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318104
Sustainability of statewide rapid HIV testing in the Labor & Delivery setting a decade after implementation of the Perinatal Rapid Testing Initiative in Illinois (PRTII)


Tuesday, November 3, 2015

Lynn M. Yee, MD, MPH, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
Emily S. Miller, MD, MPH, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
Anne Statton, BA, Pediatric AIDS Chicago Prevention Initiative, Chicago, IL
Laurie D. Ayala, MPH, Perinatal HIV Hotline, Northwestern Memorial Hospital, Chicago, IL
Sarah Deardorff Carter, MPH, CHES, Perinatal HIV Hotline, Northwestern Memorial Hospital, Chicago, IL
Amy E. Wong, MD, MPH, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Palo Alto Medical Foundation, Mountain View, CA
Mardge H. Cohen, MD, Departments of Medicine/CORE Center at John H. Stroger Jr Hospital of Cook County, Cook County Health & Hospital System, Chicago, IL
Patricia M. Garcia, MD, MPH, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
Objective: In 2004, PRTII implemented HIV rapid testing (RT) among parturients as a statewide quality initiative to further reduce maternal-to-child transmission of HIV. An initial evaluation demonstrated the proportion of mothers and/or newborns with an undocumented HIV status at discharge decreased from 2.74% in 2005 to 0.01% in 2011. The objective is to assess continued sustainability of the initiative since 2011.

Methods: Observational study of women delivered in all Illinois birthing hospitals. Key RT metrics from state-mandated monthly surveillance reports were compared for years 2012 to 2014.

Results: From 2012-2014, 456,921 women delivered in Illinois. Over 95% of pregnant women had documented HIV status at time of presentation. The proportion who were eligible for RT but were missed continued to decline from 37 (0.6%) in 2012 to 32 (0.5%) in 2013 and 23 (0.3%) in 2014 (p=0.06). The number of neonates discharged with unknown HIV status remained stable, with 9 (0.006%) in 2012, 8 (0.005%) in 2013, and 7 (0.005%) in 2014 (p=0.77), demonstrating sustained performance since program initiation. New maternal HIV diagnoses were identified via RT in each time period [6 (0.09%) in 2012, 5 (0.08%) in 2013, 3 (0.04%) in 2014 (p=0.40)].

Conclusions: Statewide implementation of perinatal HIV RT has resulted in nearly 100% of Illinois mother/baby pairs with known HIV status at delivery. After an initial period of dramatic improvement in HIV RT practices, we demonstrate continued sustainability of the RT program. The continued identification of HIV via RT affirms the necessity of this statewide initiative.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Program planning
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Demonstrate sustainability of statewide perinatal HIV rapid testing and identify key factors which promote continued success

Keyword(s): Women and HIV/AIDS, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Fellow in Maternal-Fetal Medicine at Northwestern University, Feinberg School of Medicine. I am a clinician actively involved in the care of perinatal HIV patients and have been actively involved in research efforts within the Division of Maternal-Fetal Medicine and the Women's HIV Clinic specifically. Among my interests are pregnancy-related health disparities and public health programs and policies affecting pregnant women with HIV.
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.

Back to: 4275.0: HIV: Perinatal , Children, & Adolescents