Health clearance for HIV positive healthcare professionals
Variation in the regulation of oral healthcare professionals diagnosed as HIV positive has been the subject of discussion ever since the efficacy of combination antiretroviral therapy (cART) was demonstrated. The countries of Europe have been split between those where the dentist is able to work (subject to conditions), and the situation that previously existed in the UK where the dentist was obliged to withdraw from general practice. The evidence base was reviewed in April 2009 at the 6th World Workshop on Oral Health and Disease in AIDS which produced a consensus statement known as the Beijing Declaration The proceedings of the Workshop and the were published in 2011 in Advances in Dental Research
Active lobbying for a review of the UK regulations has been supported by Dental Protection since 2005. In the intervening years, the three committees advising the Department of Health in the UK have discussed the situation affecting UK healthcare workers with blood-borne disease and in November 2011 the Department of Health announced that it was undertaking a public consultation for a change in the regulations affecting HIV positive doctors and dentists. The consultation closed 9 March 2012 and the Department of Health published its response 15 August 2013
A letter (16.1.14) from the Chief Medical Officer, Professor Dame Sally Davies, subsequently confirmed the removal of restrictions on Healthcare Workers (HCW) with HIV practising Exposure-Prone Procedures (EPPs) with effect from February 2014. Detailed guidance is available from Public Health England.
All HCWs with HIV who wish to perform EPPs must:
- Be on effective combination antiretroviral drug therapy (cART - although special considerations apply for elite controllers), and
- Have a plasma viral load <200 copies/ml, and
- Be subject to plasma viral load monitoring every 12 weeks and
- Be under joint supervision of a consultant occupational physician and their treating physician.
In addition, these HIV infected HCWs wishing to perform EPPs need to be registered on a confidential national register, the UKAP-OHR (UK Advisory Panel for Healthcare Workers Infected with Blood-borne Viruses – Occupational Health Monitoring Register for BBV Infected HCWs). The UKAP-OHR will be managed by Public Health England (PHE) and will cover the UK. An interim paper-based version will be used until the web-based UKAP-OHR becomes operational.
Initial health clearance for HIV positive HCWs who wish to perform EPPs
The decision to clear individual HCWs for work involving EPPs is the responsibility of a consultant occupational physician in consultation with the treating physician.
Consultant occupational physicians can consult an expert panel of HIV physicians experienced in management of HIV positive HCWs, to help with this decision, if required.
In preparing for clearance to perform EPPs, HCWs are advised to;
- Seek and register with a consultant occupational physician, who will provide their assessment for fitness to initiate or return to EPP work, and manage their registration on the UKAP-OHR,
- For HCWs who are newly diagnosed and/or new to EPP work, HIV viral load test results will be needed from two identified and validated blood samples (IVS). These to be taken no less than 12 weeks apart by a consultant occupational physician, with viral load levels below 200 copies/ml, to ensure stable suppression of viral load.
- For HCWs currently restricted from EPPs who are on cART with undetectable viral load (UDVL), one IVS at least 12 weeks since their last UDVL is sufficient proof on which to grant clearance for conducting EPPs.
NHS England has agreed to fund the cost of blood tests, performed in connection with UKAP-OHR, for clinicians working within the NHS. Clinicians without an NHS contract are ineligible for this funding. To validate blood tests used for registration it is necessary for clinicians to present a passport, or some other suitable form of picture identification, at the time of the test.