Preventing Perinatal HIV Transmission Newsletter: Field Update Banner Logo
May 23, 2007
Preventing Perinatal HIV Transmission Newsletter: Field Update Banner Logo

Preventing Perinatal HIV Transmission Newsletter: Field Update Banner Logo

Overview
Welcome to this issue of Preventing Perinatal HIV Transmission: Field Update. You are receiving this newsletter because you expressed an interest in perinatal HIV prevention in hospitals or have signed up to receive it. This quarterly email newsletter connects its subscribers to news updates, trends, statistics, prevention programs, policy initiatives, tools, and useful practices relating to perinatal HIV prevention in U.S. hospitals. The Health Research and Educational Trust (HRET), with support from the Centers for Disease Control and Prevention (CDC), produces this newsletter as a forum for information dissemination and for communication among and between hospital staff, HIV experts, and researchers.

For more information on HRET's Perinatal HIV Prevention project, please visit our newly updated web site.

If you have comments or suggestions for future issues of this newsletter, please contact Jennifer Reiter at jreiter2@aha.org.


One Test. Two Lives. Campaign Crucial in the Fight to End Perinatal HIV Transmission
Although perinatal HIV transmission has declined drastically over the years, there are still mothers that do not receive HIV testing during pregnancy, and babies that become infected with the HIV virus. CDC has launched its One Test. Two Lives. campaign to provide information to health care providers and patients to help encourage all pregnant patients to get tested for HIV.

One Test. Two Lives. provides quick access to a variety of resources for providers, and materials for their patients, to help encourage universal voluntary prenatal testing for HIV.

Perinatal transmission accounts for 91% of all AIDS cases among children in the United States. Antiretroviral therapy during pregnancy can reduce the transmission rate to 2% or less. The transmission rate is 25% without treatment.

Click here to view the campaign’s web site and wealth of free resources.

Georgia HIV Pregnancy Screening Act of 2007 Signed Into Law
A bill was introduced in Georgia this spring that would require physicians and health care providers to test every pregnant woman for HIV unless she specifically declines. The bill requires that physicians inform the pregnant woman of the test to be conducted and provide documentation, and an exemption from counseling requirements. This is one of many several bills currently being discussed in state capitols nationwide.
As of May 22nd, Georgia’s Governor, Sonny Perdue, had just signed the bill into law. The law will take effect on July 1st.

California Introduces Bill to Require HIV Screening of Pregnant Women
California also introduced a bill this spring that would takes into account CDC’s 2003 statistics showing that 26% of all new HIV infections are acquired by African-American and Hispanic women through heterosexual sex. To prevent HIV being passed on to their future children, any woman seeking an annual gynecological examination or family planning appointment would be provided with information on HIV and AIDS, and be offered the option of being tested onsite, if available, or provided referral information to other testing locations. If the woman chooses to be tested for HIV, the physician or other health care professional attending the woman at the time the results are received would be required to ensure that the woman receives information and counseling, as appropriate, to explain the results and the implications for the woman's health, including any follow-up care that is indicated.

HRET will keep you updated on the status of this bill.

Nevada Senate Bill 266 on Preventing Perinatal HIV Transmission Passes Senate
The state of Nevada went many years without any documented cases of perinatal transmission of HIV. However, in 2004, this trend ended and over a period of less than two years at least four cases of perinatal HIV transmission were identified in southern Nevada alone. In response to these cases, the University of Nevada Las Vegas, School of Public Health convened a panel of experts in recognition of World AIDS Day, including a representative from the CDC and members of the Nevada state legislature, to discuss opportunities to prevent perinatal transmission of HIV in Nevada. As a result of this event, Senator Steven Horsford and Assemblyman David Parks introduced Senate Bill 266 in the 2007 Nevada Legislative Session.

Senate Bill 266 has three primary components. First, the bill requires a health care provider ensure that a woman receives a test for HIV, as part of the routine prenatal care recommended during the first trimester of pregnancy, unless the woman chooses not to be tested. The bill also requires a health care provider to ensure that a pregnant woman receives a test for HIV during her third trimester if she receives health care in a jurisdiction with a high prevalence of HIV or AIDS among women of child-bearing age or in a high-risk clinical setting, or if she reports that she has one or more of the risk factors identified by the CDC, unless the woman chooses not to be tested. The second component requires a health care provider to ensure that a pregnant woman receives a rapid test for HIV during labor if she has not been tested for HIV earlier during her pregnancy or the results of an earlier test are not available, unless the woman chooses not to be tested. If the result of the rapid test is positive, the health care provider must offer to initiate antiretroviral prophylaxis as soon as possible without waiting for the results of a confirmatory test. The third primary component of this bill requires a health care provider who attends or assists at the delivery of a child to ensure that a test for HIV is performed on the child if the mother has not been tested for HIV earlier during her pregnancy or the results of an earlier test are not available, unless a parent objects that performance of the test is contrary to the religious beliefs of the parent.

