January 21, 2010
A new law effective Jan. 1 requires health care providers in Texas to screen mothers-to-be for HIV in the last trimester, unless the patient objects. Under the measure, pregnant women who test HIV-positive can begin antiretroviral therapy immediately, while treatment for the infant begins at birth and continues for six weeks.
Women who do not consent to screening are to receive information about transmission risks and anonymous HIV testing. An HIV-infected mother has a one-in-four chance of passing on the virus to her infant without treatment, compared with about a 1 percent risk on treatment, according to the Department of State Health Services. For women who present for delivery without a record of HIV testing, the hospital is required to offer the test and obtain results within six hours.
"We are hearing from colleagues in other health care systems that most hospitals are having a challenge complying with [the six-hour turnaround] and other provisions of the law," said Dr. Steve Berkowitz, chief medical officer for St. David's HealthCare, which operates five Central Texas hospitals that deliver babies. "We are in compliance with every section of this law with the exception of the six-hour turnaround time on the lab results."
The Seton Family of Hospitals, which runs six facilities where infants are delivered, performs a rapid HIV test if there is no record of a third-trimester test, said Adrienne Leyva, a hospital spokesperson. In Travis County's largest public clinic system, CommUnityCare, most pregnant patients are on Medicaid and "the cost of the HIV test is simply included in their care," said Dr. David Vander Staten, its chief medical officer.
A consortium is creating a handbook to help providers treat HIV-positive pregnant women and their babies in light of the new state law. "No woman should deliver without knowing her HIV status," said Dr. Judy Levinson, a consortium participant and associate professor of obstetrics and gynecology at Baylor College of Medicine.