All pathology testing requires informed consent, given verbally. Informed consent for testing means that the person being tested agrees to be tested on the basis of understanding the testing procedures and the reasons for testing, and is able to assess the personal implications. As people with a history of injecting drug use often experience significant barriers to accessing health services, it is critical that testing is conducted in an appropriate, non-judgemental and non-stigmatising setting to assist people with a history of injecting drug use through the testing and diagnosis process. This approach will markedly improve a person’s understanding of their condition and their likelihood of future engagement with the health system. Peer education and support will optimise testing uptake and risk disclosure and is recommended where these resources are available. All clinical staff should be cognisant of issues relating to illicit drug use, harm reduction, addressing stigma and discrimination and managing vein care issues.
Informed consent is required for HCV testing, except for rare occasions when a legal order is made for compulsory testing or in emergency settings. See section Mandatory and compulsory testing.
On these rare occasions where informed consent cannot be attained, the person being tested should be given all appropriate information before the test. The person performing the test should use their clinical judgement in securing informed consent. The decision should be based on their understanding of the context in which the test is being performed, taking into account:
- the factors which indicate a need for testing such as clinical presentation, risk exposure, community prevalence and patient request for testing
- an assessment of the understanding of the HCV testing process and the consequences of the result to the person being tested
- that patients should also be advised how the test result will be conveyed and the implications of HCV being a notifiable disease.
General principles of professional conduct apply in the case of HCV testing and informed consent. See Fact sheet for clinicians: Informed consent in health care.40
Consent to test should not be sought from sexual partners or family members of the person being tested. In the case of testing a child or person who is incapable of giving consent (perhaps due to mental illness or cognitive disability) then the responsibility for consent rests with the guardian or other person or agency legally authorised to make such decisions on their behalf.
Additional supports are available to assist the person considering testing to become adequately informed and to maintain equality of health outcomes. This information includes referral to the support groups listed in section 5.3, and access to publicly funded and accredited telephone interpreters (available nationally for use by private and public healthcare professionals).41 The Translating and Interpreting Service (TIS National) is available to doctors 24 hours a day. TEL: 1300 131 450. Culturally relevant information should be provided when seeking informed consent and providing results.42
The person being tested needs to be made aware of patient rights and responsibilities.43
Where data generated through testing are also used for research, the principles and requirements set out in the National Health and Medical Research Council’s National Statement on Ethical Conduct in Human Research must be followed.16