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New HIV-testing law focuses on pregnant women

A gap in the way Texas cared for pregnant women sometimes cost some of the state’s most innocent residents – newborn babies – their lives.

To remedy that, part of a law that took effect this month requires health care providers to test pregnant women for HIV, the virus that causes AIDS, at some point during the last three months of pregnancy unless the woman objects.

Mothers-to-be generally will be billed for the test, the cost of which varies depending on who does it. The cost is expected to be covered by insurance or Medicaid, said Allison Lowery, a spokeswoman for the Department of State Health Services.

Before the law, the state required doctors and other medical providers to test pregnant women for HIV at the first prenatal visit and at the time of birth. But because a woman’s HIV status can change during her pregnancy, potentially without her or her doctor knowing it, by the time she goes into labor, it could be too late.

Under provisions in House Bill 1795, which took effect Jan. 1, women who test positive for HIV can start getting antiretroviral drugs immediately to reduce the chances of infecting their baby. The baby gets treatment at birth and for the next six weeks. Women who object to being tested can opt out and are given information about having the test done anonymously. Health care providers also must provide the mothers information about the risks of transmission.

Experts say that infection can occur during pregnancy and that women with more virus in their blood are thought to have a higher risk of infecting their babies. More often, the transmission is thought to occur just before or during delivery because of exposure to the mother’s blood. The early testing also gives doctors time to plan for the birth because a woman might need a cesarean section delivery, depending on the amount of virus in her blood.

Without treatment, one in four pregnant women infected with HIV will transmit the disease to her baby, according to data provided by the Department of State Health Services. Treating the woman during her pregnancy can cut the risk of transmission to about 1 percent.

The number of women transmitting HIV to babies is small, an estimated 100 to 200 U.S. babies a year, said Dr. Judy Levison, an associate professor of obstetrics and gynecology at Baylor College of Medicine. She hopes laws like H.B. 1795 will get that number closer to zero.

“No woman should deliver without knowing her HIV status,” she said.

If a woman goes to the hospital to deliver a baby without a record of her HIV status, the new law requires the hospital or birthing center to test her for HIV and obtain results within six hours. The hope is the woman can get started on antiretroviral drugs before delivery, and the baby can get the drugs immediately after birth. That cuts the risk of the baby becoming HIV-positive by about half, Levison said.

Hospitals “were doing a test that would take 24 to 48 hours to come back u2026 or they would wait for a confirmatory Western blot (test) to come back that would take five days, and you would miss the opportunity to treat the woman,” she said.

Some hospitals are having trouble complying with the six-hour turnaround requirement for testing women who don’t know their status, a St. David’s HealthCare official said.

Levison worked with state Sen. Rodney Ellis, D-Houston, on the legislation in the Senate last year and is part of an HIV consortium that is producing a handbook to help health care providers treat HIV-positive pregnant women and their babies in light of the new law.

“We believe this new testing will save children’s lives,” Lowery said. It also brings Texas in line with HIV testing recommendations made by the U.S. Centers for Disease Control and Prevention in 2006, she said.

An estimated 534 people have been infected with HIV at birth and were living in Texas at the end of 2007, according to the data compiled by the Department of State Health Services. Fifty-five percent of children who had acquired AIDS from their mothers since the epidemic began in the 1980s — 182 of 328 children — had died by 2007.

Levison said she heard from critics of the law who said that it makes a “big deal” out of a problem that affects few and that it won’t detect women whose HIV status changes after they are tested in the third trimester and go to the hospital to deliver. Levison acknowledged that a small number of women become HIV-positive in the last trimester, but she said the number is very low.

“In Houston, it’s less than one (woman) a year,” she said.

Representatives of Central Texas clinics and hospitals generally spoke in favor of the law, although some raised concerns.

St. David’s HealthCare, which operates five hospitals in Central Texas that deliver babies, said that while there was a “great motive” behind the law, it affects a “vanishingly small number of patients” at St. David’s, and hospitals are having a hard time getting HIV test results in six hours.

“We are in compliance with every section of this law with the exception of the six-hour turnaround time on the lab results,” said Dr. Steve Berkowitz, chief medical officer for St. David’s. But that “in no way affects the health of our moms and babies. We are hearing from colleagues in other health care systems that most hospitals are having a challenge complying with this and other provisions of the law. We are working hard and getting closer every day to being in full compliance.”

Adrienne Leyva, a spokeswoman for the Seton Family of Hospitals, which operates six facilities that deliver babies, said Seton hospitals do a rapid HIV test to comply with the law if there is no record of a third-trimester test and get results in the six-hour window to start treatment. Seton supports the law, she said.

CommUnityCare, Travis County’s largest public clinic system, said that it started testing all pregnant patients in the third trimester a year ago because of the CDC’s recommendations. Because most of those patients are on the Children’s Health Insurance Program for their maternity care, “the cost of the HIV test is simply included in their care,” said Dr. David Vander Straten, chief medical officer of CommUnityCare. “We don’t ask patients to pay for this test.”

At Austin Regional Clinic, patients are being tested during the 28th week of pregnancy to comply with the law, officials said. The clinic charges a $39 fee to established patients to take the test, and the lab charges $113 to do the test, officials said, but insurance may cover both charges.

“While we weren’t active in lobbying for the law, we are extremely happy to see that moms and babies will be protected,” said Dr. Norman Chenven, CEO and clinic founder.

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