In Illinois, all pregnant women are eligible for Medicaid - regardless of their legal status in this country. If a woman is uninsured prior to pregnancy, she should go to her nearest Public Aid office to apply for a medical card as soon as possible. Medicaid covers all necessary HIV medications. The AIDS Drug Assistance Program, or ADAP, is a federally funded program that also covers HIV medications for those individuals without insurance or individuals with insurance who meet the financial criteria. While pregnant in Illinois, women covered by Medicaid should not need ADAP to cover medications, but this may be a helpful resource post-partum, if Medicaid is discontinued.

Women with a preliminary positive rapid HIV test who are in active labor should be counseled on the test result, the risk of vertical transmission and the potential benefit of a cesarean delivery in reducing that risk. The mother should be treated as positive until confirmatory tests prove otherwise. The Department of Health and Human Services Perinatal Guidelines indicate that intravenous AZT should be initiated immediately and that blood be sent for a subsequent supplemental HIV test to confirm the positive rapid HIV result. If needed, expedited confirmatory HIV testing is available through the Illinois Perinatal HIV Hotline with results generally obtained within 24 hours. Please call 1-800-439-4079 for additional information or specific questions. The neonate should also be managed as though the mother is positive until confirmatory tests prove otherwise. See the Illinois Perinatal HIV Hotline’s Best Practices for HIV+ Women in Labor including those with a positive rapid HIV test.

Almost half of all pregnant women living with HIV learn about their HIV status through routine, voluntary prenatal testing. The pregnant patient is concerned not only for herself, but also for the well-being of her child. It is important to reassure her that there are steps that can be taken to reduce the risk of transmission to her baby to less than 1%. Many women feel an even greater loss of control over their bodies and health of the baby with a new HIV diagnosis. It is important to validate their concerns while assuring the patient that she can regain the greatest sense of control by doing everything possible to prevent transmission. While this can be a difficult adjustment, it can be achieved by attending all scheduled appointments with her HIV specialist and obstetrician and taking her medications on time everyday.

If the woman is not in labor, and delivery is not imminent, confirmatory testing should be conducted and the patient managed accordingly.

The Illinois Perinatal HIV Hotline offers expedited confirmatory HIV testing at Northwestern Memorial Hospital’s Immunology Laboratory in Chicago for calls to the Hotline in which an urgent confirmatory HIV test result is needed for obstetrical decision making. The specimens are processed with an antigen/antibody combination immunoassay for detection of p24 antigen and HIV-1/2 antibodies, and then an HIV-1/2 antibody differentiation assay for any reactive Combo Ag/Ab tests. Please call the Illinois Perinatal HIV Hotline for information regarding how to prepare and ship the specimen and click here for further instructions.

You can call the Illinois Perinatal HIV Hotline at 1-800-439-4079 to link a woman with medical care and social services (food, housing, transportation, support groups, benefits, respite care and referrals) in her area.

Although HIV status is known in the majority of pregnant women or a rapid HIV test is done during delivery, in a small number of newborns the mother’s HIV status may not be known. In these situations, it is critical to do a rapid HIV test on the newborn as soon as possible after birth, since early prophylactic therapy for newborns of mothers with HIV can still prevent infection in almost half of infants.

The rapid test is quite accurate in diagnosing possible HIV exposure in the infant. The infant should be treated with a weight-appropriate dose of AZT as soon as possible and likely additional antiretroviral medications. Treatment of HIV-exposed newborns should continue until a maternal confirmatory HIV test result is available. See the Illinois Perinatal HIV Hotline’s Best Practices for Care of Infants with Perinatal Exposure to HIV for more detailed information.

In the state of Illinois, all preliminary positive rapid HIV tests performed on pregnant women in labor and delivery, whether the woman is delivering or not, must be reported. Additionally, all preliminary positive rapid HIV tests performed on newborns must be reported. Reporting consists of calling the Illinois Perinatal HIV Hotline, within 12 hours but no later than 24 hours of the test result, at 1-800-439-4079 and completing a Preliminary Positive Data Report.

An early infant bath should be completed in the delivery room prior to the administration of intramuscular injections or any invasive intervention. An appropriate protocol should include cleansing with chlorhexidine antiseptic solution, which is readily available in most labor and delivery units.