{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:12:35Z","timestamp":1747185155940,"version":"3.40.5"},"reference-count":19,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T00:00:00Z","timestamp":1566172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2019,10]]},"abstract":"Objectives<\/jats:title>The management of women at high risk of HIV<\/jats:styled-content> infection who repeatedly decline HIV testing in pregnancy is not covered in any national guideline. In Leeds, we had a case which prompted us to consider maternal rights plus our duty of care to the infant once born.<\/jats:p><\/jats:sec>Methods<\/jats:title>Leeds has an established HIV<\/jats:styled-content> and Syphilis in Pregnancy Multidisciplinary Team (MDT). The main issues pertaining to a pregnant woman persistently declining HIV<\/jats:styled-content> testing were discussed within the MDT<\/jats:styled-content>: identification of pregnant women declining testing; universal testing versus testing by risk stratification of their infants; calculation of vertical transmission risk; definition of unacceptable risk; timing of the decision to request court authority to test the infant; advanced preparation of court authority request papers.<\/jats:p><\/jats:sec>Results<\/jats:title>It was decided that an HIV<\/jats:styled-content> transmission risk > 1 in 1000 justified testing an infant at birth. The MDT<\/jats:styled-content> decision to request court authority for infant HIV<\/jats:styled-content> testing would be made at 32\u201334\u00a0weeks of gestation, allowing the court papers to be prepared in advance of delivery. The Leeds Obstetrics and Paediatric Guidelines were reviewed, amended and approved by the Trust Guideline Group, Risk Management team and legal team. These guidelines are outlined within the article. The Neonatal guideline also is accessible via this link: http:\/\/nww.lhp.leedsth.nhs.uk\/common\/guidelines\/detail.aspx?<\/jats:ext-link>ID<\/jats:styled-content>=177<\/jats:p><\/jats:sec>Conclusions<\/jats:title>If a woman at high risk declines HIV<\/jats:styled-content> testing in pregnancy, it remains possible to significantly reduce the risk of vertical transmission once the child is born, but the window of opportunity is small. Therefore, it is vital to have pathways already in place to address this prior to delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12775","type":"journal-article","created":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T14:37:49Z","timestamp":1566225469000},"page":"601-605","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Managing women who decline HIV<\/scp> testing in pregnancy and their infants? A multidisciplinary team guideline"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7190-8628","authenticated-orcid":false,"given":"N","family":"Astill","sequence":"first","affiliation":[{"name":"New Croft Centre for Sexual Health and HIV Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle Upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Miall","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Shillito","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Winfield","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Evans","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Schoeman","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Wilson","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,19]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"Public Health England.UK National HIV Surveillance data tables. No 1 2017. Available at:https:\/\/www.gov.uk\/government\/statistics\/hiv-annual-data-tables. (Accessed 10 January 2019)"},{"volume-title":"HIV in the United Kingdom: 2012 Report","year":"2012","author":"Health Protection Agency","key":"e_1_2_5_3_1"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.319.7219.1227"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000212"},{"key":"e_1_2_5_6_1","unstructured":"NHS Infectious Diseases in Pregnancy Screening Programme. Standards 2016\u20102017. Public Health England. Available at:https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/733044\/IDPS_Programme_Standards_2016_to_2017.pdf(accessed 18 October 2018)."},{"key":"e_1_2_5_7_1","unstructured":"Antenatal screening for infectious diseases in England: summary report for 2015. Public Health England. Health Protection Report. 2017;11(2). Available at:https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/583576\/hpr0217_naism.pdf(accessed 18 October 2018)."},{"key":"e_1_2_5_8_1","first-page":"527","article-title":"UK mother\u2010to\u2010child transmission rates continue to decline: 2012\u20132014","volume":"64","author":"Peters H","year":"2016","journal-title":"Clin Infect Dis"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12577"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdh148"},{"key":"e_1_2_5_11_1","unstructured":"British HIV Association British Association of Sexual Health and HIV British Infection Society. UK National Guidelines for HIV Testing 2008. Available at:https:\/\/www.bashhguidelines.org\/media\/1067\/1838.pdf(accessed 18 October 2018)."},{"key":"e_1_2_5_12_1","unstructured":"British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018. 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Updated 31\/12\/18. Council of Europe\/European Court of Human Rights 2018. Available at:https:\/\/www.echr.coe.int\/Documents\/Guide_Art_2_ENG.pdf(accessed 10 January 2019)."},{"key":"e_1_2_5_17_1","unstructured":"Legislation.gov.uk.The Children Act 1989 Chapter 41. 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