Amendments from the Senate require a health care provider to ensure that, before a woman or newborn child receives any test set forth in the bill, the woman or parent of the newborn child receives a pamphlet informing them of their right to refuse the test. Senate Bill 266 has passed the Senate and had its first hearing in the Assembly on April 25th. It is anticipated that the Assembly will request further amendments.

New York Recommends HIV Testing in the Third Trimester of Pregnancy
Over the past ten years, New York’s health providers have achieved a significant decrease in mother-to-child HIV transmission (MTCT) through the provision of routine prenatal testing and the incorporation of antiretroviral regimens into the clinical care of HIV-positive pregnant women and their newborns. In 1997, the statewide rate of MTCT was 10.9% with 97 infants infected. In 2004, the rate was 2.8% with 16 infants infected. In 2005, the transmission rate decreased further to 2.4% with 13 newborns infected.

To identify possible factors contributing to New York’s residual MTCT rate, the New York state department recently reviewed all MTCT cases that occurred in 2002 through 2004. In response to the review findings, and to further reduce mother-to-child HIV transmission, this health alert highlights the following important strategies:

• Identifying acute HIV infection during pregnancy
• HIV testing in the third trimester
• Point-of-care rapid testing in delivery settings

In tandem with the CDC, the state department recommends (but does not require) that prenatal providers routinely recommend repeat HIV testing, preferably at 34-36 weeks, for all women who test negative early in prenatal care. The second test should ideally be give at least three months after the initial test. Repeat testing will identify women who become infected with HIV during pregnancy, a group which accounts for an increasing proportion of MTCT. This Informed Consent to Perform HIV Testing form allows pregnant women to have repeat HIV testing during the pregnancy without signing another consent form.

New Jersey Bill Introduced That Would Make HIV Testing Mandatory for Pregnant Women and Newborns
A bill has been introduced this May in New Jersey that would require all pregnant women and newborns be tested for HIV. The law would require all pregnant women to be tested twice - once early in their pregnancy and a second time during the third trimester.

If passed into law, New Jersey would become the first state to require both pregnant women and newborns to be tested for HIV. Under the current proposal, the test would be administered unless the mother chooses, in writing, not to have it.

The bill will be scheduled for hearings in the coming weeks. HRET will keep you updated on its status.

StateHealthFacts.org Releases New Data on HIV/AIDS
In March, StateHealthFacts.org, the Kaiser Family Foundation’s source for state health data, released new data related to HIV testing and reporting policies. These new data include information on anonymous/confidential HIV testing and HIV name reporting.

Click here to view the data on anonymous/confidential HIV testing, and here to view the data on HIV name reporting.

Breast Feeding Risk Among Women with HIV
HRET was recently contacted by a physician with a pregnant patient whose viral load was undetectable on HAART and who wanted to breast feed. The doctor asked about the risk of HIV transmission from mother to child. Elaine Gross RN, MS, CNS-C, Nurse Educator from the François-Xavier Bagnoud Center, gave the doctor the appropriate clinical information he required. The response read in part:

There is a strong recommendation that women with HIV infection in the U.S. not breast feed.  Please note, this is true even with effective antiretroviral treatment for the mother and a viral load that is said to be "undetectable. "  HIV is found in both the cell-free component and within immune cells in breast milk.  A viral load of less than 400 (and in some newer tests, less than 50) is considered "undetectable," but this does not mean there is no virus present in her blood, vaginal fluids, and breast milk.  Under 400 means less than 400 viral particles per cc of blood, which is the body fluid that is tested for viral load.  A woman who protected her infant from HIV transmission before and during birth by taking antiretroviral medicines should continue to protect her infant after birth by giving her infant formula as well as the recommended antiretroviral post-exposure prophylaxis.

In developing countries where safe water and sterile preparation are often not possible, and expensive replacement feedings (formula) are not available, exclusive breast feeding (no other foods or liquids with the exception of medicines) is the option that HIV positive women have to protect their infants from HIV.  Women in this country do not have to make this difficult decision.

HRET - One North Franklin - Chicago, IL 60606 - (312) 422-2600 - (312) 422-4568

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