Changes in the State's Newborn HIV Screening Program - Starting August 1, 1999
Dear Prenatal Care Provider:
This letter announces important new changes in the State's newborn HIV screening program. Starting August 1, 1999, hospital maternity staff are required to approach all women in labor who do not have an HIV test result from prenatal care and offer them expedited HIV testing with preliminary results available as soon as possible, but no later than 48 hours. This mirrors the existing requirements for hepatitis B surface antigen testing. For those women without prenatal HIV test results who decline HIV testing during delivery, hospitals are required to conduct expedited HIV testing of all newborns with preliminary results available in the same time frame. This means that starting August 1st, your patients will be learning their HIV status during or immediately after delivery if they have not been tested during prenatal care.
This new program of HIV testing in the delivery setting is intended to achieve the goal of universal prenatal HIV counseling and testing, which is the standard of prenatal care in New York. In 1997-98, 53% of women delivering in New York were reported to have been HIV tested during that pregnancy. The proportion of HIV positive women delivering is higher, about 82% were reported to have been tested for HIV during that pregnancy or previously; those women tested previously may have correctly known their HIV status. However, as many as 200 HIV positive women delivering still may not have known their HIV status, an unacceptable missed opportunity to prevent mother-to-infant HIV transmission. Recent data showing that initiating zidovudine treatment during labor or to the newborn shortly after delivery can reduce perinatal transmission1 by up to two-thirds, and recent national recommendations to begin combination antiretroviral therapy in infants as soon as possible after HIV infection is confirmed2, make the newborn HIV screening program changes even more important.
Achieving HIV testing of all women in prenatal care is vital. It can begin by providing all new prenatal patients with a standard brochure on HIV and pregnancy, for example, the enclosed handout " Key Messages for Pregnant Women About HIV" is available free from the Health Department. A simple statement and a question: "I recommend and offer HIV testing for all my patients. The HIV test is easy and can be done along with your other prenatal blood tests. Have you ever been tested for HIV before?" "Do you have any questions?" can initiate any further counseling discussion that may be needed. Such counseling can be provided by any member of the prenatal care team; it need not be done directly by a physician. Women should be aware that their newborn will be tested even if they choose not to be and that it is better to be tested for HIV during pregnancy than to wait until delivery. Women should read and sign a standard HIV consent form before being tested.
HIV test results should be forwarded to the delivery hospital when other relevant medical information is sent. You can use the same procedures as for the transfer of other prenatal medical records; a special HIV release is not required for disclosure to medical providers when necessary for care. A list of available training courses and materials for prenatal counseling and testing are available by calling 518-474-9866.
The tools to prevent transmission of HIV from mother to child are at hand. The most important step is to achieve universal HIV counseling and testing of women during prenatal care. We urge you to incorporate this standard of medical care into your practice now, if you have not already done so.
Antonia C. Novello, M.D., M.P.H.
New York State Health Department
Louis Z. Cooper, M.D.
American Academy of Pediatrics,
District II New York State
John W. Choate, M.D.
American College of Obstetricians
Gynecologists, District II
Steven B. Tamarin, M.D.
New York State Academy of Family Physicians
John A. Ostuni, M.D.
Medical Society of the State of New York
- Wade NA, Birkhead GS., et al, Abbreviated Regimens of Zidovudine Prophylaxis and Perinatal Transmission of the Human Immunodeficiency Virus. N Engl J Med; 1998;339:1409-1414.
- Guidelines for the use of antiretroviral agents in pediatric HIV infection. MMWR;1998;47RR-4;1-43.