Current through Register Vol. 39, No. 6, September 16, 2024
The following are the control measures for the Human
Immunodeficiency Virus (HIV) infection:
(1) Persons diagnosed with HIV infection
(hereafter "person living with HIV") shall:
(a) refrain from sexual intercourse unless
condoms are used except when:
(i) the person
living with HIV is in HIV care, is adherent with the treatment plan of the
attending physician, and has been virally suppressed for at least 6 months (HIV
levels below 200 copies per milliliter) at the time of sexual
intercourse;
(ii) the sexual
intercourse partner is HIV positive;
(iii) the sexual intercourse partner is
taking HIV Pre-Exposure Prophylaxis (PrEP) - antiretroviral medication used to
prevent HIV infection as directed by an attending physician; or
(iv) the sexual intercourse occurred in the
context of a sexual assault in which the person living with HIV was the
victim;
(b) not share
needles or syringes, or any other drug-related equipment, paraphernalia, or
works that may be contaminated with blood through previous use;
(c) not donate or sell blood, plasma,
platelets, other blood products, semen, ova, tissues, organs, or breast milk,
except when:
(i) The person living with HIV is
donating organs as part of a clinical research study that has been approved by
an institutional review board under the criteria, standards, and regulations
described in 42 USC
274f-5(a) and (b);
or, if the United States Secretary of Health and Human
Services determines under USC 274f-5(c) that participation in this clinical
research is no longer warranted as a requirement for transplants, and the organ
recipient is receiving the transplant under the criteria, standards, and
regulations of USC 274f-5(c); or
(ii) Sperm or ova are harvested under the
supervision of an attending physician to be used by the person's spouse or
partner for the purpose of achieving pregnancy.
(d) have a test for tuberculosis;
(e) notify future sexual intercourse partners
of the infection, unless the person living with HIV meets the criteria listed
in Sub-item (1)(a)(i) of this Rule. If the person living with HIV is the victim
of a sexual assault, there is no requirement to notify the assailant;
(f) if the time of initial infection is
known, notify persons who have been sexual intercourse or needle-sharing
partners since the date of infection or give the names to a disease
intervention specialist employed by the local health department or by the
Division of Public Health for contact tracing and notification; and
(g) if the date of initial infection is
unknown, notify persons who have been sexual intercourse or needle-sharing
partners for the previous 12 months or give names to a disease intervention
specialist employed by the local health department or by the Division of Public
Health for contact tracing of all sexual and needle-sharing partners for the
preceding 12 months.
(2)
The attending physician shall:
(a) give the
control measures in Item (1) of this Rule to patients living with HIV in
accordance with
10A NCAC
41A .0210;
(b) advise persons living with HIV to notify
all future sexual partners of infection;
(c) If the attending physician knows the
identity of the spouse of the person living with HIV and has not, with the
consent of the person living with HIV, notified and counseled the spouse, the
physician shall list the spouse on a form provided by the Division of Public
Health and shall send the form to the Division by secure transmission, required
by 45 CFR
164.312(e)(1), or by secure
fax at (919) 715-4699. The Division shall undertake to counsel the spouse and
the attending physician's responsibility to notify exposed and potentially
exposed persons shall be satisfied by fulfilling the requirements of Sub-Items
(2)(a) and (c) of this Rule;
(d)
advise persons living with HIV concerning proper methods for the clean-up of
blood and other body fluids;
(e)
advise persons living with HIV concerning the risk of perinatal transmission
and transmission by breastfeeding.
(3) The attending physician of a child living
with HIV who may pose a significant risk of transmission in the school or day
care setting because of open, oozing wounds or because of behavioral
abnormalities shall notify the local health director. The local health director
shall consult with the attending physician and investigate the following
circumstances:
(a) If the child is in school
or scheduled for admission and the local health director determines that there
may be a significant risk of transmission, the local health director shall
consult with an interdisciplinary committee, which shall include school
personnel, a medical expert, and the child's parents or legal guardians to
assist in the investigation and determination of risk. The local health
director shall notify the superintendent or private school director of the need
to appoint this interdisciplinary committee. Significant risk of transmission
shall be determined in accordance with the HIV Risk and Prevention Estimates
published by the Centers for Disease Control and Prevention, which are hereby
incorporated by reference including subsequent amendments and editions. A copy
of this publication can be accessed at no cost online at
https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html.
