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7.0 Testing in Specific Populations

Posted in: HIV

7.1 Health care workers

CDNA, (Communicable Diseases Network of Australia)[i] professional societies, colleges and registration boards may, from time to time, publish guidelines regarding the testing of health professionals. Any HIV testing done in that context must be done in accordance with this Policy. Where testing of a health care worker is undertaken, confidentiality is paramount and must be maintained.

Previous iterations of the National HIV Testing Policy have stipulated that health care workers must not perform tests on themselves. This was written from the perspective of diagnostic testing when HIV point-of-care tests were not registered in Australia as screening tests.  In the event that a test is registered for self-testing, health care workers’ use of such a test would be impossible to regulate. The principle remains that health care workers should be encouraged to seek appropriate clinical care for themselves and not to attempt to self-diagnose or self-manage HIV, and if found to be infected to monitor their health with the aid of an HIV clinician.

7.2 Routine antenatal testing

Antenatal HIV testing should be recommended for all women and should be included as routine in tests associated with the first antenatal visit, in line with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) guidelines which state that, in the absence of complications, “all pregnant women should be recommended to have HIV screening at the first antenatal visit”(RANZCOG, 2009).[ii] The woman should be informed about the tests being performed as part of the antenatal screen, including HIV testing and provide consent. 

Jurisdictions should develop operational directives that support the RANZCOG guidelines through education and feedback on compliance allow for periodic auditing of antenatal medical records to provide evidence of recommended best practice. These should include a clear referral path for women who are diagnosed with HIV so that they can be managed by appropriate specialist teams[iii],[iv],[v]

7.3 Testing of infants born to HIV positive mothers

HIV testing with nucleic acid direct detection tests (such as proviral DNA) on infants of HIV-infected women should be performed within the first month after birth, so that appropriate treatment interventions can be implemented quickly. These tests are not registered for this purpose in Australia, and there is no MBS reimbursement. Antibody tests are not helpful in this context due to the persistence of maternal antibodies in the infant for up to 18 months. Diagnosis of HIV infection in infants born to HIV-infected mothers is complex and expert advice must be sought promptly.[vi]

7.4 Aboriginal and Torres Strait Islander people

The 4th National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy 2014-2017[vii] prioritises testing for and treatment of STIs (including HIV) through annual, routine, systematic testing programs. Policies and guidelines which respect confidentiality must be developed locally, so that health care workers are correctly advised and health services generate culturally appropriate policies and programs.

7.5 Testing in prisons

Australian prisoners are at high risk of contracting blood-borne viruses, including HIV, arising from their engagement in risk behaviours such as injecting drug use, sexual risk behaviours, amateur tattooing, body piercing, and violence. Offering HIV testing to prisoners during incarceration has the potential to identify new cases of HIV infection, allowing for prevention education, appropriate assessment, treatment and referral post-release. This has clear benefits to the individual, their sexual partners, those with whom they may share equipment for skin penetration (including injecting equipment) and to the wider community.

Australian prisoners should be able to access free, voluntary, confidential, timely, non-discriminatory HIV testing, counselling and treatment services during incarceration, in accordance with this Policy. One of the difficulties in testing prisoners is their high rate of mobility between prisons and the difficulty in reliably getting laboratory test results delivered.  As a result, offering the use of point of care HIV testing in clinical practice in prisons may increase testing rates and facilitate diagnosis of HIV.



[i] Australian Government. Department of Health. Communicable Diseases Network Australia (CDNA). Available at: http://www.health.gov.au/cdna

(Cited 5 May 2015).

[ii] Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Routine antenatal assessment in the absence of pregnancy complications (College statement: C-Obs-3). November2009. Available at: http://www.testingportal.ashm.org.au/resources/C-Obs_3_(b)_Routine_Antenatal_Assessment_in_the_Absence_of_Pregnancy_Complications_NEW_Mar_13.pdf  (Cited 9 July 2015)

[iii] Ibid

[v] Australasian Society for HIV Medicine (ASHM). Making a new HIV diagnosis. Available at:

http://www.ashm.org.au/hiv/prevention-testing-and-diagnosis/making-new-diagnosis(Cited 5 May 2015).May need easy URL

[vi] Sydney Children’s Hospital. Paediatric HIV Service. Antenatal screening for HIV. Information for health professionals. December 2011. Available at: http://testingportal.ashm.org.au/resources/practitioners/Antenatal_Screening_on_HIV.pdf  (Cited 5 May 2015)

[vii] Australian Government (2014) Aboriginal and Torres Strait Islander BBV & STI Strategy 2014 – 2017 http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-atsi (Cited 5 May 2015)

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