1 At Childbirth, 2004

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Reducing HIV Transmission

From Mother-to-Child: An Opt-Out

Approach to HIV Screening

The chance that HIV infection is transmitted from a

mother who is HIV infected to her child during

pregnancy can be reduced to 2 percent or less (fewer

than 2 out of every 100). This is possible because of

better medicines available to treat HIV. But first, the

pregnant woman and her doctor must know if she is

infected with HIV.

What do we know?

 New information gathered shows that a number of

women across the United States are not getting

tested for HIV during pregnancy.

 Studies show that more women are tested when

the HIV test is included in the standard group of

tests that all pregnant women receive routinely.

 Since 1995, CDC has recommended all pregnant

women be tested for HIV and, if found to be

infected, offered treatment for themselves to

improve their health and to prevent passing the

virus to their infant.

What Testing Approaches Are

Available?

In the November 15, 2002, Morbidity and Mortality

Weekly Report (MMWR), CDC published information on recent prenatal HIV testing rates in the United

States and Canada. The report looked at HIV

prenatal testing rates when different testing approaches were used. There are two ways to do

voluntary HIV testing:

 Opt-in:

o Pregnant women are given pre-HIV test

counseling.

o They must agree to getting an HIV test,

usually in writing.

 Opt-out:

o Pregnant women are told that an HIV test

will be included in the standard group of

prenatal tests (that is to say, tests given to

all pregnant women), and that they may decline

the test.

o Unless they decline, they

will receive

an HIV test.

Statistics published

in the MMWR

showed that in eight

states using the opt-in approach in 1998-1999, testing

rates ranged from 25% to 69%. In Tennessee, which

uses an opt-out approach, the testing rate was 85%.

This and other information on prenatal HIV testing

suggests that, of the voluntary approaches to prenatal

HIV testing, more women are tested with the opt-out

approach.

Which Approach Does CDC

Recommend?

CDC recommends the opt-out approach, which

would make the HIV test a part of the group of tests

that all pregnant women receive routinely. Studies

show that the opt-out approach can

 Increase testing rates among pregnant women,

 Increase the number of HIV-infected women who

are offered treatment, and

 Reduce HIV transmission to their babies during

birth.
 2 At Childbirth, 2004

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How is Opt-Out Implemented in the

Health Care Setting?

Opt-Out has three steps for health care providers to

follow to put this approach into practice (CDC

recommends all three steps):

 Tell all pregnant women that an HIV test will be

performed as part of the standard group of tests

for pregnant women.

 Tell them that they may decline this test.

 Give them information about how to prevent HIV

transmission during pregnancy and about treatment

for pregnant women who are HIV positive.

The opt-out approach offers the

best chance that pregnant women

will routinely be tested for HIV

during pregnancy and, if needed,

during labor and delivery. If a

woman is HIV positive, knowing

her HIV status will reduce the

chance that she will pass the virus

to her child. Reducing the transmission of HIV from mother to child is a success story,

but preventing it entirely has not yet been achieved.

Implementation of the opt-out approach is a step to

reaching this goal.

Additional Information

For more detailed information on the Revised Recommendations for HIV Screening of Pregnant

Women, please refer to the Morbidity and Mortality Weekly Report (MMWR) of November 9, 2001,

at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a2.htm, or request a copy from the National

Prevention Information Network at (800) 458-5231.