120.100 HIV Testing of Pregnant Women

Policy Number 120.100
Effective Date November 8, 1995
Revision Date July 13, 2009
Subject Matter Expert Special Projects Coordinator
Approval Authority Branch Manager
Signed by Ann S. Robbins, Ph.D. and Sharon Mellville, M.D., M.P.H.

1.0 Purpose

The purpose of this policy is to provide information and guidance to HIV Counseling and Testing sites, STD clinics and HIV Care Providers under contract with the Texas Department of State Health Services (DSHS), HIV/STD Prevention and Care Branch, regarding the HIV testing of pregnant women.

2.0 Authority

Texas Health and Safety Code §81.090, Diagnostic Testing During Pregnancy and After Birth, as amended by the 81st Legislature, effective September 1, 2009.

3.0 Definitions

Health Care Provider - a physician or other person permitted by law to attend a pregnant woman during gestation or at delivery of an infant

Patient - the pregnant woman

4.0 Background

First brought into law in 1999, the Act outlines the requirements for HIV testing of pregnant women by a health care provider. Amendments passed in 2009 make the Texas law congruent with the 2006 Centers for Disease Control (CDC) Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings. Pregnant women, as part of prenatal care are required to be HIV tested at the first visit and in the third trimester. Testing at delivery takes place only when there is no documentation of the third trimester test result for the current pregnancy. In these situations, the health care provider must test the mother in an expedited manner. If the health care provider finds no documentation of an HIV test from the third trimester and no documentation of an HIV test of the mother at delivery, then the infant must be HIV tested in an expedited manner.

5.0 Policy

5.1 Connection to Prenatal Care

When a pregnant woman presents for HIV testing, staff must first determine if the pregnant woman has a health care provider. Prenatal care is important and vertical transmission of HIV and other STDs can occur, so if the woman is not under care, staff should make every effort to connect the woman to these services. Anonymous testing protocols have not changed as a result of this law, so staff should continue to present information around the difference between a confidential and an anonymous test. Staff may also inform the client that once connected to prenatal care, her health care provider will perform a confidential HIV test at the first visit unless she objects.

5.2 Referral for an Anonymous HIV Test

The health care provider may refer the pregnant woman to the HIV testing site for an anonymous test, as Sections (i) and (k) of the law allow the pregnant woman to opt-out of prenatal HIV testing. Briefly, the law states: The health care provider verbally notifies the patient a confidential HIV test will be performed. If the patient objects, the patient is referred to an anonymous testing facility. In these situations, staff would follow regular protocols for anonymous testing, including exploring concerns around confidential testing.

5.3 Risk Reduction

Counseling and Testing sites are required to provide risk reduction counseling to pregnant women considered to be at high risk for contracting HIV, including exploration of partner risk and status. Referrals to other services, such as CRCS or other evidence-based interventions (e.g., SISTA, Willow) may also be appropriate.

5.4 If the HIV test is Positive

Whether presenting for testing on her own or through her health care provider, if the HIV test result is positive, staff must connect the woman to HIV Care Services. Testing alone will not prevent perinatal transmission of HIV. All pregnant women infected with HIV must be afforded ongoing care and treatment which includes counseling about antiretroviral drug therapy and its use in reducing the risk of transmitting HIV from mother to child. This would also include strategies for confidential testing and engaging in public health follow-up.

If a site identifies HIV infection in a pregnant woman with no connection to prenatal care, staff must take steps to ensure this connection. In this regard, sites need to develop a referral program to available prenatal care and health and social service programs in their respective area. This would include assisting with the setting of appointments to these programs and documenting the referral in the client's record.

5.5 HIV Case Management

HIV Case Management staff with HIV-positive pregnant clients should also ensure the woman’s connection to prenatal care. Staff should refer to the Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States (April 2009).

If case management staff learn an HIV-positive client has a pregnant partner, staff should ensure the client understands the importance of knowledge of status and prenatal care for the partner. A Partner Services referral should be offered, along with testing for the pregnant partner.

6.0 Revision History

Date Action Section
9/4/2014 Converted format (Word to HTML) -
7/1/2009 Update of policy brought on by bill passage amending original law Revisions in every section of the 2000 policy
11/30/2000 Revision Policy title, specific focus on PCPE sites
11/8/1995 Original implementation of the policy N/A