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Rapid HIV Testing and STD Testing for
Mothers in the Labor and Delivery and
Reporting of HIV Exposed Newborns
POLICY & PROCEDURE MANUAL
DEPARTMENT: Obstetrics and
Gynecology, Pediatrics and Nursing
EFFECTIVE DATE:
ISSUE NO.
SUPERSEDES DATE OF:
Policy: Rapid HIV Testing and STD testing of Mothers or Newborns in the Labor, Delivery,
Postpartum and Newborn Settings and Reporting of the HIV Exposed Newborn.
Purpose/Intent:
1. To provide rapid HIV testing and STD testing of pregnant women in labor or delivery, if
there is no documentation of HIV/STD testing during pregnancy, or no record of testing
after 27 weeks gestation.
2. To provide routine rapid HIV testing of pregnant women if the mother reports being HIV
infected but there is no documentation of HIV infection in the medical record.
3. To offer maternal and/or newborn antiretroviral prophylaxis if the HIV test is reactive
(positive), if the mother reports being HIV infected, or if the mother was previously
documented to be HIV positive.
4. To avoid breast feeding if the HIV test is reactive (positive), if the mother reports being
HIV infected, or if the mother was previously documented to be HIV positive.
5. To reduce the risk of perinatal HIV/STD transmission to infants born at (Name of your
Hospital).
6. To assure the prompt reporting of the birth of an HIV exposed newborn.
Supportive Data: State of Florida law (Florida Statute- s.384.31) requires that health care
providers conduct routine HIV/STD testing for all pregnant women. The Florida Administrative
Code (Ch.64D-3.042) states that HIV/STD testing must be conducted at the initial prenatal
care visit and again at 28-32 weeks. It further states that women who appear at delivery or
within 30 days postpartum with no record of HIV/STD testing, or no record of testing after 27
week gestation, shall be tested for HIV and STDs. Results of clinical trial ACTG 076 found
that treatment of identified HIV-infected pregnant women resulted in a 66% reduction in HIV
transmission to their infants. Short course antiretroviral therapy in previously untreated
women with HIV infection in labor and/or to newborns was shown to reduce perinatal HIV
transmission from 25% to 9-13% (Wade, et al.1998). The Centers for Disease Control and
Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG)
recommend routine rapid HIV testing for women admitted in labor and delivery with unknown
or undocumented HIV status (CDC, 2001) (ACOG, 2008). National perinatal treatment
guidelines (CDC, 2002) [www.hivatis.org/guidelines/perinatal] recommend short course
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antiretroviral therapy for reducing perinatal HIV transmission in untreated women with HIV
infection who present in labor.
Florida Administrative Code (Ch. 64D-3.029) states that practitioners are required to report
the birth of an HIV exposed newborn to the local county health department having jurisdiction
in the area where the birth occurred by the closure of the health department’s next business
day following the birth.
Procedure:
Responsible Individual
Actions
Labor and Delivery RN
1. During admission to Labor and Delivery assess and
Nurse Midwife
document level of prenatal care and HIV/STD status and
Attending Obstetrician
history. Documentation completed in appropriate
Admitting OB Resident/Intern
medical record.
Important: Refer to
2. If no prenatal care has been received or HIV/STD status
hospital policy: HIV and
is unknown, undocumented, or not documented after 27
STD testing.
weeks gestation of the present pregnancy, the provider
will notify the woman which tests will be conducted and
inform her of her right to refuse any or all tests. A signed
objection should be attempted. Refusal should be
documented in the chart.
Attending Obstetrician
3. Before discussing HIV/STD testing, ensure that the
Admitting OB Resident/Intern
woman is between contractions and that she is fairly
Nurse Midwife
comfortable.
Labor and Delivery RN
 For confidentiality, provide privacy (ensure the woman
is alone). Tell her that you are going to talk with her
about HIV/STD testing and ask if she wants her
partner, family member or support person to be
present.
 Explain to the woman that by law, health care
providers must conduct routine, HIV/STD testing for all
pregnant women in Florida.
 Ask if she knows her HIV status and if she has any
other STD
 If she has not been tested/does not know her status,
discuss the following:
- Modes of HIV/STD transmission
- Benefits of knowing status for her own health and for
reducing the transmission to her baby
- Availability of treatment for reducing perinatal
transmission and for care after birth for herself and
her baby
- Treatment options for the baby
- Reliability of the test, the meaning of preliminary
results and the need to confirm positive results
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- Procedure for testing
- Right to refuse testing and assurance a refusal will
not affect her care.
Note: If the test cannot be offered/completed during labor,
rapid HIV testing and other STD testing should be offered
to woman immediately postpartum.
Attending Obstetrician
4. Advise the patient that HIV/STD testing will be
Admitting OB Resident/Intern
conducted.
Nurse Midwife
5. If patient refuses testing, have the patient sign the
Objection to HIV/STD Testing form or document in the
Labor and Deliver RN
appropriate medical record.
6. If patient refuses testing for herself, offer her the option
of testing her baby immediately after birth, and verify
Important: Pursuant to
that she understands that if her baby’s test is positive, it
F.A.C. 64D-3.042, informed
means that her test is positive.
consent is no longer
7.
