Appendix C
The François-Xavier Bagnoud Center’s
Formula
for Offering Routine, Rapid HIV Testing
to Women in Labor with Unknown HIV Status
The François-Xavier Bagnoud Center’s Formula
for Offering Routine, Rapid HIV Testing to Women in Labor with Unknown HIV Status
(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.
Results
-
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.
Rx – Medications
-
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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