What information can a Nurse Practitioner (NP) disclose to an employer regarding a 33-year-old man's hepatitis and Human Immunodeficiency Virus (HIV) test results, as required for employment as a home healthcare aid, according to the Privacy Rule?

From the Guidelines

According to the Privacy Rule, the NP can only provide the hepatitis results to the employer, as HIV test results are considered sensitive and have special confidentiality protections, as stated in the revised guidelines for HIV counseling, testing, and referral 1. The Privacy Rule, which is part of HIPAA, protects the confidentiality of patient health information.

• HIV test results are considered particularly sensitive and have special confidentiality protections in many jurisdictions.
• Even if the employer paid for the testing, this does not override the patient's right to privacy regarding HIV status, as informed consent before HIV testing is essential and should be voluntary and free of coercion 1.
• The NP cannot disclose the patient's current medications as this is protected health information unrelated to the employment screening.
• Similarly, disclosing the number of HIV tests performed at the clinic would be inappropriate and potentially violate confidentiality of clinic operations. The only information that can be shared with the employer is the hepatitis test results that were specifically requested as part of pre-employment screening, and only with the patient's consent for this specific purpose, as stated in the guidelines that information regarding a client's use of HIV CTR services should remain private (i.e., confidential) 1.

From the Research

Privacy Rule and Employment

• The Privacy Rule, as part of the Health Insurance Portability and Accountability Act (HIPAA), regulates the use and disclosure of protected health information (PHI) [ 2 ].
• In the context of employment, the Privacy Rule allows employers to access certain health information, but only if it is necessary for the employer to make employment decisions [ 3 ].

Disclosure of Health Information

• The Americans with Disabilities Act (ADA) protects employees from discrimination based on their health status, including HIV-positive status [ 2 ].
• However, the scope of these laws is unclear, and state legislatures have attempted to set standards to protect the privacy of HIV-positive employees, with varying degrees of success [ 2 ].

HIV and Hepatitis Testing

• HIV and hepatitis testing are crucial for accessing care and treatment, as well as preventing further transmission [ 4 ].
• However, there are challenges to addressing HIV and hepatitis testing, including lack of simple and reliable diagnostic tests, laboratory capacity, and testing facilities [ 4 ].

Employer Attitudes towards HIV Testing

• Employers have positive attitudes towards HIV testing, with 69% believing that HIV testing should be offered in the workplace [ 3 ].
• However, perceived barriers to HIV testing in the workplace include lack of knowledge, lack of trained staff, and lack of access to HIV testing kits [ 3 ].

Nurse Practitioner Scope of Practice

• Nurse practitioners (NPs) have a variable scope of practice between states, which can lead to confusion and potential breaches of their scope of practice [ 5 ].
• Clarification and understanding of NP scope of practice are essential for safe practice and optimum access to care [ 5 ].

According to the Privacy Rule, the NP can provide information on:

• Hepatitis results only
• Hepatitis and HIV results only if the employer paid for the testing [ 2 ].