FHIR Clinical Guidelines

Elements

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
Indication for immediate screening:
- Healthcare exposure to blood or other infectious bodily fluid
- Request for pre-exposure screening prior to new partner

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

HIV Screening Protocol