Supporting Evidence

In the 2006 Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings, CDC recommended the opt-out approach to testing for all adult and adolescent patients in health-care settings, including pregnant women. These recommendations emphasize:

• Universal “opt-out” HIV testing for all pregnant women early in every pregnancy;
• A second test in the third trimester in certain geographic areas or for women who are known to be at high risk of becoming infected (e.g., injection-drug users and their sex partners, women who exchange sex for money or drugs, women who are sex partners of HIV-infected persons, and women who have had a new or more than one sex partner during this pregnancy);
• Rapid HIV testing at labor and delivery for women without a prenatal test result; and
• Exploration of reasons that women decline testing.

Studies show that the opt-out approach can:

• Increase testing rates among pregnant women, thereby increasing the number of pregnant women who know their HIV status;
• Increase the number of HIV-infected women who are offered treatment; and
• Reduce HIV transmission to their babies.

How is opt-out screening implemented in the health-care setting?

Opt-out has four steps for health-care providers to follow to put this approach into practice (CDC recommends all four steps):

• Tell all pregnant women that an HIV test will be performed as part of the standard group of tests for pregnant women.
• Tell all pregnant women that they may decline this test.
• Give all pregnant women information about how to prevent HIV transmission during pregnancy, and provide information about treatment for pregnant women who are HIV-positive.
• Perform the HIV test.

Several national professional and governmental agencies, including the American Academy of Pediatrics, ACOG, ACNM, and the U.S. Preventive Services Task Force, endorse CDC’s recommendation to routinely screen pregnant women for HIV.

Supporting Documents

The following documents relevant to HIV testing in pregnancy and updated testing recommendations are available for download from CDC:

1. CDC 2006 Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
2. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations

HIV/AIDS Medical Practice Guidelines

3. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States
4. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection

Committee Opinions and Statements

5. ACOG Committee Opinion No. 635, Prenatal and Perinatal Human Immunodeficiency Virus Testing: Expanded Recommendations (June 2015)
6. ACNM Position Statement on Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)