Regulations Regarding the Restriction of the Spread of Human Immunodeficiency Virus (HIV) Infection and AIDS

Issued pursuant to Section 5, Paragraph two of the Sexual and
Reproductive Health Law and Section 3, Paragraph two and
Section 19, Paragraph one of the Epidemiological Safety Law

I. General Provision

1. The Regulation prescribes the epidemiological safety measures to be taken to restrict the spread of human immunodeficiency virus (hereinafter - the HIV) infection, to discover infected persons and provides for the following necessary medical treatment and counter-epidemic measures:

1.1. detection of HIV infection;

1.2. procedures for the examination of circumstances of HIV infection, determination of exposed persons and the informing thereof;

1.3. organisation of HIV infection post-exposure prophylaxis;

1.4. organisational procedures for the medical treatment of HIV and acquired immunodeficiency syndrome (hereinafter - the AIDS) patients.

II. Detection of HIV Infection

2. For the detection of a possible HIV infection, express tests may be used which are performed by a person trained for this purpose within the framework of a cooperation or collaboration contract with the Centre for Disease Prevention and Control (hereinafter - the Centre) or a medical practitioner within the framework of a contract with the National Health Service (hereinafter - the Service) for the provision of health care services, ensuring a pre-test and a post-test counselling.

3. The pre-test counselling (information on the test, meaning of a positive and negative test result) and the post-test counselling (test results and actions in case of a positive or negative test result) of a person shall be ensured in compliance with the recommendations for the pre-test and post-test counselling published on the website of the Centre.

4. A person distributing home-testing kits for the detection of HIV infection shall ensure that the home-testing kit contains information according to the recommendations for the pre-test and post-test counselling published on the website of the Centre.

5. If, during the express test referred to in Paragraph 2 of this Regulation performed at an HIV prevention point, a possible HIV infection is detected, a person that has performed the test refers the client to an infectologist for the confirmation of the diagnosis, using a form attached to this Regulation or form No. 027/u in compliance with the laws and regulations regarding the procedures for keeping medical documents.

6. A medical treatment institution shall ensure laboratory examination for the detection of HIV infection in compliance with the conditions for HIV infection diagnosis published on the website of the Centre.

III. Procedures for the Examination of Circumstances of HIV Infection and Procedures for the Determination, Informing, and Examination of Exposed Persons

7. If a patient has been diagnosed with the HIV infection by the doctor, the doctor shall inform the patient of the means of the spread of the infection, risks of infection, and individual prophylactic measures to prevent the infection of other persons, and indicate that an exposed person (or a legal representative) (a sexual partner, a person who has been in contact with the blood of the patient, e.g. user of injectable narcotic substances) must be informed of the need to visit a doctor to undergo initial medical examination and medical observation for early detection of possible infection and treatment thereof.

8. In case of the HIV infection, exposed persons shall be determined by a doctor who notifies of the case of the infectious disease in compliance with the regulations regarding the procedures for registering infectious diseases or by a doctor to whom the exposed person has applied.

9. If the exposed person has been identified, the duty of the doctor is to inform him or her of the necessity of the initial medical examination, laboratory examination, and medical observation and to organise the abovementioned examinations.

10. A medical practitioner shall inform an epidemiologist of a regional division of the Centre (hereinafter - the epidemiologist) by making a relevant entry in a notification of the infectious disease or by informing individually as well as shall take the decision to determine exposed persons together with the epidemiologist and provide the epidemiologist with the information needed for the determination of exposed persons if:

10.1. a person was infected with HIV during the receipt of health care services, including if a patient was infected with HIV as a recipient of biological material;

10.2. a person has been in an epidemiologically dangerous contact with environment (including objects) containing HIV and this contact might result in him or her becoming infected;

10.3. an HIV infected person has donated a biological material when there was a cause for suspicion that the person had been infected.

11. The Centre shall ensure the examination of circumstances of infection if the HIV infection notification is received and a medical practitioner has a cause for suspicion that there is a risk of further transmission of the infection:

11.1. in case of contact with a mucosa, blood or other biomaterials while performing professional duties or receiving medical treatment, beauty treatment or other invasive services, including minor patients;

11.2. while being a recipient of blood or other biomaterial;

11.3. as a result of vertical transmission of the virus.

12. If the epidemiologist has identified the exposed person in the cases of infection referred to in Paragraph 11 of this Regulation, he or she shall inform the general practitioner of the exposed person or the medical practitioner of the place of stay or the general practitioner who services the territory in which the place of residence or place of stay of the exposed person is located (if there is no medical practitioner at the place of residence of the exposed person or the exposed person is not registered with a general practitioner) in order to organise medical examinations and medical surveillance. The information provided by the epidemiologist to the general practitioner or medical practitioner at the place of stay shall be documented (writing down also the date, time, and given name and surname of the medical practitioner who received the information).

