Details of changes to the state law are posted on the TMHP website at www.tmhp.com and will be published in the November/December 2009 Texas Medicaid Bulletin, No. 226.

The following changes will be made to the Texas Health and Safety law for the testing for human immunodeficiency virus (HIV) in pregnant women:

• An HIV test must be performed at the first prenatal care visit and during the third trimester of pregnancy.

• If there is no record of a third-trimester test when a woman arrives at labor and delivery, a test must be immediately performed. The laboratory must provide the results of the test to the provider within 6 hours of the submission of the sample. If there is no record of a third-trimester test and no test was performed during labor and delivery, the infant must be tested within 2 hours of birth, and those test results must be provided to the provider within 6 hours of the submission of the sample.

Note: Women will still have the right to refuse the test.

Current Texas state law requires providers to test pregnant patients for HIV, syphilis, and hepatitis B (HBV) at the first prenatal visit and at delivery. This law is changing to align requirements with the recommendations for prenatal HIV testing that were published by the Centers for Disease Control and Prevention (CDC).

For further information, there is a pdf document from DSHS on the TAOG website at:

http://www.txobgyn.org/files/HIVTestingandPregnancy.pdf

Important Considerations:

1. As you and your hospital are considering how to comply with this new law, please take into account the fact, that on Jan 1, 2010, each pregnant patient presenting to the hospital for delivery must have a third trimester HIV or the rapid testing performed.  To avoid a large number of patients needing the rapid test, providers should probably begin their third trimester testing as soon as possible (for instance many practitioners are beginning Nov 1, 2009).

2. Timing: you will want to allow enough time for the HIV test to make it to the chart, work-up any indeterminate results, etc, yet minimize venipunctures for patients.  Some practitioners are choosing 27-28 weeks to combine diabetic screening and third trimester HIV.

3. Please discuss with your hospital the need to ensure rapid HIV testing on pregnant patient or newborn for those patients without a third trimester HIV result.