FAQs

How should staff manage a patient who presents to labor and delivery with no prenatal care?

Any patient who presents to labor and delivery without prenatal care should be offered and recommended rapid HIV testing. People 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 patient should receive treatment appropriate for HIV in a laboring patient, until confirmatory tests prove otherwise.

Intravenous Zidovudine (AZT) should be initiated immediately and blood sent for a supplemental HIV test to confirm the positive rapid HIV result. The neonate should also be managed as though the birthing parent is positive until confirmatory tests prove otherwise. See the Illinois Perinatal HIV Hotline’s Best Practices: Labor & Delivery Care for Pregnant People with HIV and Care for Infants with Perinatal Exposure to HIV including those with a positive rapid HIV test.

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

How should staff manage a pregnant patient with a preliminary positive rapid HIV test in labor and delivery?

Patients 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 birthing patient should be treated as positive, until confirmatory tests prove otherwise. The Department of Health and Human Services Perinatal Guidelines indicate that intravenous zidovudine (AZT) should be initiated immediately and that blood be sent for a 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 birthing parent is positive, until confirmatory tests prove otherwise. See the Illinois Perinatal HIV Hotline’s Best Practices: Labor & Delivery Care for Pregnant People with HIV and Care of Infants with Perinatal Exposure to HIV including those with a positive rapid HIV test.

How should staff manage a pregnant patient with a positive rapid HIV test who is not in active labor?

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

If the patient’s rapid test is preliminary positive and a confirmatory result is urgently needed, how can we obtain an expedited result?

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.

What are the concerns for pediatricians caring for babies that are rapid tested preliminary positive for HIV at delivery?

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 zidovudine (AZT) as soon as possible and likely additional antiretroviral medications. Treatment of newborns exposed to HIV should continue until the birth parent's confirmatory HIV test result is available. See the Illinois Perinatal HIV Hotline’s Best Practices: Labor & Delivery Care for Pregnant People with HIV and Care of Infants with Perinatal Exposure to HIV for more detailed information.

When is it required to report a preliminary positive rapid HIV test?

In the state of Illinois, all preliminary positive rapid HIV tests performed on pregnant people in labor and delivery, whether the patient 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.
 

Why is it important to call the Illinois Perinatal HIV Hotline as soon as the preliminary positive result is obtained?

Twenty-four hours a day, seven days a week expert, up-to-date, real-time consultation on each individual case is available to assure that all clinical and social issues are addressed for each patient with a preliminary positive result. The intent of the legislation requiring the call is to ensure that experienced case management helps the patient and her family with this information in the very vulnerable time between receipt of the rapid result and receipt of the confirmatory HIV test result. Oftentimes, case management can also provide a home visit and help ensure the return visit to the hospital or clinic to receive the confirmatory results. Hotline staff work with hospitals and providers as a team to make clinical decisions, connect patients with case management, and assure appropriate follow up.

What happens when the enhanced case manager comes to the hospital to see a patient with a preliminary positive rapid HIV test result?

The case manager will meet with the staff that called the Illinois Perinatal HIV Hotline to report the preliminary positive test result and inquire about any particular issues of concern for either staff or the client. The case manager will then request to meet with the client privately (away from family) to discuss options. With permission, the case manager will meet with the family with the goal of stabilizing the situation. Before leaving the hospital, the case manager will update staff on any plans and referrals that might be in process for the client.

What happens to the enhanced case management relationship if the rapid HIV test is confirmed negative?

The case work is completed and the client is referred to the appropriate follow-up services for people without HIV. The clients are assisted with finding a pediatrician, where to go for benefits (WIC, KidCare) and the case may be transferred to a DHS Family Case Manager where appropriate.

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