HIV screenings

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FutureStork

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Are pregnant women REQUIRED to take an HIV test early in pregnancy or is it optional? How about later in pregnancy? What does the law in your state require?

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Futurestork,

there are two philosophies being used in USA regarding HIV testing during labor -- from:
here are the two approaches. I coudln't find a listing of what each state is doing; it seems New York & Connecticut are the most strict which is good since treating with antiretrovirals during labor has been proven to reduce transmission from 25% to less than 2 % ....

http://www.cdc.gov/hiv/projects/perinatal/materials/C_1.htm

What approaches to prenatal testing are currently used in the United States?

* “Opt-out”: Pregnant women are notified that an HIV test will be routinely included in the standard battery of prenatal tests for all pregnant women, unless they decline HIV testing. This is the current standard recommended by the CDC.
* “Opt-in”: Pregnant women are provided with pre-HIV test counseling and must specifically consent to an HIV antibody test, usually in writing.
* In addition, in cases where the mother’s HIV status is unknown at delivery, some states mandate that newborns be tested for maternal HIV-antibody, with or without the mother’s consent, if the mother’s HIV status is unknown at delivery. Results must be available within 12 hours of birth in New York and within 48 hours in Connecticut, the two states that have implemented this approach.


What are some of the advantages of routine prenatal testing with the right to decline-- the opt-out approach?

The opt-out approach is expected to substantially increase testing rates among pregnant women, based on new information from the U.S., Canada, Europe, and Africa. This approach should increase the proportion of HIV-infected women who are offered appropriate antiretroviral and obstetrical interventions to prevent perinatal HIV transmission and to protect the woman’s own health.

Data indicate that women are more likely to accept testing when it is offered and recommended by their prenatal care providers. But some providers continue to find requirements for extensive pre-test counseling and consent documentation to be barriers to offering the test. The opt-out approach is designed to reduce those barriers while preserving the voluntary nature of testing and increasing the opportunity for all pregnant women to have HIV screening.

How would the opt-out approach be implemented?

The simplest approach requires notifying the pregnant woman that an HIV test is performed as part of the standard battery of prenatal tests, but that the woman can decline the test — with documentation of her refusal in the medical chart. Another approach might be to document a pregnant woman’s consent for the routine battery of prenatal tests, including HIV screening, and, if she declines HIV testing, to document this in her medical chart. CDC recommends that pregnant women, at minimum, be given a brochure on prevention of perinatal HIV transmission and treatment of maternal HIV.
 
In Texas:
HIV testing is offered prenatally and in hospital. Patients must sign consent for it - accepting or declining by checking box. Only way it is drawn without consent is if there is a body fluid exposure - gets the whole panel regardless of consent.
 
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tiredmom said:
In Texas:
HIV testing is offered prenatally and in hospital. Patients must sign consent for it - accepting or declining by checking box. Only way it is drawn without consent is if there is a body fluid exposure - gets the whole panel regardless of consent.

so texas is using the Opt-In approach -- considered less successful by the CDC

I wonder why they don't have a list of the state laws & what state is doing what....
 
I heard the other day at a local military hospital, they get around asking for consent by drawing a CD4 count - not very ethical in my opinion. But, this was the same place where the intern came RUNNING in during my interview of a young, active duty soldier to make sure I didn't ask about sexual orientation.
Snow - I'm not really sure I understand the difference between the two approaches. In Texas, it's presented as "these are the tests we do during the pregnancy - here is the consent for the HIV testing, you can decline it if you want to", after going over the risk factors for HIV spelled out on the consent form. It's offered to everyone during prenatal care and again at hospital admission. Is that still opt-in? Thanks!
 
form. It's offered to everyone during prenatal care and again at hospital admission. Is that still opt-in? Thanks![/QUOTE]


Hey Tiredmom,

the main difference in "opt-in" vs "opt-out" is ...active vs passive participation by the patient to get the test...

in the opt-out approach (recommended by the CDC) if a test is offered as part of a standard batterry of tests (like rubella, VDRL, etc) there is NO consent .. the approach is -- "this is standard procecure" we do it to everyone ...the only way to not get tested is to say "hey don't test me for rubella (for example) -- more women will be tested.. b/c they must specifically say "hey don't test me for HIV even though it's part of the standard panel you run" (like you never hear anyone saying hey don't test me for rubella -- there is no way I could have/not have been exposed to rubella .. )

in the opt-in approach -- written consent must be obtained for each test "do you want to be tested for rubella? what? rubella -- no I don't have rubella -- so no I don't. So they must activley decide to be tested (so usually less ppl say yes ) either b/c they are afraid to test positive for HIV, the stigma of even being tested, the loss of social support if they do test positive, etc.

so anytime a consent is needed approach is the "opt-in" approach --

why do we need consent forms for HIV testing but not all the other tests we do?
 
snowinter said:
why do we need consent forms for HIV testing but not all the other tests we do?

Hi Snow!
Thanks for the explanation. That makes more sense. I'm not sure why HIV requires a special consent but the others don't. My gut feeling is that because of all the "social prejudices" associated with HIV, but it doesn't make sense in a health perspective. In Texas, it's even weirder. There are legal precedents to both disclose and not disclose HIV status to the health department for manditory notification. It's actually the physician's discretion. Talk about giving mixed messages!
 
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