Miami-Dade County is experiencing the highest incidence of new HIV infections nationwide at 47.0 new diagnoses per 100,00 population. The Ending the HIV Epidemic (EHE) initiative, proposed by the U.S. Department of Health and Human Services, has identified Miami-Dade County as one of the geographical hotspots to implement the four pillars for the initiative.
Pillar One: Diagnose all people with HIV as early as possible.
Pillar Two: Treat people with HIV rapidly and effectively to reach sustained viral suppression.
Pillar Three: Prevent new HIV transmissions using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services program (SSPs).
Pillar Four: Respond quickly to potential HIV outbreak to get needed prevention and treatment services to people who need them.
Therefore, as a clinical care provider, your participation in ongoing education activities, referrals or treatment services can make a significant difference in helping reduce new cases of HIV infections in Miami-Dade County.
In July 2015, the Florida HIV testing law was amended (section 381.004, Florida Statutes) to allow opt-out testing. The amendment to statute 381.004 removed the need for separate informed consent prior to HIV testing in health care settings. Patients must be notified either orally or in writing that they will be tested for HIV unless they decline testing. Notification must include information that a positive HIV test result, along with identifying information, will be reported to the county health department and of the availability and location of sites at which anonymous testing is performed.
The Florida Department of Health recommends including a fourth-generation antigen/antibody test on all routine lab testing for clients that are sexually active.
PrEP: Patients should be screened for PrEP eligibility. A sexual history should be taken for all sexually active patients, and HIV risk factors discussed. Those exhibiting one or more HIV risk factors and who are HIV-negative (excluding other contraindications) are eligible for PrEP. Treatment should be started as soon as possible. Factors to consider completing prior to beginning PrEP:
For further guidance on PrEP, please see the Florida Department of Health’s HIV Pre-Exposure Prophylaxis Clinical Guidelines.
nPEP: Patients who present as having experienced a high-risk HIV exposure in the last 72 hours are eligible for PEP. Eligible patients must start on medication within 72 hours of exposure. All persons considered for nPEP should undergo HIV testing to determine HIV status, preferably with rapid combined Ag/Ab, or antibody blood tests. If rapid HIV blood test results are unavailable and nPEP is otherwise indicated, it should be initiated without delay and can be discontinued if the patient is later determined to be HIV-positive already or the source is found to be HIV-negative. For further guidance on nPEP clinical implementation, please see the Florida Department of Health’s HIV Non-Occupational Post-Exposure Prophylaxis Clinical Guidelines.
For further details, please refer to the Florida Department of Health’s HIV Test and Treat and Re-engage in Care Guidance (Dec 2020).
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