• DSHS HIV/STD Program
    Post Office Box 149347, MC 1873
    Austin, TX 78714

    Phone: 737-255-4300

    Email the HIV/STD Program

    Email HIV, STD, Hepatitis C, and TB data requests to the Program – Use this email to request Texas HIV, STD, Hepatitis C, and TB data and statistics. Do not use this email to request treatment or infection history for individuals, or to request information on programs or services. Do not email personal, identifying health information such as HIV status, date of birth, or Social Security Number.

    For treatment/testing history, please contact your local health department.

    For information on HIV testing and services available to persons living with HIV, please contact your local HIV services organization.

POPS Chapter 1 - Focused HIV/STI/HCV Testing, Counseling and Linkage to HIV Medical Care

This section provides guidelines for the delivery of consistent quality services regarding HIV, sexually transmitted infection (STI), and hepatitis C virus (HCV) focused testing, counseling, and linkage to medical care. These guidelines are in accordance with the HIV National Strategy to reduce HIV transmission, identify persons living with undiagnosed HIV, enhance timely linkage to medical care, and reduce health disparities. These guidelines are written to assist risk reduction specialists, outreach workers, prevention specialists, Disease Intervention Specialists (DIS), and others who provide testing for HIV, herein after referred to as “HIV tester” in offering HIV/STI/HCV testing, counseling, and linkage services to clients at highest risk for HIV/STI/HCV infections.

HIV testing services should be client-centered. Services should be focused on the client’s concerns and situation. Services should also be culturally competent with respect to race, ethnicity, gender, sexual orientation, age, language, literacy, relationship status, and other relevant factors.

1.1 Focused HIV Testing and Linkage Protocols

In accordance with Health and Safety Code (HSC) §85.085, Physician Supervision of Medical Care, HIV testing providers are required to operate under standing delegation orders of a physician.

Providers should review guidance from the CDC on HIV testing in non-clinical settings (PDF).

1.1.1 Minimum Required Components of HIV and Syphilis Testing

Staff conducting HIV/STI testing are required to:

  1. Obtain informed consent from client;

  2. Gather sociodemographic information;

  3. Offer both anonymous and confidential HIV testing;

  4. Conduct a brief HIV exposure risk assessment including:

    • Reason for HIV test;

    • Recent sexual and injection drug use behaviors since last HIV test;

    • In the past five years, has the client:

      1. Had sex with a male, female or transgender person

      2. Injected drugs or substances;

    • Date and type of recent risk exposure;

    • History of STI diagnosis and treatment; and

    • Date of last HIV test and test result.

  5. Ensure delivery of HIV/STI test results to client in a timely and appropriate manner (All staff conducting HIV/STI testing must be permitted to deliver all HIV and/or STI results, including positive results, in both field and clinical settings);

  6. Provide basic information about HIV transmission and HIV testing including:

    • Benefits of testing;

    • Behaviors that transmit HIV;

    • How to prevent HIV transmission, including PrEP, nPEP, and Treatment as Prevention (TasP);

    • Testing technology used (rapid or blood draw); DSHS no longer supports the use of HIV oral fluid testing according to Policy Number 2013.02.

    • Estimated Detection Period (EDP); EDP is the time period estimated from possible exposure to detection specific to the testing technology used. Contractors should refer to manufacturer’s guidelines to determine EDP including relation to retesting and discuss this information with clients;

    • When and how HIV test results will be provided to client;

    • Procedure if client receives a positive diagnosis (e.g., confirmatory or subsequent testing, introduction of partner services, linkage to care); and

    • Procedure if client tests negative and is interested in accessing PrEP

  7. Provide clients with population-specific, age appropriate, culturally affirming health messages and materials that address the client’s risk level and prevention needs, which may include risk reduction counseling if appropriate for client needs and demands of the setting, including education on Combination Prevention;

  8. Screen for PrEP and nPEP eligibility, using a locally validated or CDC supported screening tool. Policies and procedures for provision of navigation services, including offering and following up on referrals to clinical providers must be in place.

