(Based on the mnemonic “C³R³”)

The three Cs represent confidentiality, comfort, and consent. The three Rs are reasons for the rapid test, results, and “Rx” for treatment, or medications to reduce mother to child transmission.

C³

• Confidentiality: It is important to reassure the woman that the discussion about HIV testing will be kept confidential and that the information will not be shared with her partner or family without her permission.
  
• Comfort: The clinician should assess the woman’s stage of labor, comfort level, and need for analgesics. Providers need to show empathy while presenting information about rapid HIV testing. The content covered should be short and to the point and should be explained between contractions. The clinician should ask the woman to signal for a pause when a contraction is starting. The clinician should always consider the woman’s language and culture and, as needed, must adjust the terminology used. The clinician should make sure that the woman being counseled understands the content being covered by checking after each point is made and before beginning the next point to be sure she understands.
  
• Consent for testing and for antiretroviral treatment, if needed, in labor: Regulations, laws, and policies about HIV testing of pregnant women vary from state to state. Providers need to know and need to follow the laws and policies of their state. The minimum content that should be included in educating a pregnant woman about HIV rapid testing during labor is detailed next under Reasons to test.

R³ Reasons to test: The woman should be informed of the important reasons to get an HIV test during labor, and the crucial opportunity to prevent possible transmission of the virus to her unborn baby should be emphasized:  

• HIV is the virus that causes AIDS. One of the ways HIV is spread is by unprotected sexual intercourse. Therefore, all pregnant women are at risk for HIV infection.
  
• A woman could be at risk for HIV and not know that she is at risk.
  
• The HIV virus can be passed from a mother to her baby during pregnancy, at delivery, and through breastfeeding.
  
• Learning that a woman has an HIV infection while she is still in labor gives her a crucial opportunity to reduce the risk of transmitting HIV to her infant; and, just as importantly, having this knowledge also ensures that both she and her baby receive the care and the treatment they need.
  
• HIV testing is recommended for all pregnant women. Hospital/national policy (and/or state law) recommends HIV testing for all women in labor with unknown HIV status.
  
• Unless the woman refuses to be tested, our hospital routinely does rapid HIV testing for all women in labor who don’t already have an HIV test result in their medical record.

• If she is tested for HIV during labor, a woman should be told when she will receive her test results.
  
• A negative HIV test result means a woman almost certainly does not have HIV infection at this time. A positive HIV test result means a woman likely has HIV infection even if she is feeling well. Further testing will be done after she delivers to confirm if she has HIV infection.
  
• A woman should be asked who she wants to be present when she receives her rapid HIV test result.

• Medications can reduce the risk of transmission of HIV to the baby. Without medication, the chance the baby will be infected is about 25%—or about 1 baby in 4 births could be infected with HIV. With the medications given to the woman during labor and to the newborn, the risk of HIV transmission can be reduced to about 10— or to about 1 baby out of 10 births.
  
• If a woman is found to have HIV infection, treatment is available to help keep her well.
  
• Any medication will be stopped if the confirmatory HIV test result is negative.

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