209474 Provider role in rapid testing of HIV during labor and delivery: An analysis of California birthing facilities

Monday, November 9, 2009

Lamiya Sheikh, BS , Department of Pediatrics, Stanford University, Stanford, CA
Clea Sarnquist, DrPH, MPH , Department of Pediatrics, Stanford University, Menlo Park, CA
Yvonne Maldonado, MD , Department of Pediatrics, Stanford University, Menlo Park, CA

Rapid testing for HIV during labor and delivery (RTLD) identifies HIV-infected women and prevents perinatal transmissions. There is a high level of test acceptance in California (98.1%). Past studies have reported that counseling before HIV testing strongly affects acceptance rates. This study aims to understand how the counseling and testing process affects rapid HIV test uptake.


Paper and electronic surveys were sent out in 2006 to nurse managers at California birthing facilities (n=260). 205 facilities responded (78.85%), of which 71 (34.6%) offered rapid testing.


Facilities where mainly attending physicians counseled patients were less likely to offer rapid tests to women, compared to facilities where other health care providers counseled (R.R. 0.34; 95%C.I. 0.18, 0.80). Facilities where attending physicians (35.3%) and midwives (35.7%) counseled patients had a longer median counseling time (>5 minutes) compared to facilities where nurses (20%) and resident physicians (23.53%) counseled. Nurses were five times more likely to provided counseling at non-teaching hospitals (95%C.I. 1.75, 14.96), and residents were three times more likely to provide counseling at teaching hospitals compared to other providers (95%C.I. 1.73, 5.98).


The type of provider giving counseling and percentage of eligible women offered a rapid test varied depending on the type of facility. Understanding the provider role in counseling women is important for hospitals and staff to consider while implementing rapid HIV testing policies to know which providers should be targeted during rapid testing training sessions, and ultimately to ensure all eligible pregnant women are offered counseling and testing.

Learning Objectives:
1. Compare the role of different types of health care providers in offering rapid testing and counseling before testing at labor and delivery in California. 2. Identify types of facilities where there are provider disparities in offering rapid testing and counseling. 3. Recognize which providers to focus on during interventions to increase rates of rapid testing offer at labor and delivery and eliminate disparities in test offer and counseling.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a graduate student in epidemiology/statistics, I have been involved with HIV and maternal child health for the past four years. Our group and I have been involved with and presented HIV/prenatal care research at the past two APHA conferences and at the International AIDS Conference last year. Our group has had several publications in the field of HIV and maternal child health; I had one paper published and we have few others under review or in preparation for publication.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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