  9. Screen for and make referrals, as appropriate, for essential support services including:

    • Health benefits and navigation enrollment;

    • Evidence-based risk reduction interventions;

    • Behavioral health services;

    • Housing; and

    • Social services

  10. Ensure supplemental testing is collected by venipuncture immediately, on-site, after a point of care HIV and syphilis health check preliminary positive test result. All staff conducting HIV/STI testing must have the ability to obtain specimens via venipuncture. All staff must be permitted to provide HIV and/or syphilis screening(s) by collecting blood-based specimens, in both field and clinical settings. Staff will perform these tests unless the client refuses;

  11. Report all positive test results, including preliminary positive results, in accordance with disease reporting rules; and

  12. Maintain documentation as required in POPS Chapter 2 – HIV/STI/HCV Testing and Linkage Documentation.

Specific arrangements should be made to ensure all clients receive their HIV test results in a timely and appropriate manner. A reliable process for verifying the client’s identity before providing test results and protecting client confidentiality must be established prior to providing any test result.

Negative HIV and syphilis test results may be given by telephone or other technology. Policies and procedures must be in place and describe under what circumstances negative results will be made available by telephone or other technology and outlining the protocol for giving negative results. Programs that wish to provide negative test results via telephone or other technology must make available their program’s policies and procedures to DSHS: 

    All staff conducting HIV/STI testing must be permitted to disclose the reason s/he is contacting client (ex. Notification of results, follow up on a preliminary positive, linkage to HIV and/or STI testing, treatment and care activities, etc.).

    Providers must ensure that all clients tested for HIV receive information on Combination Prevention, including PrEP, nPEP, and TasP, and referral to clinical, social services, and other needed services as appropriate. Combination Prevention educational information must be supported with materials approved by DSHS.

    In accordance with Health and Safety Code HSC §81.109 Counseling Required for Positive Test Results, a client must receive their HIV diagnosis   with the immediate opportunity for individual, face-to-face counseling. For this reason, all HIV diagnosis and indeterminate test results in DSHS, or DSHS-affiliated sites, will be given in person with an immediate opportunity for counseling. If unable to deliver results to persons with a HIV diagnosis (unable to locate, client does not return for results, etc.), all available information on the person should be submitted to the local or regional health department for public health follow-up. Communication with the local or regional health department must be noted in the client file.

    1.1.2 Minimum Required Components of Counseling and Linkage for Persons Living with HIV

    Qualified staff are required to:

    1. Provide face-to-face counseling to all persons diagnosed with HIV;

    2. Offer emotional support to assist the client in understanding the meaning of the test result and accessing social support;

    3. Explain the benefit of initiating and remaining in HIV medical care as well as medication adherence;

    4. Coordinate partner services and public health follow-up with the local or regional health department;

    5. Confirm linkage to HIV-medical care (DSHS standard is to maintain communication with the client for a minimum of 90 days or until the first HIV medical appointment is confirmed);

    6. Deliver risk reduction strategies, education on TasP, and referral to appropriate risk reduction interventions;

    7. Provide essential support services referrals, as appropriate;

    8. Provide ongoing support/navigation services for engagement and re-engagement in HIV-medical care; and

    9. Provide a copy of test results to the client for proof of diagnosis (An anonymous test will not include the client name). Linkage to HIV-related Medical Care

    DSHS contractors shall work with a client to establish an HIV-related medical care appointment, follow up with the client, prepare client for medical care, and confirm the client attended the appointment. This applies to individuals newly diagnosed as well as those previously diagnosed and not currently in HIV-related medical care.

    DSHS contractors must immediately link persons to HIV medical care based on a preliminary positive result. A confirmatory HIV diagnosis is not required to begin this process.

    Support needed by clients to enter care may differ based on their diagnosis and history of treatment. To determine which services are needed, providers must verify testing history and participation in HIV-related medical care with disease surveillance staff.  This process includes:

    1. Obtaining written client authorization to allow the local health authority or regional public health department to release information related to the client’s HIV diagnosis and treatment history.  An Authorization to Release Confidential Information Form should be completed and signed by the client. The form will specify to whom the information is being released, the purpose of the release and the specific information to be released.

    2. Sharing the signed Authorization to Release Confidential Information form with the local health authority or regional public health department and obtaining the client’s HIV diagnosis and treatment history

    3. If the client refuses permission for such verification, then client self-report of diagnosis history and participation in care should be used to guide linkage activities. Confirmation of Medical Care

    Client attendance of a HIV-related medical appointment is evidenced by:

    1. Verbal or written confirmation from the care provider;

    2. Medical appointment in a care reporting system;

    3. CD4 or viral load test with confirmation of a medical appointment;

    4. Confirmation from an intermediate provider, such as Disease Intervention Specialist (DIS), or case manager; and

    5. Self-report from the client. DSHS will accept client self-report in the rare circumstances that the DSHS contractor has attempted and was unable to verify client attendance using the above approaches.