13. An exposed person who has been in contact with an HIV infected person shall undergo an initial medical examination and further examinations shall be ensured in week 6 and week 12 after the contact with the infected person by a blood sample testing for HIV infection (HIV test) and a pre-test and a post-test counselling shall be ensured. Children born to HIV infected mothers shall undergo medical observation until the age of 24 months, including a blood sample virological and serological examination for detecting HIV infection, using the polymerase chain reaction (PCR) test and antibody/antigen detection, ensuring a pre-test and a post-test counselling. The blood sample test is performed at the age of six weeks, at the age of four to six months, at the age of 12 months, and at the age of 18 and 24 months, if necessary.

14. The initial medical examination of an exposed person is performed at least once after the commencement of the medical observation, regardless of the maximum duration of the observation period. The duration of medical observation shall be determined, taking into consideration the last contact with the infection source or the transmission factor of infection.

15. The medical practitioner who performs the initial medical examination and medical observation of the exposed person shall inform the exposed person of the results of the medical observation (including the results of the laboratory examination).

IV. Organisation of HIV Infection Post-exposure Prophylaxis

16. Sabiedrība ar ierobežotu atbildību "Rīgas Austrumu klīniskā universitātes slimnīca" (limited liability company Riga East University Hospital) (hereinafter - the East Hospital) shall ensure the methodical management of diagnosis and treatment for HIV infected persons and AIDS patients.

17. HIV infection specific short-term treatment immediately after the accident that caused or could have caused penetration of HIV infected blood or other infectious human body liquids into a body (hereinafter - the post-exposure prophylaxis) shall be ensured by the East Hospital as well as any other medical treatment institution that has concluded a contract with the Service for the provision of this service in accordance with the conditions for HIV infection post-exposure prophylaxis published on the website of the Centre.

18. The medical treatment institution that performs HIV infection post-exposure prophylaxis shall ensure consultations of an infectologist, necessary laboratory diagnostics and dynamic observation and shall store the stock of medications needed for the post-exposure prophylaxis so that to make the first dose of the medicinal products available to a patient, if necessary.

19. To ensure children born to HIV infected mothers with post-exposure prophylaxis:

19.1. the Service shall plan and perform centralised procurement of infant formulae and follow-on formulae for children under one year of age (hereinafter - the formulae) who were born to HIV infected mothers in compliance with the laws and regulations regarding organisation of health services and schedule of payments and distribution to the medical treatment institutions referred to in Sub-paragraph 19.2 of this Regulation and accounting for the use of the formulae;

19.2. medical treatment institutions that have concluded a contract with the Service for the provision of and payment for the secondary outpatient health care services shall:

19.2.1. from the sixteenth to twentieth day of each month, electronically inform the Service and selected formulae supplier of the need for supply of the formulae;

19.2.2. by the fifth day of each month, submit to the Service a report on the use of the formulae for the previous month.

V. Organisational Procedures for Medical Treatment of HIV and AIDS Patients

20. HIV infection shall be confirmed based on the results of affirmative tests performed by the National Reference Laboratory of the East Hospital.

21. The infectologist shall ensure that further health care services linked to the diagnosis of the HIV infection or AIDS are provided to a patient. The infectologist shall prescribe medical treatment for a patient infected with HIV, determining medicinal products and medical treatment regimen.

22. Outpatient care for a patient infected with HIV may be provided by a general practitioner or a specialist, including a prison doctor, if an infectologist has given recommendations for outpatient medical treatment under the supervision of the general practitioner or specialist.

23. In case of severe complications caused by HIV infection, diseases accompanying HIV infection, and other complicated HIV infection contingencies, an attending physician shall decide on the involvement of a doctors' council in the examination of the course of disease of the patient.

VI. Closing Provisions

24. The Regulation shall be applicable from 10 March 2023.

25. Cabinet Regulation No. 628 of 4 November 2003, Organisational Procedures for Restriction of the Spread of Human Immunodeficiency Virus Infection (HIV) and AIDS and the Treatment of HIV-Infected Persons and AIDS Patients (Latvijas Vēstnesis, 2003, No. 157, 2005, No. 172; 2007, No. 142; 2009, No. 145; 2012, No. 51), is repealed.

Prime Minister A. K. Kariņš

Minister for Health L. Meņģelsone

Annex
Cabinet Regulation No. 99
7 March 2023

Referral for Affirmative Diagnosis

The name and address of an HIV prevention point

The anonymous code of the referred person*

The date of the express test (dd.mm.yyyy)

The title of the initial examination method (express test)

The date of referral (dd.mm.yyyy)

Signature _____________________

Note. * In the first square: 1 - male; 2 - female; in the second: the first letter of the given name of the customer's mother; in the third: the first letter of the customer's name; in the fourth, fifth: the last two figures of the customer's year of birth. For example, female (2), mother's name - Kristīne (K), customer's name - Anna (A), born in - 1975 (75). Anonymous code of the visitor - 2KA75.

Translation © 2024 Valsts valodas centrs (State Language Centre)