(i) If the superintendent or private school
director establishes this committee within three days of notification, the
local health director shall consult with this committee.
(ii) If the superintendent or private school
director does not establish this committee within three days of notification,
the local health director shall establish this committee.
(b) If the child is in school or scheduled
for admission and the local health director determines, after consultation with
the committee, that a significant risk of transmission exists, the local health
director shall:
(i) notify the parents or
legal guardians;
(ii) notify the
committee;
(iii) assist the
committee in determining whether an adjustment can be made to the student's
school program to eliminate significant risks of transmission;
(iv) determine if an alternative educational
setting is necessary to protect the public health;
(v) instruct the superintendent or private
school director concerning protective measures to be implemented in the
alternative educational setting developed by school personnel; and
(vi) consult with the superintendent or
private school director to determine which school personnel directly involved
with the child need to be notified of the HIV infection in order to prevent
transmission and ensure that these persons are instructed regarding the
necessity for protecting confidentiality.
(c) If the child is in day care and the local
health director determines that there is a significant risk of transmission,
the local health director shall notify the parents or legal guardians that the
child must be placed in an alternate child care setting that eliminates the
significant risk of transmission.
(4) When health care workers or other persons
have a needlestick or nonsexual non-intact skin or mucous membrane exposure to
blood or body fluids that, if the source were HIV positive, would pose a
significant risk of HIV transmission, the following shall apply:
(a) When the source person is known:
(i) The attending physician or occupational
health care provider responsible for the exposed person, if other than the
attending physician of the person whose blood or body fluids is the source of
the exposure, shall notify the attending physician of the source that an
exposure has occurred. The attending physician of the source person shall
discuss the exposure with the source and, unless the source is already known to
be living with HIV, shall test the source for HIV infection with or without
consent unless it reasonably appears that the test cannot be performed without
endangering the safety of the source person or the person administering the
test. If the source person cannot be tested, any existing specimen shall be
tested. The attending physician of the source person shall notify the attending
physician of the exposed person of the infection status of the
source.
(ii) The attending
physician of the exposed person shall inform the exposed person about the
infection status of the source, offer testing for HIV infection as soon as
possible after exposure and at reasonable intervals until the interval since
last exposure is sufficient to assure detection using current CDC HIV testing
guidelines, and, if the source person was HIV positive, give the exposed person
the control measures listed in Sub-Items (1)(a) through (c) of this Rule. The
CDC HIV testing guidelines are hereby incorporated by reference including
subsequent amendments and editions. The CDC HIV testing guidelines can be
accessed at no cost online at
https://www.cdc.gov/hiv/guidelines/testing.html,with
the most current updates found at
https://stacks.cdc.gov/view/cdc/23447.The
attending physician of the exposed person shall instruct the exposed person
regarding the necessity for protecting confidentiality of the source person's
HIV status.
(b) When the
source person is unknown, the attending physician of the exposed persons shall
inform the exposed person of the risk of transmission and offer testing for HIV
infection as soon as possible after exposure and at reasonable intervals until
the interval since the last exposure is sufficient to assure detection using
the current CDC HIV testing guidelines.
(c) A health care facility may release the
name of the attending physician of a source person upon request of the
attending physician of an exposed person.
(5) The attending physician shall notify the
local health director when the physician has cause to suspect a patient living
with HIV is not following or cannot follow control measures and is thereby
causing a significant risk of transmission. Any other person may notify the
local health director when the person has cause to suspect a person living with
HIV is not following control measures and is thereby causing a significant risk
of transmission.
(6) When the local
health director is notified pursuant to Item (5) of this Rule of a person who
is mentally ill or intellectually impaired, the local health director shall
confer with the attending mental health physician or Local Management
Entity/Managed Care Organization and the physician, if any, who notified the
local health director to develop a plan to prevent transmission.
