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Third-trimester repeat HIV testing: it is time we make it universal.

Irina R Cassimatis1, Laurie D Ayala2, Emily S Miller1

  • 1Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.

American Journal of Obstetrics and Gynecology
|May 1, 2021
PubMed
Summary
This summary is machine-generated.

Universal third-trimester repeat HIV testing in pregnancy is crucial for preventing perinatal HIV transmission. Implementing this strategy, alongside improved diagnostics and treatment, can significantly reduce transmission rates and work towards elimination goals.

Keywords:
HIV testingadvocacyneonatal HIVperinatal HIV transmissionprenatal HIV testinguniversal HIV testing

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Area of Science:

  • Obstetrics and Gynecology
  • Infectious Diseases
  • Public Health

Background:

  • Perinatal HIV transmission has decreased due to screening and antiretroviral therapy but elimination remains elusive.
  • Most perinatal HIV transmissions occur late in pregnancy, emphasizing the need for early diagnosis and intervention.
  • Current guidelines recommend routine HIV screening, with third-trimester repeat testing reserved for high-risk individuals.

Purpose of the Study:

  • To review evidence supporting universal third-trimester repeat HIV testing in pregnancy.
  • To present a successful state-mandated program in Illinois as a model.
  • To provide recommendations for reducing missed perinatal HIV transmissions.

Main Methods:

  • Review of evidence on the efficacy of universal third-trimester repeat HIV testing.
  • Analysis of a state-mandated HIV testing program in Illinois.
  • Development of clinical recommendations for implementation and monitoring.

Main Results:

  • Universal third-trimester repeat HIV testing can significantly lower the risk of perinatal transmission.
  • Timely diagnosis and intervention during pregnancy reduce transmission from 25% to 10%.
  • A state-mandated program demonstrated the feasibility and success of universal testing.

Conclusions:

  • Universal third-trimester repeat HIV testing is essential to achieve the elimination of perinatal HIV transmission.
  • Implementation requires hospital buy-in, monitoring, multidisciplinary communication, and clinician advocacy.
  • Further strategies are needed to bridge gaps in state statutes and ensure comprehensive testing coverage.