If
the parent/guardian agrees to HIV testing on the baby,
required for pregnant
a signed consent to test must be obtained.
women. The woman
should be advised that she
will receive HIV/STD
testing in accordance with
Florida law and that she
has a right to decline the
testing.
Labor and Delivery RN
8. Write STAT order for rapid HIV testing.
Nurse Midwife
 For a rapid HIV test obtain specimen following
Attending Obstetrician
instructions in appropriate test tube or container for
Admitting OB Resident/Intern
either venous or capillary testing, label specimen
STAT and either send to lab or perform test at
point-of-care following hospital policy and test kit
instructions. .
Labor and Delivery RN
9. Obtaining Result of Rapid HIV Test
Midwife
 Rapid HIV testing should be done as soon as
Attending Obstetrician
possible.
Admitting OB Resident/Intern
 If test is done by the lab within one hour of
completion of a rapid HIV test, lab personnel
notifies the designated health care professional with
the preliminary results.
* The laboratory can release preliminary HIV results to
a designated individual. This individual should be a
Labor and Delivery RN, nurse midwife, attending
obstetrician, OB Resident or Intern.
 If the Rapid HIV test is negative, no further action
is needed in labor and delivery. Inform woman of
negative test results and document results in the
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Nurse Midwife
Attending Obstetrician
Admitting OB Resident
Obstetrician, Pediatrician
OB/Pediatric Provider
HIV Counselor
OB Resident/Intern
Pediatric Resident/Intern
Postpartum RN
Pediatric RN
Pediatric Provider
Important: Pursuant to
F.A.C. 64D-3.029, Diseases
or Conditions to Be
Reported, practitioners are
required to report the birth
or diagnosis of an HIV
exposed infant <18 months
of age to the County Health
Department by the close of
the next business day.
appropriate medical record. If clinically indicated,
arrange for and document follow-up for HIV
testing/risk reduction counseling in the postpartum
period prior to discharge or at the first postpartum
visit.
10. If preliminary Rapid HIV test is positive, send
additional specimen for confirmatory testing.
11. Provide post-test counseling. This must include the
preliminary nature of the screening results and the
need to confirm results
 Provide privacy for confidentiality
 Discuss the options for short course antiretroviral
therapy with the woman. If antiretroviral therapy is
acceptable to the woman follow the protocol for
treatment of HIV positive women in labor (see
attached)
 Counsel woman regarding the benefits/risks of a
Cesarean Section
 Counsel woman to not start breastfeeding while
waiting for confirmatory results
 Document results and discussion of treatment
protocols in appropriate medical record.
 Treatment should not be delayed while awaiting
confirmatory test results
 Ensure confidentiality regarding IV and oral
medication administration.
12. If the preliminary rapid test is positive, but medication
cannot be started before the birth of the infant, start
antiretroviral treatment for the baby ASAP
13. Assure that the woman has access to a full six-week
supply of antiretroviral medication for the newborn
before discharge. Confirm that she can verbalize an
understanding of the medication schedule and
demonstrates the ability to administer the medication
to her infant.
14. Document on the appropriate medical record,
medication administration teaching and woman’s
response to teaching.
15. Report the birth to the County Health Department’s
HIV/AIDS Surveillance office (having jurisdiction in the
birth hospital’s area) before the end of the next
business day.
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Obstetric/Pediatric Provider
16. After obtaining the mother’s consent, refer the woman
and infant to a provider with experience and expertise
in HIV disease. Arrange for the mother to meet with
pediatric/family HIV provider before discharge. Refer
the infant to Children’s Medical Services for case
management if the mother was not referred during
pregnancy.
References:
New Jersey Department of Health and Senior Services (2001). Standard of Care for Women
who present in Labor with Unknown HIV Status.
Paul, S.M. & Burr, C. (2001). A Statewide approach to reducing vertical HIV transmission.
AIDSline, 13, 1-5.
Paul, S.M. & Burr, C.K & DiFerdinando, G.T. (2001). Updated recommendations for reducing
vertical HIV transmission. New Jersey Medicine, 98, 35-38.
Academy of Medicine of New Jersey (2002). Rapid testing for HIV. AIDSline, 14, 1-4.
American College of Obstetricians and Gynecologists (2008). Prenatal and perinatal human
immunodeficiency virus testing: Expanded Recommendations. Committee Opinion 418.
Washington, DC.
Centers for Disease Control and Prevention (2001). Revised Recommendations for HIV
Screening of Pregnant Women. MMWR; 50 (RR-19); 59-86.
Centers for Disease Control and Prevention, (1998). Public Health Service task Force
recommendations for the use of antiretroviral drugs in pregnant women infected with HIV-1 for
maternal health, and for reducing perinatal HIV-1 transmission in the United States. MMWR,
47 (Rr-2), 1-30 (and updates http://www.hivatis.org/guidelines/perinatal/).
Wade, N.A., Birkhead, G.S., Warren, B.L, et al. (1998). Abbreviated regimens of zidovudine
prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med,
339, 1409-1414.
APPROVED BY:
Chairperson, Obstetrics and
Gynecology
Chief, Department of
Pediatrics
Director, Laboratory Services
Director, Women’s and
Children’s Services
NAME
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