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.
The
Institute of Medicine (IOM) recommended in 1998 a national policy of
universal testing with patient notification as a routine component of
prenatal care.
In
May of 1999, the American College of Obstetricians and Gynecologists and
the American Academy of Pediatrics issues a joint statement on HIV
screening supporting the IOM recommendation.
Universal
HIV testing for pregnant women includes:
- 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.
MIH
works with the HIV Program to reduce perinatal HIV transmission through
reduction of HIV infection in women.
-
CFH/MCH/HIV
workgroup meets regularly to promote effective policies and programs
for prevention and care in MCH populations. The workgroup is a collaborative effort that includes DOH
program representation (MCH, HIV/AIDS and FPRH), DSHS Medical
Assistance Healthy Options Quality Improvement and Northwest Family
Center. The workgroup
finalized a revised edition of the Family Resource Guide in 2001 for
providers and families affected/infected by HIV.
-
Workgroup
has established a community advisory group comprised of HIV service
providers/insurers and women infected/affected by HIV/AIDS from
around the state, which meets four times a year.
-
On May 8, 2002, the State
Board of Health adopted revised rules for AIDS counseling for
pregnant women. The new rules are 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.
In part, the amended rules
require that 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 consent
may be part of the general consent for other tests provided that the woman
is informed a test for HIV is included. If the test is refused,
refusal must be documented.
3. Provide information,
either verbally or in writing, addressing:
--All pregnant women are
recommended to have an HIV test;
--HIV is the cause of AIDS and how HIV is transmitted;
--A woman may be at risk for HIV infection, and not know it;
--The efficacy of treatments to reduce vertical transmission;
--Anonymous testing is available, and why confidential testing is
recommended;
--The need to report HIV infection;
--Public funds are available to assist eligible infected women receive HIV
care; and
--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.
The Department developed a
brochure,
Prenatal Testing for HIV:
What you should know, which meets the requirement to provide certain
information. If you would like a hard copy, please contact
Polly Taylor, Washington State Department of Health,
on Maternal and Child Health, at 236-3563
-
Available
at no charge are low literacy cards: Prenatal Testing for HIV in
English and Spanish. Camera ready materials for these cards are at
the HERE
in Washington site.
-
Screening
and Management of Maternal HIV Infection: Implications for Mother
and Infant.
Revised 2005
This best practice guide includes information on HIV counseling and
testing during pregnancy, perinatal transmission risk, diagnostic
tests, HIV reporting requirements, medications and treatment during
pregnancy, labor, delivery and postpartum, rapid testing during
labor, family planning information, newborn treatment and
consultation, and referral information. Booklets are available
on-line
(Acrobat Reader) and can be ordered from the DOH warehouse using
this
order form.
Rapid HIV Testing
During Labor and Delivery
The risk for infant
HIV infection has been reduced from approximately 25% to less than
2% by the use of currently recommended prenatal antiretroviral
medications and obstetric interventions for the 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, so that 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 therapy
can be provided to the mother intrapartum. Antiretroviral
prophylaxis 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 (e.g., artificial rupture of membranes,
fetal scalp electrode placement, and amniocentesis). In addition,
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 awaiting 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 now licensed in the United States make test results
available in 20 minutes or less. Findings from the CDC-sponsored
Mother-Infant Rapid Intervention at Delivery (MIRIAD) study indicate
that offering voluntary HIV testing during labor is feasible in
obstetric settings and that 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 CDC recommends that 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.
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/print/rt-labor&delivery_appendixD.htm
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
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