The CDNA has published updated guidelines which include expert consensus in relation to health-care workers and their blood-borne virus (BBV) status.34,35 The 2018 guidelines state that all health-care workers should be aware of their BBV status and all health-care workers who perform exposure prone procedures (EPPs) must take reasonable steps to know their BBV status and should be tested for BBVs at least once every 3 years. Health-care workers who perform EPPs and assess their risk of exposure to be high should consider more frequent BBV testing. Examples of EPPs can be found in the CDNA’s information sheet Guidance on classification of exposure prone and non-exposure prone procedures in Australia. Additionally, all student health-care workers should be aware of their BBV status and should be offered testing at or before entry to their course.33
Any HIV testing done in the above context should be performed in accordance with this policy. Where testing of a health-care worker is undertaken, confidentiality is paramount and must be maintained. If a health-care worker who performs EPPs tests positive for HIV infection, they must stop performing these procedures immediately and seek specialist advice.33 The CDNA’s guidelines (2018) provide very clear advice about the circumstances in which a health-care worker who has been diagnosed with HIV can perform EPPs.33 If the health-care worker is found to have HIV infection, adequate confidential psychosocial support should be provided.
To meet CDNA guideline requirements, testing of health-care workers should be performed in accredited laboratories. Health-care workers should not perform or request tests on themselves, including laboratory tests, and self-testing in any form does not meet CDNA testing requirements.
Antenatal HIV testing is recommended for all pregnant women and should be included as routine in tests associated with the first antenatal visit, in line with the Department of Health Clinical Practice Guidelines: Pregnancy Care (2019) 36 and 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.37 The woman should be informed about the tests being performed, including HIV testing, as part of the antenatal screen and should provide consent.
Jurisdictions should develop operational directives that support the RANZCOG guidelines through education and feedback on adherence, and that allow for periodic auditing of antenatal medical records to provide evidence that recommendations for best practice are being followed. These recommendations should include a clear referral pathway for women who are diagnosed with HIV so that they can be managed by appropriate specialist teams.
HIV testing with nucleic acid direct detection tests (such as proviral DNA) of infants of women with HIV infection should be performed within the first month after birth in parallel with testing of the mother, so that appropriate treatment interventions can be implemented quickly. 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 mothers with HIV infection is complex and expert advice must be sought promptly.38,39
Currently there are no HIV nucleic acid tests approved by the TGA for this purpose in Australia and there is no MBS reimbursement. However, access to an unapproved device can be sought from the TGA through certain exemption provisions (Special Access Scheme).
Australian prisoners are at high risk of contracting blood-borne viruses, including HIV, arising from their exposure to risks such as injecting drug use, sexual risk behaviours, amateur tattooing, body piercing, and violence resulting in injury. 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. Making HIV testing available has clear benefits for the individual, their sexual partners, those with whom they may share equipment for skin penetration (including injecting equipment) and 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. High and unpredictable rates of prisoner movement between different correctional facilities and the community can create difficulty in ensuring engagement with care after a positive diagnosis. As a result, offering the use of point-of-care HIV testing in clinical practice in prisons may increase testing rates and facilitate the timely and accurate diagnosis of HIV.