    Varied attempts (phone call, letter, field visit, email, text message) to contact persons should be made when trying to link to medical care. Date, time, activity, and result of attempts to link clients must be documented. Contractors should continue to attempt to link clients to medical care for a minimum of 90 days.

    Contractors must ensure client confidentiality is maintained while attempting to link persons to care.

    1.2 Confirmatory Testing

    In accordance with DSHS Policy Number 2013.02 confirmatory testing must be collected by venipuncture on-site immediately after a point of care (e.g., rapid) preliminary positive test result. All indeterminate and non-reactive confirmatory tests must be automatically referred for Nucleic Acid Amplification Testing (NAAT) to determine if a client has an acute HIV transmission. Blood specimens allow access to the newest and most sensitive technology that can detect acute infections and also provide an opportunity to test for syphilis. Confirmatory testing using another protocol must be pre-approved by DSHS in writing.

    1.3 Recruitment and Outreach

    Each DSHS contractor must identify focus population(s) for their specific activities, based on state and local morbidity. In order to narrow the overall focus population to reach persons most vulnerable to HIV, agencies will need to know what behaviors and other risk factors are related to HIV vulnerability, who is engaging in these behaviors or is affected by these factors, and where to identify the focus population(s). This process will help to tailor messages and services in a way that resonate with the focus population(s) and develop a plan for how to engage these communities.

    DSHS contractors are expected to develop a recruitment plan that outlines when, where, and how recruitment of the focus population(s) will be conducted. The plan must include ideas about where to reach the focus population(s), as well as the specific recruitment strategies and messages that will be used for engaging them in HIV testing, other risk reduction interventions, or health and other support services.

    In order to have an effective and innovative program, resources should be dedicated to implementing a recruitment plan. Successful recruitment and outreach programs typically:

    • hire and train specific recruitment staff who are separate from HIV testing or other prevention staff, and who are from within the communities you serve;

    • build partnerships in the community to ensure multidirectional referrals and expand recruitment networks;

    • use innovative approaches for reaching the focus population through the Internet and social media; and

    • offer tangible reinforcements to reach previously underserved subpopulations, generate interest in new services, or obtain buy-in for testing at high-risk venues (e.g., club or bar) where clients might need extra motivation to access HIV testing; and

    • provide supportive services that meet the needs of clients beyond HIV-related care.

    A comprehensive recruitment plan aims to deliver strategic, culturally competent, community-based recruitment strategies that engage the focus population and motivate them to access HIV testing services and other risk reduction interventions.
    DSHS contractors are expected to collaborate with other organizations that have a history of working with and recruiting the focus population(s). Agencies must seek input from community stakeholders, such as their Community Advisory Board, to select the most appropriate program promotion and recruitment strategies. Community stakeholders can also be useful for crafting recruitment messages, which may focus on increasing public awareness of services, destigmatizing HIV and HIV testing, and providing key information about HIV and HIV testing.

    The 6 primary categories of recruitment strategies are the following:

    1. Street-based and venue-based outreach – conducted by engaging the focus population in their own environment, such as a particular street, neighborhood, hot spot, or venue (e.g., a bar, hotel, or community center). Outreach workers, who may include HIV testing providers, aim to reach the focus population with key messages about HIV and HIV testing. HIV testing services may also be offered in conjunction with street- and venue-based outreach, if appropriate.

    2. Internet outreach - involves reaching the focus population through online venues, such as chat rooms, social networking sites, hook-up sites, and mobile geo-location applications. Internet-based outreach may be especially useful for reaching young people and MSM who do not identify as gay or who cannot be found in traditional outreach settings.

    3. Internet Referrals - accessing the focus population through other services offered within a DSHS contractor such as substance misuse programs, mental health services, evidence-based HIV prevention interventions, STI testing and treatment programs, and HIV medical care (for partners of people already in care).

    4. External referrals - persons from the focus population are referred to HIV testing services by agencies outside the DSHS contractor. External agencies may include, substance misuse programs, mental health services, evidence-based HIV prevention interventions, STI testing and treatment programs, HIV medical care, and homeless shelters. These offsite programs identify people who are accessing their services that may benefit from HIV testing or other related services (i.e., HIV/STI testing, ARTAS, or other risk reduction interventions). Building strong partnerships with external agencies that tend to serve clients at risk of acquiring HIV is important, as is sharing information with them about how to make appropriate referrals to your program.

