PURPOSE: This rule defines the manner in which the sampling and client-centered counseling for HIV antibody testing is to be administered by persons authorized by the Department of Health and positive test results reported to the Department of Health and positive tests results reported to the Department of Health.

PUBLISHER’S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.

1. (1) The following definitions shall be used in administering this rule:

   1. (A) Department means the Missouri Department of Health;
   2. (B) Health care professional means a state licensed professional involved in direct patient care, other than those persons licensed as physicians under Chapter 334, RSMo; and
   3. (C) Window period means the interval between exposure to HIV and development of a positive HIV test.

2. (2) Except as provided by 19 CSR 20-26.040, a person performing HIV sampling and preand posttest counseling services shall be a health care professional or other public health professional authorized by the Department of Health to provide these services and shall provide current and accurate HIV education and testing information in person to the person tested or his or her legal guardian or custodian. If, after investigation by a department employee, the person responsible for providing preand posttest counseling services is determined not to be observing the provisions of this rule, the department shall deny authorization.

   1. (A) Pretest client-centered counseling shall occur before HIV sampling and include a knowledge and risk assessment of the person to be tested to determine the person’s potential for exposure and infection. The person to be tested shall be asked about his/her basic HIV knowledge, and if such knowledge is lacking, advised of the means of HIV transmission and the meaning of the test results. Informed consent shall be obtained from the person prior to HIV testing, unless otherwise permitted by law. A plan to receive test results shall be established with the person.
   2. (B) Posttest client-centered counseling shall be provided to all persons tested for 19 CSR 20-26

HIV infection. It shall include the test results and their significance, risk reduction and prevention information, and referral of the person to medical care and other support services as needed. If the test results are positive, included in the posttest counseling, there shall be a discussion of the client’s responsibility to ensure that sex/needle-sharing partners are advised of their potential exposure to HIV. If the test result are negative, the person tested shall be advised of the window period and possible need for retesting if exposure has occurred within the window period. If the test results are equivocal, the person shall be advised of the need for retesting.

1. (C) If the test results are positive, the identity of the person tested along with related clinical and identifying information shall be reported to the department or its designated representative by the person who performs or conducts HIV sampling within three (3) days of receipt of the test results on forms provided by the Department of Health (see Form #1 incorporated into this rule by reference).
2. (D) Client-centered counseling shall be utilized, as outlined by the current Centers for Disease Control and Prevention HIV Partner Counseling and Referral Services (PCRS) Guidance. This method of counseling shall include the following basic elements: a) encourage client participation by informing, reassuring and developing an atmosphere of trust for the client; b) formulating a realistic PCRS plan to assist HIV negative persons to stay negative and HIV positive persons to access support services; and c) assist the HIV positive person in developing a plan for contact tracing and partner notification services.

3. (E) Sites testing persons under the following situations shall be exempt from reporting the identity of persons testing positive for HIV. These sites shall report HIV positive test results as well as related clinical and other information within three (3) days of receipt of the test results on forms provided by the Department of Health (see Form #1), but shall be exempt from reporting the patient’s name and street address—instead a unique patient identifier shall be used:

   1. 1. Persons tested anonymously at

department-designated anonymous testing sites;

1. 2. Persons tested as part of a research

project that is approved by an institutional review board and as part of the research, subjects are tested for HIV infection. Written documentation of institutional review board approval must be submitted to the department’s Office of Surveillance; or

1. 3. Where prohibited by federal law or

regulation.

1. (F) Laboratories which perform HIV testing shall report identifying information as specified in 19 CSR 20-20.080.
2. (G) All persons reported with HIV infection to the department or its designated representative shall be contacted by public health personnel for partner elicitation/notification services according to protocols and procedures established by the department.

3. (H) The following material is incorporated into this rule by reference:

   1. 1. U.S. Department of Health and

Human Services, Centers for Disease Control and Prevention, HIV Partner Counseling and Referral Services (PCRS) Guidance, December 1998.

AUTHORITY: sections 191.653, 191.656 and 192.006, RSMo Supp. 1999 and 192.020, RSMo 1994.* Original rule filed March 14, 1989, effective July 13, 1989. Rescinded and readopted: Filed April 14, 1992, effective Dec. 3, 1992. Emergency amendment filed June 1, 2000, effective June 15, 2000, expired Dec. 11, 2000. Amended: Filed June 1, 2000, effective Nov. 30, 2000. *Original authority: 191.653, RSMo 1988, amended 1996; 191.656, RSMo 1988, amended 1992, 1993, 1996, 1999; 192.006, RSMo 1993, amended 1995; 192.020, RSMo 1939, amended 1945, 1951.