Universal HIV Testing for Pregnant Women

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Prenatal testing is very important for the health of newborn infants.  Routine prenatal testing includes multiple blood tests that are related to the health of the mother and infant.  Routine prenatal care includes testing for blood type and multiple tests for infection.  These tests for infection include Hepatitis B, Syphilis, Rubella, and various cultures to detect bacterial infections such as urinary infections and Group B streptococcus infections.  The current recommendations from the Centers of Disease Control and Prevention (CDC), American Academy of Pediatrics, and American Congress of Obstetricians and Gynecologists all recommend universal testing for Human Immunodeficiency Virus (HIV).  HIV is a progressive chronic illness that may lead to early death and transmission can be prevented by medication therapy provided to the mother during pregnancy and delivery.  Testing can be done with the other prenatal laboratory blood tests and does not require extra clinic appointments or procedures.   Even with the above recommendations and almost 100% prevention of transmission of HIV to the infant, universal testing for HIV in pregnant women is not still routine.    Some of this may be related to the stigma associated with HIV/AIDS.  There are still cases of perinatal transmission (infection from mother to infant) in the United States. (See figure below from CDC website)

AIDS cases due to the perinatal transmission of HIV infection,

by year of diagnosis, 2001–2005, United States

Our mission is to obtain universal prenatal testing of all pregnant women for HIV in the state of California.  We encourage all health care providers and hospitals to include HIV testing with routine antenatal testing.  We also want to encourage all pregnant women to ask their physicians to provide testing for HIV.

Other Important Links:

One Test Two Lives – CDC site with HIV information for pregnant women.

Act Against Aids – CDC site with general HIV information including testing locations.

California Department of Public – Find the health department in your area.

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6 Responses to “Universal HIV Testing for Pregnant Women”

  1. mjberley Says:

    I agree that prenatal testing for HIV is absolutely essential and I find it shocking that with everything we have learned that there are still individuals that are falling through the cracks. It would be interesting to learn if the mother’s involved in the perinatal transmission of HIV received prenatal care at all. If not, perhaps ensuring that every woman receives the prenatal care she needs would be an essential part of combating this problem.

  2. robertmartenjhsph Says:

    I wholeheartedly agree, and must confess that I find it both shocking and abominable that this is not commonplace in the United States. It would be interesting to do a state by state comparison in the US, and see if there are any positive deviants (ie: states that are doing particularly well), and then try to figure out how and why. But perhaps this research is already done? Does anyone know?

  3. hbbos Says:

    Although HIV testing has been recommend by ACOG for some time, the debate has essentially be tied up in the type of testing that should be done. The options are opt-in or opt-out. In opt-in, each patient must be counselled about the risks and benefits of HIV testing, just as any person who would receive the test. Physicians are required to document this discussion due to the implications of a positive test – it is not as simple as just drawing the blood. The opt-out method means patients are informed that this is a routine test, and the can opt out of having it done. The consent process for the women is not as indepth – great is the test is negative, but maybe not as good for those who get a positive test.

    Another option is rapid testing in the labout room, with results available immediately – however, this test has a high false positive rate. That means you do the test, if come back postive, you counsel the woman and treat her and her infant, then in several weeks, you get the final results. This test is often reserved for those with limited antenatal care or very high risk factors – often a less educated population. It is not easy to explain the difference between the rapid “screening” test and the longer diagnostic test.

    In Ontario, HIV testing is mandatory, and women may opt out. Out documentation has been reduced because we changed to opt-out. Most women consent to the test. Every year in our centre we have 7500 births and maybe 4-6 HIV positive patients. However, half of those are generally picked up with the routine screening test.

    I think routine testing is an essential part of antenatal care. Not surprisingly, some of those who are not identified also don’t have prenatal care, and that is a more up stream issue. The complexity of testing for HIV make it harder to implement this as a national strategy. Ironically, some of the refugees I have seen in antenatal clinics tell me that prenatal care in their country involved mostly just malaria prophylaxis, prenatal vitamin and a HIV test (maybe a fetal heart rate if the batteries are working on the doptone) – interesting how this are viewed differently in other countries.

  4. ikeajoku Says:

    Pre natal HIV testing should be made compulsory especially judging what we know about mother to baby transmission.The earlier we know about the Baby’s status and provide care as early as we can the better for humanity.However, the number of Perinatal HIV transmission has decreased as a result of timely intervention on pregnant women found to be HIV positive during pregnancy.

  5. cheeseqo Says:

    I definitely would agree with this policy. However other issues around counseling ( Pre and Post test) and spousal disclosure must have clearly defined strategies and policies. So that in the process of solving a problem, we don’t as PH professionals and policy makers, create other problems.

  6. rosekm Says:

    Prenatal testing of HIV should be required considering the mother-to-child transmission of the disease. One of the comments above mentions changing HIV testing to an opt-out mechanism which I agree with. Research has shown that this automatically increases the rate of testing/vaccination. Patients that opt-out can be further counseled on the risks to the infant if they are born with HIV and the difficulties they would face with life-long anti-retroviral therapy. Increasing access to prenatal care for all pregnant mothers will also go a long way in preventing infants from being born with HIV. With all HIV testing their must be a counseling available both pre- and post-testing for those who request it. Some patients may need further education or reassurances

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