Evaluation of State-Mandated Third Trimester Repeat HIV Testing in a Large Tertiary Care Center

Abstract

Objective: The Illinois Perinatal HIV Prevention Act was passed to ensure universal HIV testing once during pregnancy and was extended in 2018 to add third trimester repeat HIV screening. The objectives of this analysis were to describe uptake of, and patient factors associated with, third trimester repeat HIV testing at a high-volume birthing center. Study Design: This is a retrospective cohort study of people who delivered at a single tertiary care hospital in Illinois during 2018. Women who delivered before 27 weeks, had an intrauterine fetal demise, a known diagnosis of HIV, or no HIV test during pregnancy were excluded. Repeat testing was defined as an HIV test at or after 27 weeks’ gestation after an earlier negative HIV test during the same pregnancy. The primary outcome was the proportion of people who received repeat testing prior to delivery. Bivariable analyses were performed to identify patient characteristics associated with documentation of repeat HIV testing. Results: Of 12,053 people eligible for inclusion, 3.4% (N=414) presented without a documented third trimester repeat HIV test. The proportion of people with repeat testing improved from 80% to >99% in the first year. Patient factors were largely not associated with testing performance although multiparous people were more likely to have documented repeat testing. Conclusion: Rapid implementation of third trimester repeat HIV testing was achieved without disparity. Patient factors were largely not associated with testing performance, which reinforces the goal of a universal screen: to test all people equitably and effectively without bias.

HIV testing during pregnancy among women with a recent live birth—Seven US States, 2016–2019

“…Our results are like previous studies in some jurisdictions that have shown that most women get tested during pregnancy, but that universal testing is not reported consistently, as recommended. 12 Evidence from self-reported survey data and chart review studies suggests that in recent years in the areas covered by these studies, 57%-81% of women have been tested for HIV during pregnancy. 17,18 However, prenatal testing rates for sexually transmitted infections (STIs), such as syphilis, and rubella and hepatitis B, have been found to be 97% or higher.…”

“…Our results are like previous studies in some jurisdictions that have shown that most women get tested during pregnancy, but that universal testing is not reported consistently, as recommended. 12 …”

“…10,11 Furthermore, being uninsured or underinsured could also lead to inadequate access to family planning and other services that often contribute to HIV transmission among Black women. 6,8 One of the objectives of the Centers for Disease Control and Prevention (CDC) for updating its HIV testing guidelines 12 was to increase HIV screening among pregnant women. These updated guidelines specifically state that HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.…”

“…One of the objectives of the Centers for Disease Control and Prevention (CDC) for updating its HIV testing guidelines 12 was to increase HIV screening among pregnant women. These updated guidelines specifically state that HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.…”

“…Repeat HIV testing during pregnancy among women who have a negative HIV test result early in pregnancy is important for reducing the risk for perinatal HIV transmission. 12 It is worth noting that there are differences in state-based laws that mandate HIV testing more than once during a pregnancy, and the states that mandate repeated testing report favorable outcomes. 13 For instance, the implementation of a statewide initiative in the state of Illinois helped to maximize opportunities that identify HIV-positive pregnant women and, in turn, helped to reduce perinatal HIV transmission.…”