A rapid HIV test is a screening test that produces very quick results, in approximately 20 minutes. Rapid tests use blood from a vein or from a finger stick, or oral fluid, to look for the presence of antibodies to HIV. A standard HIV test may take several days to obtain a result.

Tremendous strides have been made in the care of pregnant people living with HIV. Because of this progress, the risk of vertical transmission (when HIV is transmitted from birth parent to newborn) can be as low as less than 1%. Maximum reduction in transmission occurs when a person knows their HIV status early in pregnancy and receives treatment in the prenatal period and during labor, and the infant receives treatment once they are born. Some people present to labor and delivery without a documented HIV test or may require repeat HIV testing in the third trimester. In these cases a rapid HIV test on labor and delivery is necessary. It is critical that a patient's HIV status is known because appropriate medical decisions can be made at the time of delivery that have the potential to reduce the risk of HIV transmission by almost half. The sooner a doctor or nurse knows that a patient has HIV, the sooner treatment can be started, and the greater the chance the baby will be born without HIV.

A rapid test in the labor and delivery setting offers several advantages. Rapid testing preliminarily diagnoses a person with HIV before they leave labor and delivery. This allows for initiation of treatment while awaiting the confirmatory testing result. For a patient whose preliminary result is confirmed positive, they can be linked with appropriate follow up care and support services prior to being discharged from the hospital.

In Illinois, any healthcare professional or hospital caring for a pregnant patient during labor or delivery is required to offer counseling and opt-out rapid HIV testing if that pregnant patient does not have a documented third trimester HIV test. Testing is not required if the pregnant patient has a documented negative HIV test from the third trimester of the current pregnancy or is already documented to be living with HIV.

The Illinois Perinatal HIV Prevention Act (410 ILCS 335/) aims to eliminate perinatal HIV transmission. The U.S. Centers for Disease Control and Prevention (CDC) recommended in 2006 that providers conduct opt-out HIV testing of pregnant people. According to the CDC, before testing, providers should counsel pregnant patients about the benefits of HIV testing, inform them that they will be tested unless they decline, explain how to decline, advise that HIV testing is voluntary, and test the patient for HIV unless they decline. Illinois Public Law 95-702, effective June 1, 2008, implements these guidelines, mandates the counseling before the offer of testing and permits opt-out HIV testing. For additional information about the law, click here

The Perinatal HIV Prevention Act (410 ILCS 335/) aims to eliminate perinatal HIV transmission and serves as the legal basis for rapid HIV testing in Illinois. It was first passed in August 2003 as Public Act 93-566 and was amended in 2006 and 2007. The law was most recently amended in August 2017 by Public Act 100-0265 and mandates the following:

  1. Standardized and mandated counseling of all pregnant people.
  2. Opt-out HIV testing as early in pregnancy as possible.
  3. Repeat opt-out HIV testing during the third trimester, ideally by the 36th week of pregnancy (August 2017 amendment).
  4. Opt-out rapid HIV testing be offered on labor and delivery to people without a documented HIV test from the third trimester of the current pregnancy (August 2017 amendment).
  5. Mandatory rapid HIV testing of newborns to determine HIV-exposure if there is no documentation of maternal HIV testing during the third trimester of pregnancy or at delivery (June 2006/August 2017 amendments).
  6. Reporting of all preliminary positive rapid HIV tests on birthing parents and infants within 12 hours, but no later than 24 hours, of the test result to the 24/7 Illinois Perinatal HIV Hotline at 1-800-439-4079 to ensure medical consultation and linkage to case management (June 2006/August 2017 amendments).
  7. Documentation of HIV test results in prenatal, labor and delivery, and newborn pediatric charts.
  8. Hospitals submit monthly aggregate statistics that include the number of people who present with known positive HIV status, the number of pregnant people rapidly tested for HIV in L&D, the number of newborn infants rapidly tested for HIV, the number of preliminarily positive pregnant people and preliminarily HIV-exposed newborn infants identified and other information determined necessary.
  9. Hospitals report cases of perinatal HIV exposure of newborns.

The Perinatal Rapid Testing Implementation Initiative in Illinois (PRTII2) was established in 2004 to support hospital implementation of rapid HIV testing as mandated by the Perinatal HIV Prevention Act. The Illinois Department of Public Health funded this effort. Leadership was provided by Dr. Mardge Cohen, MD (Cook County Bureau of Health Services), Dr. Patricia Garcia, MD, MPH (Northwestern Memorial Hospital), Yolanda Olszewski, MSc, MPH (Cook County Bureau of Health Services) and Anne Statton (Pediatric AIDS Chicago Prevention Initiative). Today, ongoing technical assistance is available through the Mother and Child Alliance (formerly Pediatric AIDS Chicago Prevention Initiative - PACPI). Please contact us if you have specific questions about rapid HIV testing or require assistance.

Providers must report, within 12 hours but no later than 24 hours of a test result, all pregnant people or newborns with preliminary positive rapid HIV test results to the 24-hour Illinois Perinatal HIV Hotline (800-439-4079). Hospitals must also report aggregate statistics monthly and inform parents of the importance of treatment to prevent HIV transmission to the newborn. Every healthcare facility caring for a newborn whose birth parent was diagnosed with HIV prior to labor and delivery must report a case of perinatal HIV exposure to the appropriate health department.

In Illinois, mandatory rapid HIV testing of newborns to determine exposure to HIV is required if there is no documentation of the birth parent's HIV test result from the third trimester of pregnancy or at delivery. This testing should be done as soon as medically possible and is mandated by law in the Perinatal HIV Prevention Act.

Every healthcare professional involved in providing prenatal care, labor and delivery services, or care for newborns—including licensed physicians, physician’s assistants, and registered nurses—must counsel pregnant people about HIV and, unless they decline, provide HIV testing. For delivering patients and newborns, that HIV test must be a rapid test.