HIV Testing and Prophylaxis During Labor and in Newborns
- When a patient in labor is not known to have HIV, does not have a documented third-trimester negative HIV test result, has been diagnosed with a sexually transmitted infection during pregnancy, or reports exposure risk for themselves or sex partners, the clinician should perform expedited HIV testing with consent and discuss the use of antiretroviral prophylaxis for the patient and the newborn [a]. (A2)
- If the result of the expedited HIV screening test for a patient in labor is reactive, the clinician should:
- Obtain HIV diagnostic testing according to the standard HIV laboratory testing algorithm. (A1)
- Initiate maternal antiretroviral prophylaxis (A1); immediate initiation is recommended. (A3)
- Administer newborn prophylaxis [b] as soon as possible after birth. (A2)
- If supplemental diagnostic testing confirms that a patient in labor has HIV, the clinician should:
- Ensure that an HIV diagnostic test of the infant is obtained within 48 hours of birth. The infant’s specimen should be sent to the Pediatric HIV Testing Service at the Wadsworth Center for a nucleic acid test (NAT) to detect HIV-1 RNA or DNA. (B3)
- Make arrangements for the patient with newly diagnosed HIV to see an experienced HIV care provider and, if indicated, provide referrals for case management and support services [c]. (A3)
- Ensure that the HIV-exposed infant is discharged from care with antiretroviral medications in hand, not just a prescription. (B3)
- Make arrangements for the infant’s medical follow-up with an experienced pediatric HIV care provider. (A3)
