Medical and Surgical Complications in Pregnancy
CDC screening for HIV screening in pregnancy (AIIMS May 2009)
|A||Opt out testing|
|B||Opt in testing|
Opt out testing
Controversial options as cdc guidelines recomends universal opt-out screening
But opt-out screening is better option to mark as explained below.
a. Diagnostic testing. Performing an HIV test for persons with clinical signs or symptoms consistent with HIV infection.
b. Screening. Performing an HIV test for all persons in a defined population
c. Targeted testing. Performing an HIV test for subpopulations of persons at higher risk, typically defined on the basis of behavior, clinical, or demographic characteristics.
d. Informed consent. A process of communication between patient and provider through which an informed patient can choose whether to undergo HIV testing or decline to do so. Elements of informed consent typically include providing oral or written information regarding HIV, the risks and benefits of testing, the implications of HIV test results, how test results will be communicated, and the opportunity to ask questions.
e. Opt-out screening. Performing HIV screening after notifying the patient that 1) the test will be performed and 2) the patient may elect to decline or defer testing. Assent is inferred unless the patient declines testing.
f. HIV-prevention counseling. An interactive process of assessing risk, recognizing specific behaviors that increase the risk for acquiring or transmitting HIV, and developing a plan to take specific steps to reduce risks
CDC guidelines are as follows:
2. HIV Screening for Pregnant Women and Their Infants
a. Universal Opt-Out Screening
i. All pregnant women should be screened for HIV infection.
ii. Screening should occur after a woman is notified that HIV screening is recommended for all pregnant patients and that she will receive an HIV test as part of the routine panel of prenatal tests unless she declines (opt-out screening).
iii. HIV testing must be voluntary and free from coercion. No woman should be tested without her knowledge.
iv. Pregnant women should receive oral or written information that includes an explanation of HIV infection, a description of interventions that can reduce HIV transmission from mother to infant, and the meanings of positive and negative test results and should be offered an opportunity to ask questions and to decline testing.
v. No additional process or written documentation of informed consent beyond what is required for other routine prenatal tests should be required for HIV testing.
vi. If a patient declines an HIV test, this decision should be documented in the medical record.
b. Timing of HIV Testing
i. To promote informed and timely therapeutic decisions, health-care providers should test women for HIV as early as possible during each pregnancy. Women who decline the test early in prenatal care should be encouraged to be tested at a subsequent visit.
c. Rapid Testing During Labor
i. Any woman with undocumented HIV status at the time of labor should be screened with a rapid HIV test unless she declines (opt-out screening).
ii. Reasons for declining a rapid test should be explored
iii. Immediate initiation of appropriate antiretroviral prophylaxis should be recommended to women on the basis of a reactive rapid test result without waiting for the result of a confirmatory test.