CDC Issues Revised Guidelines for HIV Testing for Pregnant Women

In its revised guidelines for HIV testing and screening for pregnant women, which were released for public comment on Monday, the U.S. Public Health Service and CDC urged that all pregnant women be tested for HIV. The document, titled Revised U.S. Public Health Service Recommendations for Human Immunodeficiency Virus Screening of Pregnant Women, replaces guidelines set forth by the CDC in July 1995. Directed mainly toward providers of health care for women, the new report emphasizes HIV testing "as a routine part of prenatal care," recommends a simplification of the testing process, suggests that the consent process be "more flexible" to allow for various types of consent, recommends that providers "explore and address reasons for refusal of testing" and places more emphasis on HIV testing and treatment at the time of delivery for women who have not received prenatal testing and chemoprophylaxis. Although the report maintains that consent to HIV testing should remain voluntary, it puts forth a "strong recommendation for universal HIV testing of all pregnant women." The report's recommendations are outlined below:

• HIV Screening in Pregnant Women and Infants: "All women's health care providers should recommend HIV testing to all of their pregnant patients, pointing out the significant benefit of knowledge of HIV status for the health of both women and their babies," the report states. The testing should be conducted "as early as possible during pregnancy," and retesting before 36 weeks of gestation is recommended. Women should ideally give written consent to the procedure, but in cases where this poses a "barrier" to testing, verbal consent with documentation in the medical record "may be sufficient" if it is in accordance with state laws. Women should also have the option to refuse testing, and the CDC stresses that women "should not be tested without their knowledge." Health care providers should provide brochures, pamphlets or videos that are "culturally and linguistically appropriate" and that outline information on HIV, its methods of transmission, the benefits of HIV testing and the services offered to pregnant women with the disease. The information should also state that women who refuse testing will not be denied care for themselves or their infants. Providers should also recommend HIV testing for newborns. In administering and recommending testing, health care providers should "be familiar with and adhere to state [and] local laws, regulations and policies concerning HIV screening of pregnant women and newborns."
• Educating Pregnant Women about HIV: "In simplifying the pretest process to the provision of a minimum of information, ... the value of prevention counseling should not be lost and cannot be over-emphasized," the report states. The CDC calls for HIV prevention counseling to be included as part of routine prenatal health education. The report says that focusing on increased HIV testing should not hinder health care providers from offering effective HIV counseling, and offering counseling should not be a barrier to testing. Women with "high risk" behaviors, such as a history of multiple sex partners, STD infections or intravenous drug use, or those who "express a need for further, more intensive client-centered HIV prevention counseling" should be referred to HIV risk reduction services, such as drug or STD treatment programs or HIV centers with counseling experts.
• Recommendations for HIV-Positive Pregnant Women: Referring to its revised recommendations for HIV counseling, testing and referral, the CDC states that HIV counseling should include information regarding the "need for, benefit of, and access to HIV-related medical and other early intervention services." In addition, health care providers should discuss the risk for vertical HIV transmission, ways to reduce that risk and the prognosis for HIV-infected infants. HIV-positive women should also be informed of antiretroviral therapy and its role in aiding their own health and preventing vertical transmission. HIV-positive pregnant women should receive "nondirective" information about "all reproductive options." In addition, to reduce risk of postnatal transmission, the CDC urges HIV-infected women not to breastfeed. The report states that HIV status "should be available to a woman's health care provider and included on her confidential medical records and those of her infant." More information on antiretroviral therapy for pregnant women can be found at the federal government's HIV/AIDS Treatment Information Service Web site at http://hivatis.org/guidelines/perinatal/PerinatalFeb2500.pdf.
• Recommendations for Post Partum Follow-Up for HIV-Positive Women and Exposed Children: HIV-positive women should have access to "ongoing HIV-related medical care," such as immune-function monitoring, recommended therapy and prophylaxis for and treatment of opportunistic infections and other HIV-related conditions. Women with HIV should be informed of the importance of follow-up visits for their children (CDC, Revised U.S. Public Health Service Recommendations for Human Immunodeficiency Virus Screening of Pregnant Women, 10/20).