WASHINGTONThe 8-year drive to test pregnant women for HIV as a means of preventing perinatal transmission of the virus had varying degrees of success, according to a new report from the Centers for Disease Control and Prevention (CDC).
Although a small sampling in 2000 showed that 766 (93%) of 824 HIV-infected women in 25 states knew their HIV status prior to delivery, an estimated 280 to 370 perinatal HIV transmissions still occur annually in the United States. Moreover, the rate of HIV testing varies considerably among the states, depending on which of three approaches to testing is used.
The three approaches are generally known as opt-in, opt-out, and mandatory. The opt-in methodology provides women with pre-HIV testing counseling, but they must specifically give their consent to an HIV antibody test. Opt-out notifies women that an HIV test will be part of a standard battery of prenatal tests unless they specifically refuse the test. In mandatory newborn testing, babies are tested with or without the mother’s consent when her HIV status is unknown at the time of delivery.
HIV testing rates varied with each approach. Medical records suggest that the voluntary opt-in approach is associated with lower testing rates, while either the opt-out approach or mandatory testing of newborns results in higher testing rates.
Testing rates in states using opt-in ranged from 25% to 69%. Two states (Arkansas and Tennessee) and two Canadian provinces (Alberta and Newfoundland, including Labrador) use the opt-out approach. Tennessee had a testing rate of 85% and Alberta recorded a rate of 98%.
New York and Connecticut mandate testing of newborns when mothers are not tested during pregnancy. Medical records from seven counties in the Rochester, New York, area showed the prenatal testing rate increased from just over half of 483 mothers to 83% of 112 mothers after testing became mandatory.
An even greater increase in prenatal testing occurred in Connecticut after the state made newborn testing mandatory for children born to mothers whose HIV status was unknown. The testing rate went from 31% of 668 mothers to 81% of 93 mothers.