FAQs

What counseling and testing services must providers offer to pregnant people?

  • Prenatal care: Health care professionals must counsel all pregnant people about HIV and provide HIV testing as early in pregnancy as possible unless they decline or there is documentation that they were previously tested during the current pregnancy. Providers must explain that individuals may decline HIV testing, but that if they decline testing, HIV testing will be mandatory for the newborn.
  • Third trimester repeat HIV testing: As of January 1, 2018, healthcare professionals who provide healthcare services to pregnant people are required to give HIV counseling and provide repeat opt-out HIV testing during the third trimester, ideally by the 36th week of pregnancy. 
  • Labor and delivery:  As of January 1, 2018, 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 person does not have a documented third trimester HIV test. Testing is not required if the pregnant person has a documented negative HIV test from the third trimester of the current pregnancy or is already documented to be living with HIV. Providers must explain that patients may decline HIV testing, but that if they decline testing, HIV testing will be mandatory for their newborn.
  • After delivery: If there is no documentation of an HIV test on the birth parent from the third trimester or at delivery, then mandatory rapid HIV testing of the newborn, as soon as possible within medical standards to determine HIV exposure, is required. The birth parent's or guardian’s consent is not required to test the newborn.

 

What must HIV counseling include?

All HIV counseling for pregnant people must be in accordance with the AIDS Confidentiality Act and include:

  • The voluntary nature of testing for pregnant people.
  • The requirement that opt-out testing of the patient be performed, unless they decline, and how to decline.
  • The benefits of HIV testing for pregnant people, including the opportunity to prevent HIV transmission to the newborn.
  • The benefit of HIV testing for the infant, including interventions to prevent transmission, and the side effects of those interventions.
  • The confidentiality provisions that relate to HIV and AIDS.
  • The requirement that if the birth parent’s HIV status from the third trimester is unknown, the newborn must be tested for HIV.
  • An explanation of the test, including its purpose, limitation, and the meaning of its results.
  • An explanation of the procedures followed.
  • The availability of additional or confirmatory testing, if appropriate.
  • Counseling may be provided in writing, verbally, by video, electronic or other means. The patient must be offered an opportunity to ask questions about testing and to decline testing for themself.

How must the HIV test be administered?

  • All testing of pregnant people must be voluntary. Only newborns whose birth parent’s HIV status from the third trimester is unknown may be tested without consent.
  • Opt-out HIV testing must be conducted for all pregnant people. They must be provided with counseling prior to HIV testing. Providers must explain that individuals may decline HIV testing, advise that they will be tested for HIV unless they decline, and informed how to decline testing. They must be counseled on the benefits of HIV testing, and providers must inform patients that their newborn will be tested if they are not tested.
  • Any testing and test results must be documented in accordance with the AIDS Confidentiality Act (410 ILCS 305/). All counseling and acceptance or refusal of testing must be recorded in the birth parent's medical records.
  • The law requires that the birth parent’s HIV test results be recorded in the newborn’s chart. The provider must note if the test results are not available because the birth parent declined testing or was not tested.
  • Testing of patients in labor and newborns must be performed by a rapid HIV test.
  • Providers may be fined for violations of the AIDS Confidentiality Act, including failing to provide adequate pre-test counseling.

What does a positive rapid HIV test mean?

A positive rapid HIV test is interpreted as a preliminary positive. Because no test can be both 100% sensitive (no false-negative results) and 100% specific (no false-positive results), a given test is typically designed to primarily possess one of these characteristics at the expense of the other. A rapid HIV test is a screening test meaning that it is a sensitive test but not specific. Practically, this translates to more false-positive test results. This is why all positive rapid HIV test results require confirmation with a subsequent supplemental HIV test different from the initial test. In certain situations, such as labor, it may be necessary to initiate treatment prior to obtaining a confirmatory result. Other times treatment can be delayed until a confirmatory test result is obtained. The Illinois Perinatal HIV Hotline is available to help you make these treatment decisions.

What does a negative rapid HIV test mean?

A negative rapid HIV test is interpreted as negative. No confirmatory testing is required. If a person was recently exposed to the virus or has symptoms of acute HIV infection, additional testing may be recommended as the rapid test may not detect a recent infection.
 

What should we do if a patient has a positive rapid HIV test result?

When a patient has a positive rapid HIV test result, it is critical that a confirmatory test be sent immediately. A positive result should promptly trigger a call to the Illinois Perinatal HIV Hotline as required by Illinois law. As a team, you and the hotline staff will determine the most appropriate clinical and social course to assure the risk of HIV transmission from the patient to their infant is optimally reduced.

How should preliminary positive test results be communicated to the patient?

During this time, it is important to note that a patient’s decision to accept an HIV test and the results of that test are to be kept confidential. Labor and delivery staff need to be vigilant of this at all times. The discussion of test results should occur in an environment where the patient feels comfortable and safe. The patient may not want to disclose information regarding their choice to be tested or the results of the test to their family members, partner, or friends. Ask the patient prior to obtaining the rapid HIV test who they want present when they receive the results. Only the individuals identified should be in the room when the results are relayed. If English is not the patient’s primary language, interpretation services should be utilized. Staff should not use family members or friends to discuss test results or provide information surrounding the results.

What should the patient be told about the preliminary positive result?

Patients should be counseled that positive test results are only preliminary and that additional testing is necessary to confirm the diagnosis. If the patient is at risk for delivery, they should be informed that the second test will likely not be back prior to delivery of their baby. They should be counseled that antiretroviral medication is recommended to reduce the risk of transmission of the virus to the baby. Additionally, they should be counseled to avoid breastfeeding (or pump/store breastmilk in the event of a false positive test) until confirmatory test results are available.
 

If the rapid test is preliminary positive, should we repeat it?

No. Rapid tests cannot be confirmed with another rapid test. It is important to act quickly and obtain a confirmatory test, report the result, and depending on the scenario initiate treatment.

If the birthing parent's test is preliminary positive, should we also test the baby?

No. There should be only one rapid HIV test on the birth parent/newborn pair. If the birth parent declines HIV testing or is missed for HIV testing when pregnant and/or delivering, the newborn must be tested (by law in Illinois). If the newborn’s test is preliminary positive, it means that maternal antibodies to HIV may have been detected in the newborn’s blood. Therefore, it is not necessary to also rapid test the birth parent if the newborn has been tested. A sample may be drawn from the birth parent for confirmatory HIV testing if the newborn's rapid test is preliminary positive.

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