    5. Social networking - a peer-driven approach to recruitment that involves identifying persons living with HIV or individuals vulnerable to HIV from the community to serve as “recruiters” for your agency. Recruiters deliver key messages and encourage HIV testing among persons at risk of acquiring HIV in their social, sexual, or drug-using networks. Partner referral is a type of social networking that involves recruiters referring their sexual partners to an HIV testing program or other risk reduction interventions.

    6. Social marketing - the use of media (e.g., flyers and brochures, posters, or advertisements using print, radio, television or social media) to recruit clients into HIV testing programs and other risk reduction interventions. Agencies can develop their own social marketing campaigns but are encouraged to use existing resources, such as those available from CDC, and tailor them to their community’s specific requirements. CDC’s Act Against AIDS campaign materials can be accessed at cdc.gov/actagainstaids/ and additional materials are available at effectiveinterventions.cdc.gov.

    1.3.1 Tangible Reinforcements

    Tangible reinforcements can be useful tools for reaching underserved focus populations and engaging vulnerable communities. However, challenges to using tangible reinforcements include cost and the potential to attract repeat participants who are more interested in the reinforcement than the HIV programming and services. In developing a plan for tangible reinforcements, agencies should identify an appropriate reinforcement rate for reaching the identified focus population. Agencies must consult with community advisory boards or clients to elicit feedback on appropriate reinforcements for HIV testing, linkage to medical care, and other risk reduction interventions.

    Use of tangible reinforcements are intended to:

    • assist individuals living with HIV to engage and access services that will assist with linkage to medical care or engagement in other intense risk reduction interventions designed to support HIV medication adherence and attain viral suppression

    • assist individuals who are HIV negative, yet still vulnerable to HIV, to know their status and to engage in services and programming that provide a support network to incorporate harm reduction and safer sex options

    Prior to purchasing and distributing tangible reinforcements, DSHS contractors must:

    • receive prior approval by DSHS;

    • have a line item budget detailing the cost and type of tangible reinforcements to be used;

    • have policies and procedures in place to track the purchase and distribution of tangible reinforcements;

    • conduct quality assurance activities to account for the proper use of tangible reinforcements; and

    • ensure that funds are not used for cash payments to individuals accessing or linking to HIV services

    Providers must use community assessments to evaluate and improve recruitment and outreach strategies. If it is determined that your program is not reaching the focus population or your agency is not on track to meet performance measures, different recruitment strategies should be considered. The DSHS prevention consultant assigned to your program is available to provide technical assistance should your agency need to revise program recruitment strategies.

    Agencies are encouraged to incorporate a variety of recruitment strategies and not rely solely on tangible reinforcements to attract and retain clients. Using a combination of strategies that appeal to multiple segments of the community will ultimately be more sustainable.

    1.4 Confidentiality

    All client and partner information is confidential, whether the client is tested confidentially, anonymously, or declines testing. At minimum, HIV testers are expected to maintain and demonstrate a high level of confidentiality regarding client information and strictly adhere to the policies and procedures of their agencies. Releasing test results or any information to unauthorized persons which leads to the disclosure of a client’s identity is a breach of confidentiality and punishable by applicable statutes and administrative regulations.

    Violation: In accordance with Health and Safety Code HSC §81.103 Confidentiality; Criminal Penalty, breach of confidentiality is a Class A misdemeanor and is punishable by up to one year in jail and fines of up to $5,000. Violation of confidentiality is also a civil offense that may result in liability for damages plus fines.

    1.4.1 Release of Information

    Information regarding a client’s HIV test result may be released only under specific circumstances, in accordance with Health and Safety Code HSC §81.103 Confidentiality; Criminal Penalty. For information on authorization to release confidential information, see Chapter 2 HIV/STI/HCV Testing and Linkage Documentation Standards.

    1.5 Epidemiological Reports

    HIV, AIDS, gonorrhea, chlamydia, chancroid, and syphilis are reportable diseases and law requires a report of disease be submitted to the local and regional health department. dshs.texas.gov/reporting

    Reportable conditions include preliminary positive HIV test results.

