“Given the enormous advances in the prevention of perinatal transmission of HIV, it is clear that early identification and treatment of all pregnant women with human immunodeficiency virus (HIV) is the best way to prevent neonatal disease and also may improve the woman’s health.” (ACOG Committee Opinion Number 418, September 2008)
HIV/STD Testing in Pregnancy: IT’S THE LAW
Get the Facts: Compare Florida’s HIV Testing Requirements for Pregnant Women to ACOG’s Recommendations
Florida Administrative Code (FAC) Rule 64D-3.042 requires that healthcare providers conduct routine testing for HIV, Chlamydia, gonorrhea, hepatitis B, and syphilis on all pregnant women, using the opt-out approach, at the initial prenatal care visit and again at 28 to 32 weeks gestation. Women who present in labor and delivery or within 30 days post-partum with no record of HIV/STD testing after 27 weeks gestation will be tested using the same guidelines.
* Florida has a high HIV prevalence among women of childbearing age.
* HIV/STD testing and rapid testing in labor and delivery are covered by state and private funding sources.
* ACOG Committee Opinion No. 418 states “Women who are candidates for third-trimester testing, including those who previously declined testing earlier in pregnancy sould be given a conventional HIV test rather than waiting to receive a rapid test at labor and delivery (as allowed by state law and regulations).”
* A documented HIV status is either a negative or a positive. If a woman declines testing prenatally, the delivering hospital is required to test based on FAC 64D-3.042.
A signed consent to test is no longer required. A woman must be notified that she is being tested and that she has the right to refuse any or all of the tests. If she declines, a signed objection must be attempted. If she refuses or is unable to sign it must be documented in the medical record.
* Using the opt-out approach increases the HIV testing rate.
* Women are more likely to test based on the providers approach.
* Best Approach: “STDs can significantly impact your baby’s health if you are not treated; therefore, we routinely test for Chlamydia, gonorrhea, syphilis, hepatitis B, and HIV unless you tell us not to.”
* Giving or posting written material that explains Florida’s HIV/STD testing law and why it is important constitutes notification.
F.A.C. Rule 64D-3.029 requires that practitioners report the birth of an HIV exposed newborn and a newly diagnosed infant up to 18 months of age to their local county health department’s surveillance office by the next business day of the birth or diagnosis.
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Do your part to reduce the incidence of HIV.
* Encourage HIV testing as a routine part of health care.
* Test all women for HIV/STDs in pregnancy using the opt-out approach.
* Educate women who decline testing on the mode of transmission, risk factors, and the success of treatment to reduce the risk of transmission.
* Document test results on prenatal records.
* Make sure that prenatal records are available in labor and delivery to avoid unnecessary rapid testing.
* Report all HIV exposed babies (birth to 18 month of age) to your local surveillance office by the next business day.
* Over 125,000 Floridians are infected with HIV.
* Florida is ranked third in the country for total HIV/AIDS cases.
* Women ages 13+ accounted for 31% of reported AIDS cases and 26% of the HIV cases reported in 2008.
* Florida is ranked second for total pediatric HIV/AIDS cases
-First for total pediatric AIDS cases
-Second for total pediatric HIV cases
* Of the 601 babies known to be born to an HIV infected mother in 2008, 9 are known to be infected.
* Seven infected babies have been identified so far in 2009.
Source: Florida Department of Health, Bureau of HIV/AIDS. Data as of 2/15/10.
Reminder: Florida law (Florida Statute s.383.14 and Florida Administrative Code-Ch.64C-7) requires all pregnant women and infants to be screened for Healthy Start to improve birth, health, and developmental outcomes.