What's new? | HIV
The Expert Reference Committee met via teleconference from November 2018 to November 2019 to review the HIV Testing Policy v1.4. Each section of the Testing Policy was systematically reviewed during these conversations. The recommended changes were incorporated in the revised HIV Testing Policy v1.5.
In 2020, the Blood Borne Viruses and Sexually Transmissible Infections Standing Committee endorsed the HIV Testing Policy v1.5. The Testing Policy was then formally re-named the National HIV Testing Policy.
Some of the amendments made during this review were minor wording changes to aid clarification, revisions to include reference to The Eighth National HIV Strategy 2018-2022, and updates to statistical information. Other more significant changes made included:
Principles for HIV testing
This policy now incorporates the World Health Organization’s five principles of testing: consent, confidentiality, counselling, correct test results, and connection/linkage to prevention, care and treatment.
The list of principles for HIV testing has been expanded to include principles of point-of-care testing, HIV testing in the context of pre-exposure prophylaxis (PrEP), and quality assurance mechanisms for testing services.
Section: Types of HIV Testing
HIV seroconversion period
A new addition to the policy, this section explains the length of time required before an HIV test can detect any markers of HIV infection. A clinician can say with confidence that a person with a negative HIV antibody test has not acquired HIV infection after 12 weeks, provided there has not been any further risk exposure. This approach considers all antibody-based tests, including rapid HIV tests, where longer seroconversion periods have been observed.
Point of care testing
Additional references to Australian evaluations of point-of-care tests used within high HIV incidence populations have been added to this section.
In 2018, the first self-testing device was approved by the Therapeutic Goods Administration (TGA) in Australia. This section has been expanded to explain the benefits of self-testing and the TGA’s requirements for self-testing devices to be approved in Australia.
Novel testing technologies and sample collection processes
This section now combines with the section Self sampling for HIV testing found in the previous version of this policy.
The policy notes that there is no TGA-approved HIV test that is intended for use with self-collected samples such as oral fluid or dried blood spots. However, there are various provisions for exemption, such as for a clinical trial, that allow for regulated access to unapproved devices. The TGA provides guidance on accessing unapproved devices, available here.
Local and international studies regarding use of self-sampling have been added.
Section: Indications for HIV testing
Indications for HIV Testing
This section has been expanded to include more behavioural, epidemiological and clinical indicators for testing. A table of clinical indicator conditions for HIV testing has been added.
HIV testing in the context of surveillance
There may be circumstances where, on public health grounds (e.g. prevalence studies), anonymous delinked testing is legitimately performed in accordance with this policy. The policy recommends that those who are responsible for a project should consider making test results available on a confidential basis to participants who wish to receive their results. Examples of research supporting this and guidelines for bio-behavioural studies have been added to this section.
Mandatory and compulsory screening and testing
This policy recommends that, in situations where testing is being undertaken to exclude transmission of HIV, the agency that requires the test to be performed should use the most sensitive available laboratory test (i.e. tests that directly detect the HIV virus) rather than antibody tests such as antigen or nucleic acid tests.
Public health management of HIV
A link has been updated to refer to the National Guidelines for Managing HIV Transmission Risk Behaviours 2018.
Section: Informed Consent for HIV Testing
This section has been summarised to to provide readers a succinct explanation of the requirements for informed consent of a HIV test.
Section: Conveying HIV Test Results
This section has been expanded to discuss the psychological impacts of a positive HIV diagnosis. A link to the National Standards for Psychological Support for Adults with HIV has been added.
Confidentiality of HIV test results and testing data
Additional text has been written to include reference to the storing of HIV data on MyHealthRecord.
Section: Surveillance and Research
Data linkage projects
An example of an approved framework for the linkage of HIV notification data in NSW has been added.
Section: Testing in specific populations
This section now reflects the updated guidelines published by the Communicable Diseases Network of Australia (CDNA) in 2018 regarding health-care workers and their blood-borne virus status.
Testing of infants born to HIV-positive mothers
A link to the Therapeutic Goods Administration’s Special Access Scheme has been added.
Section: Quality Assurance of In-vitro Diagnostic Medical Devices (IVDs) for HIV Testing
Post-market quality assurance of HIV IVDs
This section has been rewritten in recognition of the National Association of Testing Authorities (NATA) and National Pathology Accreditation Advisory Council (NPAAC) standards and guidelines for performing HIV testing in diagnostic pathology laboratories.
Section: Funding of HIV testing
This section has been updated to advise that currently, no tests performed outside of accredited laboratories are eligible for MBS rebate, including approved self-tests which are purchased by the end user.