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1993-01-14
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/* MISSOURI administrative regulations from their Department of
Health deal with tests, consultation and reporting performed by
the Department and by private physicians. */
Title 19-DEPARTMENT OF HEALTH
Division 20-Division of Environmental Health and Epidemiology
Chapter 26-Sexually Transmitted Diseases
19 CSR 20-26.030 Human Immunodeficiency Virus (HIV) Antibody Test
Consultation and Reporting
PURPOSE: This rule defines the manner in which the sampling and
consultation for human immunodeficiency virus antibody testing is
to be administered by persons authorized by the Department of
Health and the reporting of positive test results.
(1) The following definitions shall be used in administering this
rule:
(A) Department means the Missouri Depart. ment of Health;
(B) Health care professional means a state licensed professional
involved in direct patient care, other than those persons
licensed as physicians under Chapter 334, RSMo; and
(C) Window period means the interval between exposure to human
immunodeficiency virus (HIV) and development of a positive
antibody test.
(2) To be authorized by the department to do HIV sampling, a
person shall be a health care professional or able to provide
accurate and current information about HIV serologic testing
along with pretest and posttest consultation in accordance with
this rule and shall provide or make provisions for pretest and
posttest consultation in person to the person tested or his/her
legal guardian or custodian. If after investigation by a
department employee, the person responsible for sampling is
determined not to be observing the provisions of this rule, the
department shall deny authorization.
(A) Pretest consultation shall occur before sampling and include
a risk assessment of the person to be tested to determine the
person's potential for exposure and infection. The person to be
tested shall be advised of the etiology and methods of
transmission of HIV, the testing methodology, the meaning of the
test results and the type of behavior necessary to reduce the
risk of exposure to the virus.
(B) Posttest consultation shall also be provided to all persons
tested for HIV anti-bodies. It shall include the test results and
their significance, information on good preventive and risk
reduction practices and referral of the person for medical care
and other support services as needed. If the test results are
negative, the person tested shall be advised of the window period
and possible need for retesting. If the test results are
equivocal, the person shall also be advised of the possible need
for retesting.
(C) If the test results are positive, the identity of the person
tested along with related clinical and identifying information
shall be reported to the department or its designated
representative by the person who performs or conducts HIV
sampling within seven (7) days of receipt of the test results on
forms provided by the Department of Health (see Form #1).
(D) Sites testing persons under the following situations shall
be exempt from reporting the identity of persons testing positive
for HIV. These sites shall report HIV positive test results as
well as other related clinical and identifying information within
seven (7) days of receipt of the test results on forms provided
by the Department of Health (see Form #1), but shall be exempt
from reporting the patient's name and street address-instead a
unique patient identifier shall be used:
1. Persons tested at department-designated anonymous testing
sites;
2. Persons tested as part of a research project approved by an
institutional review board with notification of the board's
approval submitted to the department in writing; or
3. Where prohibited by federal law or regulation;
(E) Laboratories which perform testing shall report identifying
information as specified in 19 CSR 20-20.080; and
(F) All persons reported to the department with HIV infection to
the department or its designated representative shall be treated
as referrals for public health partner elicitation/notification
services according to protocols and procedures established by the
department.
19 CSR 20-26.040 Physician Human Immunodeficiency Virus (HIV)
Antibody Test Consultation and Reporting
PURPOSE: This rule establishes guide-lines specific to
physicians and other health care professionals working under
physician orders for human immunodeficiency virus blood sampling
and pretest and posttest consultation arid for the reporting of
persons diagnosed with human immunodeficiency virus infection.
(1) The following definitions shall be used in administering this
rule:
(A) Conduct means to direct, lead, order or undertake to perform
or to provide guidance as a licensed physician to a patient;
(B) Confirmed human immunodeficiency virus (HIV) infection means
the clinical diagnosis and conclusion that a patient is infected
with HIV, made in the professional judgment of the physician
based upon clinical history, physician examination, diagnostic or
laboratory serological testing or other available clinical
information which allows the physician to make clinical and
therapeutic decisions based upon this infected status;
(C) Department means the Missouri Department of Health;
(D) Physician means any person licensed to practice as a
physician and surgeon under Chapter 334, RSMo;
(E) Physician's delegated representative means state licensed
professional involved in direct patient care, other than those
persons licensed as physicians under Chapter 334, RSMo; and
(F) Serological test means-
1. A serum specimen repeatedly reactive for HIV antibody by a
licensed screening test (for example, enzyme-linked immunosorbent
assay (ELISA)) that has been verified by a more specific
subsequent test (such as Western Blot or immunofluorescence assay
(IFA));
2. A positive lymphocyte culture verified by a specific HIV
antigen test or by in situ hybridization using a deoxyribonucleic
acid (DNA) probe;
3. A positive result on any other highly specific test for HIV;
or
4. A T-Helper (CD4) lymphocyte count performed as a part of the
clinical management of a person who in the professional judgment
of the physician is infected with HIV.
(2) The physician or the physician's delegated representative
shall provide consultation with the patient or his/her legal
guardian or custodian prior to conducting HIV blood sampling, and
to the patient, guardian or custodian during the reporting of the
test results or diagnosis.
(A) The physician or the physician's delegated representative
shall only be allowed to provide consultation through the use of
protocols and standing orders which shall be written, signed and
dated by the physician prior to their implementation or, in the
case of a hospital, the policies and procedures as approved by
the medical staff.
(B) The scope of the consultation shall be governed by the
physician's professional judgment based on the clinical
situation, including the purpose of and need for HIV testing, and
shall be at least as comprehensive as the type of consultation
provided for other diagnostic tests or procedures.
(3) The physician shall report to the department or its
designated representative the identity of any person with
confirmed HIV infection along with related clinical and
identifying information within seven (7 days of receipt of the
test results on forms provided by the department (see Form #1
following 19 CSR 20-26.030).
(4) Physicians testing persons under the following situations
shall be exempt from reporting the identity of the person testing
positive for HIV. In these situations, physicians shall report
HIV positive test results as well as other related clinical and
identifying information within seven (7) days of receipt of the
test results on forms provided by the department (see Form #l
following 19 CSR 20-26.030), but shall be exempt from reporting
the patient's name and street address-instead a unique patient
identifier shall be used.
(A) Persons tested solely as part of a research project at those
sites participating in a research project approved by an
institutional review board with notification of the hoard's
approval submitted to the department in writing; or
(B) Where prohibited by federal law or regulation.
(5) All persons reported with HIV infection to the department or
its designated representative shall be treated as referrals for
public health partner elicitation/notification services according
to protocols and procedures established by the department.