FHIR Clinical Guidelines

1. http://hl7.org/fhir/uv/cpg/examples/hiv/hiv-guideline.html

Elements

1. Factors Conferring “High Risk” Category Membership - Value Set Here

   1. Male-to-male sexual contact

   2. IV drug use

   3. Heterosexual or other contact with:

      • Anal intercourse without condom

      • Vaginal intercourse without a condom and with more than 1 partner whose HIV status is unknown

      • Individuals who exchange sex for drugs or money

      • Having STI

      • Partner with STI

      • Partner with HIV

      • Partner in other high-risk category above

   4. People requesting STI testing

   5. Patients with TB

2. Indication for immediate screening:

   • Healthcare exposure to blood or other infectious bodily fluid

   • Request for pre-exposure screening prior to new partner

Testing:

Pregnant women in labor, recommend Rapid HIV test—otherwise routine HIV testing

• Rapid testing: Rapid HIV test IF POSITIVE then:
  • also order HIV-1 and HIV-2 with HIV-1 p24 antigen IF POSITIVE then use routine testing pathway
• IF NEGATIVE:
• OR
• Routine testing: HIV-1 and HIV-2 antibodies with HIV-1 p24 antigen with reflex (automatic) supplemental testing if positive
• IF NEGATIVE: STOP
• AND: If supplemental testing indeterminate:

• HIV-1 RNA

• After all NEGATIVE testing:
  • Routine safe sex counseling
  • Consider offering PrEP
• After all POSITIVE testing:
  • Optimally there would be an HIV treatment CDS pathway triggered
  • At a minimum:
    • Counseling
    • Referral for HIV specialty treatment
    • HIV viral load test