Managing women who decline HIV testing in pregnancy and their infants? A multidisciplinary team guideline.
Adult
Female
Gestational Age
HIV Infections
/ diagnosis
Health Services Research
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical
/ prevention & control
Interdisciplinary Communication
Mass Screening
/ legislation & jurisprudence
Patient Compliance
/ statistics & numerical data
Practice Guidelines as Topic
Pregnancy
Pregnancy Complications, Infectious
/ diagnosis
HIV
antenatal screening
mother-to-child transmission
pregnancy
Journal
HIV medicine
ISSN: 1468-1293
Titre abrégé: HIV Med
Pays: England
ID NLM: 100897392
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
accepted:
03
05
2019
pubmed:
20
8
2019
medline:
2
7
2020
entrez:
20
8
2019
Statut:
ppublish
Résumé
The management of women at high risk of HIV infection who repeatedly decline HIV testing in pregnancy is not covered in any national guideline. In Leeds, we had a case which prompted us to consider maternal rights plus our duty of care to the infant once born. Leeds has an established HIV and Syphilis in Pregnancy Multidisciplinary Team (MDT). The main issues pertaining to a pregnant woman persistently declining HIV testing were discussed within the MDT: identification of pregnant women declining testing; universal testing versus testing by risk stratification of their infants; calculation of vertical transmission risk; definition of unacceptable risk; timing of the decision to request court authority to test the infant; advanced preparation of court authority request papers. It was decided that an HIV transmission risk > 1 in 1000 justified testing an infant at birth. The MDT decision to request court authority for infant HIV testing would be made at 32-34 weeks of gestation, allowing the court papers to be prepared in advance of delivery. The Leeds Obstetrics and Paediatric Guidelines were reviewed, amended and approved by the Trust Guideline Group, Risk Management team and legal team. These guidelines are outlined within the article. The Neonatal guideline also is accessible via this link: http://nww.lhp.leedsth.nhs.uk/common/guidelines/detail.aspx?ID=177 CONCLUSIONS: If a woman at high risk declines HIV testing in pregnancy, it remains possible to significantly reduce the risk of vertical transmission once the child is born, but the window of opportunity is small. Therefore, it is vital to have pathways already in place to address this prior to delivery.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
601-605Informations de copyright
© 2019 British HIV Association.
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