This page is devoted to the essential resources and implementation tools needed to establish a sustainable routine HIV screening program in your healthcare organization. Topics include Texas law related to HIV testing and reporting, testing technology, billing and reimbursement, referral essentials including medical and other support services, as well as HIV clinician hotlines.
Routine HIV Testing as a Standard of Care – Implementation Essentials – This checklist provides a step-by-step guidance for establishing a routine HIV screening program in your practice or clinic. Topics include obtaining leadership support, Texas law, referral information and resources, and other essential criteria to ensure a sustainable routine HIV screening program.
Recommendations & Guidelines
- 2006 CDC Guidelines
- US Preventive Services Task Force Grade A Recommendation
- National HIV/AIDS Strategy
HIV and Texas Law
Consent to Test
Texas law does not require a separate signed consent form to test for HIV. General consent and documentation of verbal consent are sufficient. Minors who have the capacity to consent may also consent to HIV testing. For specific information related to Texas law on consent, delivering positive test results, and reporting requirements, see the HIV and Texas Law fact sheet.
Delivering Positive Test Results
Texas law requires that people receiving a positive HIV test result be given the opportunity for immediate, face-to-face counseling related to the meaning of the test and possible need for further testing and available resources. To learn more about Texas law and delivering results, see the Texas Health and Safety Code §81.109.
HIV is a reportable disease under Texas Law. Requirements for reporting HIV test results are addressed in Texas Health and Safety Code §81.041, §81.042, §81.043, & §81.044 and Texas Administrative Code §97.133 & §97.134.
To report a positive HIV test result, submit a completed Adult HIV/AIDS Confidential Case Report Form (DSHS 13-13674) to your local reporting authority within seven calendar days. Case report forms can be ordered from your local reporting authority. Due to concerns about potential for misuse, case report forms are not available online.
Acute HIV cases must be reported by phone within one working day. For more information see the DSHS HIV/STD Disease Reporting page.
Texas law supports current HIV screening recommendations. For specific information related to Texas law on consent, delivering positive test results, and reporting requirements read HIV and Texas Law fact sheet.
Advances in HIV testing technology over the past few years has narrowed the window to diagnose HIV infection earlier than ever before. Fourth generation technology allows detection of the p24 antigen, one of the earliest markers to identify HIV infection, as early as 14 to 16 days after exposure.
For more information, read Advantages and disadvantages of FDA-approved HIV immunoassays used for screening.
- Current HIV testing algorithm
- Lab reporting language interpretation chart
- CDC step-by-step recommendations for HIV testing in laboratories
Learn More about Specific Guidelines and Recommendations for Both Types of Testing
The following resources provide more information about testing technology to help you choose which technology is most appropriate in your setting.
Updated guidelines for laboratory testing can be found on the CDC website. Updates include
- 2018 Quick Reference Guide: Recommended Laboratory HIV Testing Algorithm for Serum or Plasma Specimens and includes guidance for reporting results, January 2018
- Revised and updated 2017 APHL Suggested Reporting Language for the HIV Laboratory Diagnostic Testing Algorithm, April 2017
- Full version of the Laboratory Testing for the Diagnosis of HIV Infection; Updated Recommendations, June 2014
- Technical Update on HIV-1/2 Differentiation Assays, August 2016
Rapid testing (CLIA waived point of care testing):
Clinical Laboratory Improvement Amendments
- Clinical Laboratory Improvement Amendments (CLIA) from CMS
- Clinical Laboratory Improvement Amendments (CLIA) from the FDA
Reimbursement – Billing and Coding
The following resources will help your organization successfully seek reimbursement for routine HIV screening:
- US Preventive Services Task Force recommendations (Grade A)
- We Order the Test, a brochure for Medicare HCPS, CPT codes, and ICD-10 CM diagnosis codes.
- Texas Medicaid Providers Procedures Manual – Volume 1. General Information: Appendix C: HIV/AIDS
- Billing Coding Guide for HIV Prevention: PrEP, Screening, and Linkage Services
Delivering a Positive Test Result
When delivering a positive HIV result, patients should be given the opportunity for immediate, face-to-face counseling about several aspects of the test:
- the meaning of the test and possible need for further testing
- how to prevent transmission of HIV to others
- how to access available resources (see Referral Services below)
- the benefits of partner notification and availability of notification services for patients.
To learn more about delivering positive HIV test results, see the DSHS brochure HIV/STD Partner Services: The Health Provider’s Role. CDC also provides guidance in Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection.
Services for Patients Living with HIV
Medical and other support services
Review the program resources below available across Texas to help your patient stay in care.
- The HRSA/Ryan White Program provides access to services for people who do not have sufficient health care coverage or financial resources to cope with HIV disease.
- Local providers across the state provide a wide range of services for those with HIV.
- The Texas HIV Medication Program can help your patients afford HIV medications.
- An additional resource to help find an HIV provider and other services in your community for your patients is the Referral Link on The American Academy of HIV Medicine website. You can search by provider name and/or by city. Refine your search by checking HIV Primary Care under the Primary Care Services section, select AAHIVM Credentialed Providers, and Payment Types that apply. Specialty care services and other services are also available.
Linkage and Retention in Medical Care
People with HIV have higher quality of life and a better prognosis when they are actively engaged in care. Your referral to an HIV specialist and follow-up may make all the difference to your patient. The HIV Care Continuum illustrates how many people fall out of care.
To learn more about the progress being made in HIV patient care, read the Office of National AIDS Policy report National HIV/AIDS Strategy Improving Outcomes: Accelerating Progress Along the HIV Care Continuum, December 2013.
HIV Hotlines for Clinicians
- Perinatal HIV Hotline, PEPline, and Warmline – The Perinatal HIV Hotline (888-448-8765) and the PEPline (888-448-4911) are both available 24 hours, seven days per week. The Warmline (800-933-3413) is available 7:00 a.m. to 7:00 p.m. Central, Monday through Friday. All consultations are free and confidential.
- Clinician Consultation Center – The Clinician Consultation Center at the University of California, San Francisco operates an HIV/AIDS Care Consultation line (800-933-3413), providing U.S. clinicians of all experience levels with prompt, expert responses to questions about managing HIV/AIDS, perinatal HIV, pre-exposure prophylaxis, and blood borne pathogen exposures. The Warmline is staffed by clinicians experienced in HIV care who can help you provide the best possible care to your HIV-positive patients.
- PEPline – The Clinician Consultation Center at the University of California, San Francisco operates the PEPLine (800-448-4911) to provide rapid, expert guidance in managing healthcare worker exposures to HIV and hepatitis B and C, including information on post-exposure prophylaxis (PEP). Operates seven days a week, 10 a.m. to 3 a.m. CST
- PrEP – Clinically supported advice on PrEP for healthcare providers from the Clinician Consultation Center at University of California, San Francisco. Call 855-448-7737 or 855-HIV-PrEP for a phone consultation, Monday – Friday, 10:00 a.m. to 5:00 p.m. CST.
- Perinatal HIV Hotline – Operated by the Clinical Consultation Service at the University of California, San Francisco, the National Perinatal HIV Consultation and Referral Service (888-448-8765) offers healthcare providers around-the-clock advice on the testing and care of HIV-infected pregnant women and their infants. Consultation is provided on all levels of perinatal HIV management, including on complex and unique treatment dilemmas.