One Test. Two Lives. HIV Testing during Pregnancy

CDC's new campaign, One Test. Two Lives., gives providers tools to help reduce the number of infants born with HIV. The campaign gives obstetricians, nurse-midwives, and other providers new tools to ensure that all of their patients have the opportunity to learn their HIV status as a routine part of prenatal care, and to protect their newborns from HIV infection. "One Test. Two Lives. is such a vital program because it significantly enhances the opportunity for key obstetrical providers to address, recommend, and perform HIV testing in pregnancy, which is the critical first step in preventing maternal-to-child transmission of HIV", according to Richard Beigi, MD, Assistant Professor of Reproductive Infectious Diseases at Magee-Women's Hospital of the University of Pittsburgh Medical Center.

Since 1995, CDC has recommended routine HIV screening for all pregnant women. Since that time, the estimated incidence of mother-to-child transmission has dropped by approximately 85 percent due to routine screening and the use of antiretroviral medications. However, mother-to-child HIV transmission does continue in the United States in part because many pregnant women are still not being tested. Data suggest that in recent years roughly 35–40 percent of mothers who gave birth to HIV-infected infants were unaware of their infection prior to labor and delivery.

Campaign Designed to Overcome Barriers to Prenatal HIV Testing

Extensive input from providers during the development of the campaign identified a number of barriers to fully implementing routine HIV screening in prenatal care settings, including:

• Misperceptions about patient risk

• Time constraints

• Reluctance to discuss patient concerns about testing

• Lack of patient and provider informational materials

In response, One Test. Two Lives. offers a range of provider materials to help facilitate screening in prenatal settings, such as CDC's practical guide for providers on rapid HIV testing during labor and delivery, and patient materials to ensure that patients are aware of the facts and benefits of HIV testing, such as a patient brochure, a fact sheet on recommended prenatal tests and a display poster for medical offices.

"Research indicates that the majority of pregnant patients will decide to get tested when their prenatal care provider recommends the HIV test and One Test. Two Lives. has tools to facilitate this discussion" noted Lisa Summers, CNM, DrPH, Director of Professional Services, American College of Nurse -Midwives.

One Test. Two Lives. emphasizes three points:

• Testing for HIV early in pregnancy, preferably at the first obstetrical visit, benefits both mothers and babies. Women with HIV who start treatment early and maintain it throughout their pregnancy protect their own health and rarely pass HIV to their infants.

• It is never too late for pregnant women to get tested. With the availability of rapid HIV tests, women who arrive at delivery rooms with unknown HIV status can still receive an HIV test. Preventive medications administered to the mother during labor, and to the infant after birth, can reduce the risk of mother-to-child HIV transmission to about 10 percent.

• Pregnant women are likely to get tested if their providers strongly recommend it. In a study of 1,362 pregnant women, 93 percent of women who felt their providers strongly recommended an HIV test decided to get tested.

A number of medical organizations recommend routine prenatal screening for HIV, including American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Academy of Pediatrics, Institute of Medicine, and the U.S. Preventive Services Task Force.

Resources

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