    Violation: In accordance with Health and Safety Code HSC §81.049 Failure to Report; Criminal Penalty, failure to report a reportable disease or health condition is a Class B misdemeanor and may result in fines and incarceration of up to six months.

    1.6 Risk Reduction Counseling

    Every client who requests a test does not require an in-depth counseling encounter. Qualified staff use professional discretion based on a risk assessment to determine the level of counseling required. Risk reduction counseling is appropriate for those persons at high risk of acquiring or transmitting HIV, STI, and HCV, and should integrate Combination Prevention education. In general, a person is thought to be at risk for HIV, STI, and HCV, based on their sexual and drug use behavior and the community viral load.

    1.6.1 Minimum Standards for Risk Reduction Counseling

    Decisions about the duration or extent of a counseling session will be based on several factors, including:

    Setting - In-depth, personalized risk reduction counseling may not be feasible in some settings. The intent of some events may be to screen a high number of people in a short amount of time, in which case conducting in-depth counseling would not be appropriate because staff would be able to test and counsel only a small number of clients.

    Client risk profile - If the setting is conducive to individualized counseling, qualified staff should consider the client’s reported risks. If the client reports little to no risk for HIV, STI and HCV, there is no need to conduct in-depth counseling. Instead, staff can provide some brief tailored health messages about risk reduction and close the counseling session. If the client does report engaging in high-risk behaviors, an attempt to conduct in-depth counseling should be made.

    Client willingness - If the client reports high risk behaviors and a readiness to engage in the process of individualized risk reduction counseling, qualified staff can proceed with in-depth counseling. If the client is reluctant, provide tailored health messages, test the client, and let the client know that they may return in the future to continue the discussion of risk reduction.

    When the need for in-depth counseling is determined, qualified staff uses active communication skills to:

    1. Determine client concerns, needs, and priorities;

    2. Provide basic information about HIV, STI and HCV transmission and testing;

    3. Support the client to reach a better understanding of personal HIV/STI risk;

    4. Develop a risk reduction plan; and

    5. Make referrals as appropriate.

    Qualified staff is expected to maintain and demonstrate a high level of confidentiality regarding client information, and strictly adhere to the policies and procedures of their agencies.

    Qualified staff will meet minimum DSHS training requirements. More information on HIV/STI training requirements can be found at the following DSHS website: dshs.texas.gov/hivstd/training/

    Agencies will maintain appropriate referral networks to provide accessible and appropriate referrals to clients in need of additional services (mental health counseling, substance abuse treatment, intensive case management, etc.).

    1.7 Department of State Health Services Laboratory Specimen Submission

    Contractors should visit DSHS Laboratory website for information on specimen collection, submission and shipping. Contractors are not required to use DSHS lab for specimen submission.

    1.7.1 HIV Serology Submission Form

    A lab serology form ( Serology Specimen Submission Form) should be provided with each specimen submitted for an HIV, STI, and HCV test as required by DSHS laboratory. DSHS bar code labels will be used to identify and track specimens using DSHS Laboratory Information Management System (LIMS).

    The Specimen Submission Form must include:

    1. A DSHS bar code label in the identified upper right side of the form;

    2. Submitter information (accurately complete all the fields denoted with a double asterisk **);

    3. Accurate client information (information on the form should be identical to the client information on the specimen being submitted);

    4. Specimen source;

    5. Ordering physician’s information;

    6. Payor source (DSHS contractors must select HIV/STI box to avoid being charged for the test);

    7. Selected HIV, STI, and HCV test to be processed; and

    8. Date of collection.

    1.7.2 Required Components for Specimen Submission

    The following sections describe appropriate specimen preparation and submission required to ensure specimen safety and proper testing in DSHS Lab. Blood Tubes

    It is necessary to label each tube of blood or serum accurately, with the name and client ID exactly the way it is written on the Serology Submission Form. Container Sets

    Container sets are available in 3 sizes. The size should correctly match the size of the specimen being submitted. Containers may be ordered for: 1 specimen (small), 4 specimens (medium), and 7 specimens (large). A container set consists of a secondary container (plastic liner) with screw cap and an outer shipping container.

    For more information on lab mailing containers and supplies, call (512) 776-7661 or toll free at (888) 963-7111 ext.7661 Assembly

    Appropriate packaging will reduce the number of broken blood tubes.

