120.100 HIV Testing of Pregnant Women

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 Section (Section), 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, require HIV testing 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 healthcare provider tests 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 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 make every effort to connect her to these services. Anonymous testing protocols have not changed because of this law, so staff continue to present information about the difference between a confidential and an anonymous test. Staff may also inform the client that, once connected to prenatal care, her healthcare provider performs 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 they are performing a confidential HIV test. If the patient objects, the healthcare provider refers the patient to an anonymous testing facility. In these situations, staff follow regular protocols for anonymous testing, including exploring concerns around confidential testing.
 

5.3 Risk Reduction

DSHS requires counseling and testing sites to provide risk reduction counseling to pregnant women considered 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 connect the woman to HIV Care Services. Testing alone does not prevent the perinatal transmission of HIV. If a site identifies HIV infection in a pregnant woman with no connection to prenatal care, staff take steps to ensure she receives a connection to prenatal care. In this regard, sites need to develop a referral program for available prenatal care and health and social service programs in their respective areas. This includes assisting with the setting of appointments for 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 also ensure the woman’s connection to prenatal care. Staff 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 (2014).

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

6.0 Revision History