In June 1981, the CDC issued its first warning about a rare form of pneumonia, which later was determined to be AIDS-related. It's been almost 30 years since HIV/AIDS first appeared on the health community's radar. How do you think dentists' attitudes towards treating patients with HIV/AIDS have changed in that time?
Under the Americans with Disabilities Act (AwDA), dentists have a legal obligation to treat patients with HIV/AIDS. I believe that over the past 28 years we as healthcare providers have become more educated (and less ignorant) about the disease and have become less prejudice towards those suffering from HIV/AIDS. Dentists who have been properly educated and practice universal precautions are more likely to have more positive attitudes today and are not concerned about contracting HIV/AIDS during treatment.
Who performs the rapid oral HIV test?
My entire staff (including administrative staff) is trained to perform the rapid oral HIV test. However, when performing the test in the office during routine patient care, we've decided to have only the licensed clinical staff (dentist and hygienist) perform the test with patients while the administrative staff keeps track of the time. When performing the test off site, like at health fairs, the entire staff will aid in testing and keeping time.
How often do you recommend patients receive the rapid oral HIV test?
I recommend that all patients who have never been tested for HIV, at least get tested once to confirm their status.
The CDC recommends patients to consider getting tested at least once a year for those who engage in behaviors that can transmit HIV infection. These include:
- Injecting drugs or steroids with used injection equipment
- Having sex for money or drugs
- Having sex with an HIV-infected person
- Having more than one sex partner since your last HIV test
- Having a sex partner who has had other sex partners since your last HIV test
Because it can take up to 4-6 weeks for HIV antibodies to appear in the body after initial exposure, we recommend the following:
For those who have tested preliminary negative, but may have engaged in risky behavior or may have been exposed 3 months prior to taking the test, we advise taking a repeat test 3 to 6 months later. There is a small chance that you were tested during the "window period," meaning that you were infected within the past 3 months but your body hasn't produced detectable levels of HIV antibodies to yield a positive result. The key is, however to change your behavior during that time by only engaging in safe sex and taking all other precautions to limit exposure so that the follow up test results are accurate.
If you have tested preliminary negative and are confident that you have had no chance of exposure to the HIV virus, then I'd recommend taking the oral rapid HIV test annually just to confirm your status. The idea is to make this a routine test like your yearly physical test with your medical doctor. That's why doing it at the dental office is such a perfect setting since you need to see your dentist at least twice yearly, every 6 months.
Are special precautions taken to ensure the results remain confidential?
Our clients HIV status results are kept with the rest of their dental records and locked securely in our file cabinets. We respect our client’s privacy and follow the Health Insurance Portability and Accountability Act (HIPAA). We deliver test results only to the clients being tested and deliver post test counseling in a discrete setting in our office. We do not disclose test results (positive or negative) to spouses, family members, or friends. We are however, legally required to report all HIV positive results to the New York City Department Health and will refer HIV positive patients to their primary care physician for treatment or one of our treatment center partners.
Is the test covered under dental insurance plans or health care plans?
Unfortunately at this time, HIV testing is not considered a billable dental service for insurance payment or reimbursement. The reason dental insurances will not cover HIV testing is because it is considered solely as a medical procedure. In order to bill for HIV testing, a separate claim form must be submitted to the patient’s medical insurance. The proper form is called a CMS 1500 and the current CPT Code is 86701. Just remember, dentists who submit medical claims for HIV testing will not be a preferred provider on the patient’s health insurance plan and will be considered an out of network provider with out of network reimbursement fees. In order for dentists to start getting paid for HIV testing, we will need The American Dental Association along with other dental organizations, dental office staff, dental claims reviewers, and other activists to pull together and convince the Federal Government under the Health Insurance Portability and Accountability Act (HIPAA) as well as Council on Dental Benefits to recognize this as the new standard of care and create a dental procedure code (CDT code) for dental billing.
