Timely turnaround of results will vary by hospital site depending on factors such as laboratory equipment and staffing capacity, ED capacity, and geographic location. EDs should work directly with their hospital laboratory director to determine what is possible in their setting. Ideal test turnaround occurs while patients are still in the ED to facilitate immediate treatment and care linkage. Some newer generation laboratory-based machines can perform all three tests (HIV antigen/antibody, syphilis TPA, and Hepatitis C antibody) in less than an hour.

Ideal test turnaround occurs while patients are still in the ED to facilitate immediate treatment and care linkage. However, screening tests are not required to be performed in the hospital laboratory. Standard operating procedures for disclosure, treatment, and linkage to care should account for delay in returned test results when performed outside of the hospital to ensure appropriate follow up and management of patients who test positive.

• Syphilis: TPA, TPPA, TPHA, FTA-ABS, EIA, CIA, and RPR
• HIV: HIV 1 & 2 antigen/antibody tests, HIV 1 & 2 antibody tests (aka HIV 1 & 2 differentiation tests) and HIV NAAT and/or HIV Viral load by RNA PCR, HIV genotype testing
• Hepatitis C: HCV antibody, HCV RNA (quantitative or qualitative), HCV genotype testing

• Point-of-care tests can support timely follow-up with patients as results are available before a patient leaves the ED. Patients with reactive point-of-care tests can be treated empirically (as appropriate) and linked to care while waiting for confirmatory testing.

• Point-of-care tests are done under a laboratory CLIA-waiver license, so it’s important to gain lab director buy-in to implement this type of testing.

• Specimens for point-of-care testing can come from standard HIV, HCV, or syphilis rapid finger stick collection, from drawn blood samples (e.g., venipuncture), or from oral fluid if using the HIV OraQuick Advance test kit. 

• Point-of-care, CLIA waived tests require space and a staffed parallel workflow. Point-of-care tests must sit flat (e.g., on a table) and can be performed bedside or in a separate space (e.g., lab or secure room). Space and workflow considerations also include the need to set up multiple point-of-care tests over time and to read the result of each test at the correct time.

• • Depending on the test, it can take 1 – 20 minutes to process so a staff member will need to operate a timer for each test and read the individual test when each one has completed the processing time period. This typically requires having a process where a staff member (e.g., MA, RA) is seeing patients in parallel to the clinician.  

• • It’s important to consider whether the test can be completed at the patient’s bedside or if it will need to be placed in a secure room while resulting. It may be easier to conduct the test before a patient goes into a room, and then read the results once they are in a room.
• It is best practice to send confirmatory tests for any reactive point-of-care tests.
• Additional Point-Of-Care Implementation Resources:
  
  • Syphilis Health Check – Rapid Point-of-Care Syphilis Testing Fact Sheet and Frequently Asked Questions (CDPH)
  • Implementing HIV Testing in Nonclinical Settings: A Guide for HIV Testing Providers (CDC)
  • AB 446 HIV testing (CDPH) This letter outlines the key changes for HIV testing in healthcare settings resulting from AB 446 & provides additional implementation resources. For additional information regarding the requirements of AB 446, please visit Bill Text – AB-446 HIV testing, and HSC 120990: Law section.
  • HCV Testing in Non-Health Care Settings – Guidelines for Site Supervisors and Testing Coordinators (CDPH)
  • Quality Assurance Guidelines for OraQuick HCV Antibody Testing in Non-Healthcare Settings (CDPH)
  • Quality Assurance Plan Template for OraQuick HCV Antibody Testing in Non-Healthcare Settings (CDPH)
  • Hepatitis C Testing – Frequently Asked Questions (CDPH)
  • Senate Bill 306 Fact Sheet – HIV, HCV, and STI Test Counselor Training (CDPH)

Performing reflexive confirmatory testing automatically for any reactive tests is considered best practice and supports the patient-centered, low-barrier access to care goals of the program. This averts missed opportunities that may arise from referring patients to an outpatient lab for an additional appointment and blood draw. Automated reflexive testing also supports timely identification, treatment and linkage to care.

Laboratories carrying out testing for syphilis, HIV and/or HCV may consider a variety of factors when selecting from available test systems. These include cost, turn-around-time, anticipated volume, speed of implementation, and their site’s existing base system/analyzer equipment. Some newer generation laboratory-based machines can perform all three tests (HIV antigen/antibody, syphilis TPA, and Hepatitis C antibody) in less than an hour. Sometimes increased test volume, as a result of routine screening, may qualify for volume discounts on reagent ordering. 

Sites without resources to purchase test systems can consider other practices to increase lab turnaround times. For example, utilizing a once-a-day courier to a local commercial or public health lab that can provide rapid turnaround (within 24 hours for a screening result) can increase opportunities to quickly link patients to care.