Provider Notice issued 12/11/06

Perinatal Human Immunodeficiency Virus (HIV) Testing

The Illinois Perinatal Prevention Act was enacted in 2003 to ensure that women are screened for HIV as early in pregnancy as possible and to reduce the risk of HIV transmission from mother to newborn infant. The Act was amended in 2006 to further reduce the risks to newborn infants. This notice includes information from the Act regarding perinatal HIV testing. A letter from the Illinois Department of Public Health summarizing the amended Act is attached for your information.

HIV Testing for Pregnant Women

Advanced knowledge of a pregnant woman’s HIV status provides opportunities for interventions to reduce mother-to-child transmission, such as antiretroviral therapy and elective cesarean section. Antiretroviral therapy is most effective when initiated early in a pregnancy and can reduce the chances of mother-to-child transmission from approximately 25 percent to less than 2 percent.

The rapid HIV test is an important step employed by health care professionals to help improve birth outcomes. Health care professionals can administer the rapid HIV test to determine the HIV status of the mother. If the test result is HIV positive, chemoprophylaxis can dramatically reduce vertical transmission from mother to infant.

The American College of Obstetrics and Gynecology (ACOG) recommends that during the initial prenatal care visit all pregnant women be screened for HIV as part of the routine battery of prenatal blood tests (unless they decline the test). ACOG further recommends that an offer of HIV testing be repeated in the third trimester to women in areas with high HIV prevalence, women known to be at high risk for HIV infection, and women who declined testing earlier in pregnancy. Conventional HIV testing should be used during the third trimester and a rapid HIV test should be performed during labor and delivery for all women whose HIV status is unknown. If a rapid HIV test result performed during labor and delivery is positive, ACOG recommends initiating antiretroviral prophylaxis (with consent) without waiting for the results of the confirmatory test. Starting treatment during labor and delivery, or providing treatment to the newborn within hours of birth can reduce mother-to-child transmission by half. 

HIV Test Results

HIV test results should be documented in the woman’s medical record and such documentation should be provided to the labor and delivery hospital so that necessary interventions to protect the child can be taken during labor and delivery.

Rapid HIV Testing

Healthcare and Family Services (HFS) encourages providers to use rapid HIV testing during labor and delivery for women whose HIV status is unknown. Test results are available in 20-40 minutes allowing providers to determine the necessity of interventions to protect the child.

Written Informed Consent and Counseling

Providers must provide counseling before administering an HIV test. Initial counseling must include at a minimum:

• The benefits of HIV testing for pregnant women, including the prevention of transmission;

• The benefit of HIV testing for the newborn infant, including interventions to prevent HIV transmission;
• The side effects of interventions to prevent HIV transmission;
• The statutory confidentiality provisions that relate to HIV and acquired immune deficiency syndrome (AIDS) testing;
• The voluntary nature of the testing, including the opportunity to refuse testing of a newborn infant in writing based on religious tenets and practices;
• If the woman declines HIV testing during pregnancy, her newborn infant will be tested for HIV upon delivery;
• Information about the natural history of HIV infection and HIV transmission;
• Information about the meaning of the test and test results, such as: the purpose, potential uses, and limitations of the test, rapid HIV test, rapid HIV test results and the need for confirmatory testing;
• Methods of preventing HIV transmission; and

• Information about the availability of referrals for further information or counseling.

The woman’s written informed consent must be obtained before administering an HIV test. At a minimum, the written consent must include:

• An explanation of the test, including its purpose, potential uses and limitations and the meaning of its results; and

• An explanation of the procedures to be followed, including the voluntary nature of the test, the right to withdraw consent at any time; the right to anonymity in accordance with the AIDS Confidentiality Act.

Counseling and Testing During Labor and Delivery

Health care professionals or facilities that care for a pregnant woman during labor or delivery must provide the women with HIV counseling and offer rapid HIV testing if HIV test results are not already documented in the woman’s medical record. Informed written consent must be obtained prior to rapid HIV testing. If the woman’s HIV status is documented in the medical record, counseling is not required.

Counseling and the offer of testing must be documented in the woman’s labor and delivery medical record. Any testing or test results are to be documented in accordance with the AIDS Confidentiality Act and the HIV/AIDS Confidentiality and Testing Code in the woman’s medical record.

When disclosing a positive result of a rapid HIV test to a pregnant woman during labor and delivery, health care professionals must provide the woman with post-delivery follow-up referrals to physicians or facilities with experience in providing services to women with HIV.

HIV Testing of a Newborn Infant

Hospitals must adopt policies to record the mother's HIV test result in the newborn infant's medical chart if available. Additionally, it must be noted whether the mother’s HIV test result is not available because she declined testing. When the HIV status of the infant's mother is unknown, HIV testing must be performed on an infant upon delivery or within 48 hours after the infant's birth. Testing is required unless the mother or legal guardian refuses based on religious tenets and practices by presenting a written statement to the health care provider. If a newborn infant tests positive, counseling, the recommendation of testing for the newborn infant and whether the parent or guardian refused testing based on religious tenets and practices for the infant must be documented in the woman’s medical record.

The health care professional or facility caring for a newborn infant must provide counseling to the parent or guardian of an infant who tests positive that includes the following:

• The benefits of HIV testing for the pregnant woman, including the prevention of transmission;

• The benefit of HIV testing for the newborn infant, including interventions to prevent HIV transmission;
• The side effects of interventions to prevent HIV transmission;

• The statutory confidentiality provisions that related to HIV and AIDS testing; and

• The voluntary nature of the testing, including the opportunity to refuse testing in writing.

For newborn infants who test positive, the health care professional must:

• Provide the parent or guardian with an explanation of antiretroviral preventive treatment;

• Provide information on antiretroviral preventive treatment;
• Explain how the test detects HIV antibodies;
• Offer HIV risk counseling;
• Encourage HIV testing for the mother; and
• Provide referrals to physicians or facilities that have experience treating women and children with HIV.

Reimbursement for Rapid HIV Testing

HFS covers Rapid HIV testing. Reimbursement for the test, which consists of a finger stick and mouth swab, is $11.60. The procedure code for billing is 86701 with the QW modifier and can be billed by the following providers: physicians, laboratories, FQHCs, RHCs, ERCs and hospitals. FQHCs, RHCs and ERCs billing an encounter should provide detail of all procedures performed during the encounter using the appropriate CPT codes.

Perinatal HIV Hotlines

For more information regarding the hotlines listed herein and the services they provide, visit the HFS Web site at: <http://www.hfs.illinois.gov >. Links to resources and information on Rapid HIV testing are available at: <http://www.hfs.illinois.gov/html/hivlinks.html>. For billing questions, call the Bureau of Comprehensive Health Services at 1-877-782-5565.

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs

IDPH Letter (pdf)