    Gather the following components:

    1. Appropriate sized container set;

    2. Accurately labeled blood tubes;

    3. Absorbent material (e.g., cotton balls, gauze); and

    4. Paper towels. Shipping

    Use the following steps to package blood tubes for shipping:

    1. Line bottom of secondary container (plastic liner) with absorbent material (e.g., cotton balls, gauze);

    2. Wrap blood tubes in paper towels;

    3. Place wrapped blood tubes in the secondary container (plastic liner);

    4. Place absorbent material on top of the blood tubes;

    5. Screw on secondary container (plastic liner) cap securely;

    6. Place lab form around the outside of the secondary container (plastic liner);

    7. Place secondary container (plastic liner) in cardboard mailer; and

    8. Screw on metal cap.

    Questions on proper packaging and shipment of blood tubes should be directed to the Specimen Acquisition Branch (512) 776-7598

    For more information on shipping with commercial carriers please read over DSHS Laboratory Shipping Guidelines.

    Please note: Laboratory policy specifies ALL blood specimens in a container will be considered broken if one tube in that container is broken during shipment.

    1.7.3 Receiving Laboratory Test Results

    Contractors using the DSHS Laboratory can receive paper test results and access a Lab Portal to retrieve test results in a timely manner. Paper Laboratory Test Results

    Obtaining a Submitter Identification Number is required to submit specimens and receive documented results. A request form must be submitted to obtain a Submitter Identification Number. LabWare Retrieval for Test Results

    Sites submitting blood specimens to DSHS laboratories and using LabWare Remote Data System (RDA) must submit a Facility Security Agreement and User Security Rights and Confidentiality form to DSHS for each site. dshs.texas.gov/lab/rdsFAQ.shtm   

    1.8 Rapid HIV, Syphilis, and HCV Testing

    Contractors wishing to use DSHS resources for HIV, Syphilis, and/or HCV rapid testing must submit evidence to DSHS that their governing body has researched and established policies and procedures to reflect the effect HIV and HCV rapid testing will have on their facility including:

    1. Assurances that current insurance and other liability coverage is appropriate;

    2. Legal implications for conducting medical and laboratory procedures;

    3. Standing delegation order from contractor’s medical authority;

    4. Provisions for medical waste disposal; and

    5. Guidelines and standards developed by the Occupational Safety and Health Administration (OSHA) for occupational exposure through blood borne pathogens.

    Contractors should review the Field Use of the Rapid Syphilis Health Check (SHC) Test: Quality Assurance Plan (PDF) before implementing the Rapid Syphilis Health Check test.

    1.8.1 Clinical Laboratory Improvement Amendments (CLIA)

    Prior to implementing HIV, Syphilis, and/or HCV rapid testing, all agencies must have a current CLIA certificate of Compliance or Waiver.

    CLIA establishes quality standards for all laboratory testing to ensure the accuracy, reliability and timeliness of client test results, regardless of where the test was performed. Requirements are based on the complexity of the test and not the type of laboratory where the testing is performed.

    CLIA requires all facilities that perform even one test, including waived tests on, “materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings,” to meet certain Federal requirements. If a facility performs tests for these purposes, it is considered a laboratory under CLIA and must apply and obtain a certificate from CLIA program that corresponds to the complexity of tests performed.

    1.8.2 Applications and Waivers for Clinical Laboratory Improvement Amendments

    CLIA certificate of wavier and certificate application can be found at the following DSHS website: dshs.texas.gov/facilities/clia.aspx  

    The staff at the Health Facility and Licensing Compliance Division of DSHS can assist you in obtaining a CLIA certificate of waiver.

    1.9 Quality Assurance Requirements for HIV Testing

    Contractors must maintain policies and procedures to address quality assurance and training requirements. Written, step-by-step instructions for performing an HIV test (with all testing technologies available at the agency) should be made available to all testing personnel.

    Prior to conducting an HIV testing session, testing personnel must:

    1. Complete the necessary trainings as required by DSHS;

    2. Observe an experienced HIV tester conduct at least four HIV testing sessions; and

    3. Be observed by a supervisor conducting at least four HIV testing sessions.

    1.9.1 Staff Observations

    Observations of testing personnel must be conducted according to the following schedule:

    Observation Schedule
    Length of time the staff member has been performing HIV testing: HIV tester must be observed at least:
    3 months or less Twice a month
    4 to 6 months Twice a month
    7 to 12 months Monthly
    1 to 2 years Quarterly
    2 years or more Every 6 months

    1.9.2 Chart Reviews

    In addition to staff observations, supervisors must review client charts completed by the HIV tester during a testing session. For testing personnel with less than 6 months experience, supervisors must review no fewer than 10 charts monthly.

