A strategic planning approach to influencing hospital pactice regarding rapid HIV testing in labor and delivery

Issues: For women presenting in labor with undocumented HIV status, rapid HIV testing can reduce the risk of perinatal HIV transmission and engage women with HIV in care. A series of strategic planning workshops was designed to increase the number of hospitals in the U.S. with comprehensive policies offering rapid HIV testing in labor and delivery (RTLD). Description: 70 hospital teams from 28 states/territories participated in one of 8 workshops. Hospitals sent leaders from administration, nursing, obstetrics, and laboratory to workshops which provided current scientific information on RTLD and facilitated the development of individualized action plans. Interviews of key hospital leaders nine to fifteen months following the workshops evaluated their progress regarding RTLD. Lessons learned: 48 (69%) hospitals responded to the follow-up evaluation; 40 (83%) had decided to offer RTLD (35 had policies in place or in process) and 2 (4%) offered expedited ELISA. Barriers to policy development included administrative hurdles and knowledge/attitudes of physician and nursing staff. Keys to implementation included a multidisciplinary team approach, education of hospital staff, a “champion,” and laboratory support. Recommendations: Strategic planning workshops were effective in building hospitals' capacity to offer RTLD to women with undocumented HIV status by engaging key leaders, providing a scientific foundation for policy change, and facilitating planning by hospital teams. Strengthening hospitals' capacity fosters the goals of universal HIV testing for pregnant women, engaging women with HIV in care, and further reducing perinatal HIV transmission. Similar workshops can be designed to increase HIV screening in other medical settings.