(7) The Division of Public Health shall
notify the Director of Health Services of the North Carolina Department of
Public Safety and the prison facility administrator when any person confined in
a state prison is determined to be living with HIV. If the prison facility
administrator, in consultation with the Director of Health Services, determines
that a confined person living with HIV is not following or cannot follow
prescribed control measures, thereby presenting a significant risk of HIV
transmission, the administrator and the Director shall develop and implement
jointly a plan to prevent transmission, including making recommendations to the
unit housing classification committee.
(8) The local health director shall ensure
that the health plan for local jails include education of jail staff and
prisoners about HIV, how it is transmitted, and how to avoid acquiring or
transmitting this infection.
(9)
Local health departments shall provide counseling and testing for HIV infection
at no charge to the patient. Third party payers may be billed for HIV
counseling and testing when such services are provided and the patient provides
written consent.
(10) HIV pre-test
counseling is not required. Post-test counseling for persons i living with HIV
is required, must be individualized, and shall include referrals for medical
and psychosocial services and control measures counseling.
(11) Notwithstanding Rule .0201(d) of this
Section, a local or state health director may require, as a part of an
isolation order issued in accordance with
G.S.
130A-145, compliance with a plan to assist
the individual to comply with control measures. The plan shall be designed to
meet the specific needs of the individual including linkage to care and may
include referral to one or more of the following available and appropriate
services:
(a) substance abuse counseling and
treatment;
(b) harm reduction
services;
(c) mental health
counseling and treatment required to prevent transmission;
(d) education and counseling sessions about
HIV, HIV transmission, and behavior change required to prevent transmission;
and
(e) intimate partner violence
intervention services.
(12) The Division of Public Health shall
conduct a partner notification program to assist in the notification and
counseling of partners of persons living with HIV.
(13) Every pregnant woman shall be offered
HIV testing by her attending physician at her first prenatal visit and in the
third trimester. The attending physician shall test the pregnant woman for HIV
infection, unless the pregnant woman refuses to provide informed consent
pursuant to
G.S.
130A-148(h). If there is no
record at labor and delivery of an HIV test result during the current pregnancy
for the pregnant woman, the attending physician shall inform the pregnant woman
that an HIV test will be performed, explain the reasons for testing, and the
woman shall be tested for HIV without consent using a rapid HIV test unless it
reasonably appears to the clinician that the test cannot be performed without
endangering the safety of the pregnant woman or the person administering the
test. If the pregnant woman cannot be tested, an existing specimen, if one
exists that was collected within the last 24 hours, shall be tested using a
rapid HIV test. The attending physician must provide the woman with the test
results as soon as possible.
(14)
If an infant is delivered by a woman with no record of the result of an HIV
test conducted during the pregnancy and if the woman was not tested for HIV
during labor and delivery, the fact that the mother has not been tested creates
a reasonable suspicion pursuant to
G.S.
130A-148(h) that the newborn
has HIV infection and the infant shall be tested for HIV. An infant born in the
previous 12 hours shall be tested using a rapid HIV test
(15) Testing for HIV may be offered as part
of routine laboratory testing panels using a general consent that is obtained
from the patient for treatment and routine laboratory testing, so long as the
patient is notified that they are being tested for HIV and given the
opportunity to refuse.
Authority
G.S.
130A-135;
130A-144;
130A-145;
130A-148(h);
Temporary Rule Eff. February 1, 1988, for a period of 180 days to expire on
July 29, 1988;
Eff. March 1, 1988;
Amended Eff.
February 1, 1990; November 1, 1989; June 1, 1989;
Temporary
Amendment Eff. January 7, 1991 for a period of 180 days to expire on July 6,
1991;
Amended Eff. May 1, 1991;
Recodified from
15A NCAC
19A .0201 (d) and (e) Eff. June 11,
1991;
Amended Eff. August 1, 1995; October 1, 1994; January 4,
1994; October 1, 1992;
Temporary Amendment Eff. February 18, 2002;
June 1, 2001;
Amended Eff. January 1, 2018; November 1, 2007; April
1, 2005; April 1, 2003;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. January 9,
2018.
