collect the following information: Partner name, address, home phone number, age and/or date of birth, race, sex, partner/marital status, height, size/build, general description of the partner, and dates of first and last exposure. Any other information that may help in locating and counseling the partner may also be included, such as medical conditions, place of employment, cell phone numbers, or other unusual circumstances/situations.
Iowa code also allows for direct notification of an identifiable sexual or needle-sharing partner when the partner is deemed to be in imminent danger of infection and the HIV-infected client will not agree to participate in voluntary partner notification. Healthcare providers may contact the HIV/AIDS Program’s surveillance office (515-242-5141) for more information or to request assistance with partner notification or the direct notification of a third party. Physicians may also notify identifiable third parties directly. The Iowa Administrative Code 641-11.18 outlines procedures for direct notification by physicians.
C. Managing Special Situations
Occupational Exposures in Non-clinical Settings
If a care provider (including EMT, fire fighters, peace officers, and volunteers) sustains a significant exposure to blood or other potentially infectious fluids from an individual, that individual is deemed to consent to a test to determine the presence of HIV infection (or other infectious blood-borne pathogens) upon certification of a Report of Exposure to HIV or Other Infectious Disease form [See Iowa Code 139A.19 and Iowa Administrative Code 641-11.21 to 11.26]. The individual is also deemed to consent to notification of the care provider of the test results. These consents are contingent upon submission of a significant exposure report by the care provider and its certification by an infection preventionist or physician. [Significant exposure report forms are available from the Clearinghouse at 319-398-5133].
The hospital or clinic to which the individual was delivered shall conduct the testing. If the individual is delivered to an institution administered by the Iowa Department of Corrections, testing shall be conducted by the staff physician of the institution. If the individual is delivered to jail, testing shall be conducted by the attending physician of the jail or the county medical examiner. The sample and test results shall only be identified by a number.
If the test results are positive, the hospital or other person performing the test shall notify the subject of the test and ensure the performance of counseling and reporting requirements in the same manner as for an individual from whom consent was obtained. The report to the department shall include the name of the individual tested along with other required demographic information. The hospital or other person performing the test shall notify the care provider or the designated representative of the care provider who shall then notify the care provider who sustained the exposure.
Occupational Exposures in Clinical Settings
If a care provider sustains a significant exposure to blood or other potentially infectious fluids from an adult patient in a clinical setting (including home-health settings), a previously signed general consent for medical care shall include testing to determine the presence of HIV (or other infectious blood-borne pathogens) and notification of the care provider of the test results. Minors should be handled in the same way as an exposure that occurred in a non-clinical setting (see above). The adult patient shall be informed of the exposure and of the test(s) performed.
If the test results are positive, the hospital or other person performing the test shall notify the adult patient of the results and ensure the performance of counseling and reporting requirements in the same manner as for an individual from whom consent was obtained. The report to the department shall include the name of the individual tested along with other required demographic information. The hospital or other person performing the test shall notify the care provider or the designated representative of the care provider who shall then notify the care provider who sustained the exposure.
Information on post-exposure prophylaxis protocols is available 24 hours a day at the National Clinicians’ Post-Exposure Prophylaxis Hotline at (888) 448-4911.
Reported Incidence Is Higher than Usual/Outbreak Suspected
Report to the Iowa Department of Public Health at (515) 242-5141.
D. Preventive Measures
Preventive Measures/Education (Iowa Code 141A.4)
Testing and education shall be offered to all persons who are at risk for HIV infection. Risk factors include male-to-male sex; injection drug use; testing positive for an STD; exchange of sex for money or drugs; blood transfusion before 1986; immigration from a high-incidence country; or having a sex partner who is HIV positive or who is in one of the previous risk groups.
All pregnant women shall be tested for HIV infection as part of the routine panel of prenatal tests. A pregnant woman shall be notified that HIV screening is recommended for all prenatal patients and that the she will receive an HIV test as part of the routine panel of prenatal tests unless she declines the test. A declination shall be documented in her medical record. Information about HIV prevention, risk reduction, and treatment opportunities to reduce the possible transmission of HIV to the fetus shall be made available to all pregnant women.
Free HIV counseling, testing, and referral sites are available across the state for persons with risk factors.
Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
The CDC issued revised recommendations for HIV testing in health care settings in September 2006. They recommend routine opt-out testing for HIV for all patients aged 13 to 64 years of age unless the prevalence of undiagnosed HIV infection in the patient population has been determined to be less than 0.1 percent (1 per 1,000 patients). They also recommend that separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient. The full recommendations can be found at: www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
Iowa Dept. of Public Health, Reviewed 7/15