Rationale for antenatal screening

• Voluntary antenatal HIV testing was introduced in England in 1999, against increasing evidence that timely interventions could greatly reduce the risk of MTCT, making it apparent that the greatest risk for babies born to HIV positive mothers was having a mother who was unaware of her HIV diagnosis
• Since April 2003 all pregnant women in Northern Ireland are offered screening for HIV
• Knowing their status allows a woman to access appropriate care, treatment and support, protect her baby from HIV and to protect her own health

Antenatal screening procedure

• UK policy adopted an ‘opt-out’ approach to antenatal screening, offering HIV testing along with screening for rubella, syphilis and hepatitis B at the booking visit, usually around 12 weeks of gestation
• All pregnant women should be offered a HIV screening test early in pregnancy or at the earliest opportunity if presenting late, in labour or newly delivered
• Informed consent:
  • Screening consent leaflet given with time for the woman to read it
  • Information given to include the reason for screening, HIV risk factors, outcomes of a test, possibility of a second test, implications of a positive result, how results are recorded and who will have access to results
  • Because there is a possible window period of 3 months from exposure to antibodies being detected, midwives should be alert to any possible ongoing risk of exposure (for example, sexual intercourse with a high risk partner) and advise repeat testing
  • Details of information given, tests offered and consent given recorded in notes
  • If woman presents > 20 weeks, sample sent to the relevant laboratory and marked as urgent

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