    For those with more than 6 months experience, supervisors may do either of the following:

    1. Review a minimum of 5 charts:

      • Monthly for HIV testers with 6-12 months of experience;

      • Quarterly for HIV testers 1-2 years of experience; and

      • Semi-annually for HIV testers with more than 2 years of experience.

    2. Conduct quarterly reviews of a random sample of 10% of the charts across testing personnel, ensuring a minimum of one chart for each HIV tester, for clients seen during that quarter.

    All client files with an HIV diagnosis must be reviewed by a designated supervisor.

    1.9.3 Rapid HIV Testing Quality Assurance

    Testing personnel must be trained to perform the rapid test, quality control and other related procedures. Testing personnel must follow instructions provided by the manufacturer for how to conduct the test.

    The rapid test kit package insert provides text that can be used as a procedure for steps in the testing process, including:

    1. Pretest information;

    2. Materials and storage;

    3. Test performance; and

    4. Quality control.

    Documentation must be maintained to confirm that external controls are being run according to the test manufacturer’s schedule and that test kits are properly stored.

    Helpful information for developing rapid HIV testing quality assurance guidelines can be found on the CDC website: cdc.gov/hiv/pdf/testing_qa_guidlines.pdf (PDF).

    1.10 List of Helpful Websites and Websites Referenced in Chapter 1

    The Use of Testing Technology to Detect HIV Infection Policy Number 2013.02 can be found at the following DSHS website: dshs.texas.gov/hivstd/policy/policies/2013-02.shtm

    Information regarding reportable diseases can be found at the following DSHS website: dshs.texas.gov/hivstd/reporting/

    Information regarding reporting preliminary positive rapid HIV test results can be found on the Technical Assistance page at the following DSHS website: dshs.texas.gov/hivstd/fieldops/techassist.shtm

    Information on HIV/STI training requirements can be found at the following DSHS website: dshs.texas.gov/hivstd/training/

    DSHS Laboratory information can be found at the following DSHS website: dshs.texas.gov/lab/

    Guidelines for specimen collection and submission can be found at the following DSHS website: dshs.texas.gov/lab/MRS_specimens.shtm

    Guidelines for specimen shipping and mailing can be found at the following DSHS website: dshs.texas.gov/lab/MRS_shipping.shtm

    Lab serology submission forms can be found at the following DSHS website: dshs.texas.gov/lab/mrs_forms.shtm#email

    Information on shipping with commercial carriers can be found at the following DSHS website: dshs.texas.gov/lab/MRS_shipping.shtm

    Information regarding how to obtaining a Submitter Identification Number can be found at the following DSHS website: dshs.texas.gov/lab/MRS_forms.shtm

    Information regarding Facility Security Agreement and User Security Rights and Confidentiality can be found at the following DSHS website: dshs.texas.gov/lab/rdsFAQ.shtm

    CLIA certificate of wavier and certificate application can be found at the following DSHS website: dshs.texas.gov/facilities/clia.aspx  

    Information on assistance from the Health Facility and Licensing Compliance Division for obtaining a CLIA certificate of waiver can be found at the following DSHS website: dshs.texas.gov/facilities/clia.aspx   

    Information for developing rapid HIV testing quality assurance guidelines can be found on the CDC website: cdc.gov/hiv/pdf/testing_QA_Guidlines.pdf (PDF)

    Centers for Disease Control and Prevention: cdc.gov

    Texas Constitution and Statutes: statutes.legis.texas.gov

    Health and Safety Code: statutes.legis.texas.gov/?link=HS

    Texas Family Code: statutes.legis.texas.gov/?link=FA

    U.S. Code: law.cornell.edu/uscode/text


    1.1 Focused HIV Testing and Linkage Protocols

    1.2 Confirmatory Testing

    1.3 Recruitment and Outreach

    1.4 Confidentiality

    1.5 Epidemiological Reports

    1.6 Risk Reduction Counseling

    1.7 Department of State Health Services Laboratory Specimen Submission

    1.8 Rapid HIV, Syphilis, and HCV Testing

    1.9 Quality Assurance Requirements for HIV Testing

    1.10 List of Helpful Websites and Websites Referenced in Chapter 1

    Last updated May 28, 2021