Maternal and Child Health Programs

HIV

All pregnant women should be tested for HIV prior to pregnancy, or as early in the pregnancy as possible. Dramatic declines in reported pediatric AIDS cases have been observed due to major advances in the treatment of HIV infection and prevention of perinatal transmission.

In May 1999, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics issued a joint statement on HIV screening supporting the Institute of Medicine recommendation.

• HIV test is integrated into a standard battery of prenatal tests.
• Pregnant women are informed that the HIV test is being conducted and would have the right to refuse.
• Universal testing applies to all pregnant women regardless of risk factors or prevalence rates where they live.

The Division of Community and Family Health workgroup meets regularly to promote effective policies and programs for prevention and care in Maternal and Child Health populations. The workgroup is a collaborative effort that includes department program representation (Maternal and Child Health, HIV/AIDS, and Family Planning and Reproductive Health) and Northwest Family Center.

On May 8, 2002, the State Board of Health adopted revised rules for HIV/AIDS counseling for pregnant women. The new rules became effective July 6, 2002, and are designed to reduce barriers to routine HIV testing of pregnant women consistent with the recommendations of the Centers for Disease Control and Prevention, the Institute of Medicine, the American College of Obstetricians and Gynecologists, and other national and state organizations.

The amended rules require health care providers to:

1. Encourage all pregnant women to have a test for HIV, regardless of identified risk.
2. Obtain the verbal or written consent of the pregnant woman prior to testing. The woman is informed a test for HIV is included as part of general consent for tests. If the test is refused, refusal must be documented.
3. Provide information, either verbally or in writing, including the following:

• All pregnant women should have an HIV test.
• HIV is the cause of AIDS and explain how HIV is transmitted.
• A woman may be at risk for HIV infection, and not know it.
• Treatments to reduce vertical transmission are available.
• Anonymous testing is available and why confidential testing is recommended.
• Public funds are available to assist eligible infected women receive HIV care.
• Women who decline testing will not be denied care for themselves or their infants.

4. Based on the risk assessment, provide counseling to those women who identify a behavioral risk for HIV.

• Prenatal Testing for HIV low literacy cards are available at no charge in English and Spanish. Camera ready materials for these cards are at the HERE in Washington site.
   

• Guidelines for Management of HIV + Women Birthing in Washington Hospitals. Revised 2010

Maternal and Infant Health, in collaboration with HIV/AIDS program, Ryan White Part D Network, University of Washington School of Medicine, Children’s Hospital and Regional Medical Center, and the Northwest Regional Perinatal Program developed Guidelines for Management of HIV+ Pregnant Women Birthing in Washington Hospitals: Hospital Preparation Checklist available at the HERE in Washington site, and Guidelines for Management of HIV + Pregnant Women Birthing in Washington Hospitals: Prenatal Checklist available at the HERE in Washington site. (These documents were designed for physicians, nurses, and other healthcare professionals and is not intended for the general public. It contains terms, abbreviations, and acronyms that may not be familiar to those outside the field of healthcare.) These checklists for hospitals and prenatal providers outline appropriate in-hospital care including lab tests and medications for laboring mothers and their newborns.

Rapid HIV Testing During Labor and Delivery

The risk for infant HIV infection was reduced from approximately 25 percent to less than 2 percent by the use of currently recommended prenatal antiretroviral medications and obstetric interventions for known HIV positive pregnant woman.

Current Washington State rules require health care providers to encourage all pregnant women to have a test for HIV, regardless of identified risk. Ideally, all women should be screened for HIV before labor and delivery, during routine prenatal care. This helps ensure appropriate counseling and care including combination antiretroviral treatment can be given to women who test HIV-positive. However, not all women get tested before delivery.

Timely rapid HIV test results may allow providers to initiate antiretroviral therapy to decrease the risk of mother-to-child HIV transmission. If rapid HIV test results are available before delivery, antiretroviral drug therapy can be provided to the mother during labor and birth. Antiretroviral drugs should also be provided to the infant as soon as possible after delivery. Rapid HIV test results may also allow providers to avoid some common obstetric practices that may increase the risk of HIV transmission (for example, artificial rupture of membranes, fetal scalp electrode placement, and amniocentesis). Also, knowledge of a positive rapid HIV result allows the prenatal provider time to advise the mother to avoid breastfeeding her infant and to initiate other counseling regarding her new HIV diagnosis while waiting for confirmation of the rapid test results.

Routinely offering rapid HIV testing to women whose HIV status is unknown during labor and delivery provides the opportunity to reduce transmission even among women who do not seek care until labor begins. The rapid HIV test kits make test results available in 20 minutes or less. Findings from the Center for Disease Control and Prevention-sponsored Mother-Infant Rapid Intervention at Delivery study indicate that offering voluntary HIV testing during labor is feasible in obstetric settings. The OraQuick Rapid HIV-1 Antibody Test, used on whole blood specimens, delivers accurate and timely test results. However, a positive rapid HIV test must be confirmed using a conventional HIV testing algorithm including enzyme immunoassay and Western blot confirmation.

The Center for Disease Control and Prevention recommends hospitals adopt a policy of routine, rapid HIV testing using an opt-out approach for women who have undocumented HIV test results when presenting to labor and delivery unit.

For more information on developing and implementing an HIV rapid testing during labor and delivery protocol, go to the following web address to get a copy of “Rapid HIV Testing During Labor and Delivery for Women of Unknown HIV Status: A Practical Guide and Model Protocol. http://www.cdc.gov/hiv/topics/testing/resources/guidelines/pdf/Labor&DeliveryRapidTesting.pdf (PDF, 689 KB)

For more information on HIV/AIDS go to the Washington State Department of Health, Office of HIV/AIDS website.

Documents posted in PDF version on the Department of Health Web site will be made available on request to users who are unable to download or view them. For persons with disabilities, PDF documents will be made available on request in other formats. To submit a request, contact: mih.support@doh.wa.gov