HIV Testing & Reproductive Health. Treatment of TB , STDs, HIV, Hepatitis C, Family Planning and Substance Abuse: Focus on TESTING June 21 , 2014 El Centro California. Mary Caffery RN MSN UCSD Mother Child Adolescent HIV Program 858-534-9202 [email protected]
I do not have any financial arrangements or affiliations with commercial sponsors which have direct interest in the subject matter.
At the end of this session, participants will be able to:
in reproductive health care settings?
The AIDS epidemic is integrally linked to sexual and reproductive health
Percentages reproductive of HIV Cases Diagnosed Among Female Adults and Adolescents, by Transmission Category 46 States and 5 US-Dependent Areas 2010
Revised reproductive Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care SettingsSeptember 22, 2006 / 55(RR14);1-17
. adults in your community?
1 Test 2 Lives adults in your community?CDC /ACOG Recommendations for HIV Screening for Pregnant Women
Rapid Testing of Diagnosis, 1985–2010 — United States and Dependent Areas in Labor
Read results in 20-40 minutes
Late entry or no prenatal care
Patient perceived as not at risk
Provider does not strongly recommend testing to all women
The CDC and the ACOG recommend that females aged 13–64 years be tested at least once in their lifetime and annually thereafter based on factors related to risk
Ob–gynsshould annually review patients’ risk factors for HIV and assess the need for retesting. Repeat HIV testing should be offered at least annually to women who are injection drug users are sex partners of injection-drug users exchange sex for money or drugs are sex partners of HIV-infected persons have had sex with men who have sex with men since the most recent HIV test have had more than one sex partner since their most recent HIV test
The opportunity for repeat testing should be made available to all women even in the absence of identified risk factors
ACOG Number 596, May 2014
“I test all my patients who are between 19 and 64 years old for HIV as a routine part of their care
More than one million people in the U.S. have HIV and about one in five of these people don’t know it
Because they don’t know, they can’t get medicine that may help them live longer”
“This brochure (HIV and Women) tells you about HIV and why you should be tested. When you have finished reading this information, I would be glad to answer any questions that you have. You will be tested for HIV today unless you tell me not to”
Old kit?& New Tests
in New Combinations
With More on the Way
Recommended kit?Testing Algorithm
DRAFT Recommendations: Diagnostic Laboratory Testing for HIV Infection in the United States 2012, CDC.gov
How do these kit?tests differ from
earlier HIV tests?
How kit?do these differ from earlier tests?
Tests for both virologic (p24 antigen) and serologic (antibody) markers of HIV infection
Incorporates NAT to resolve discordant results, reduce indeterminate test results, and identify acute HIV infection
All antibody-positive specimens tested for HIV-2; previously, only those with negative or indeterminate HIV-1 Western blot received specific HIV-2 testing
Emphasizes sensitivity during initial testing. Rare false-positive antibody test results might occur; will be resolved during subsequent laboratory testing recommended as part of initial clinical evaluation
Nearly 1.2 million people in the United States are HIV-positive.
One in five of those don’t know they’re infected, a major contributing factor to the 50,000 new HIV infections each year
Testing is the first step to engaging HIV-positive patients in care, stopping individual disease progression, and stemming the spread of HIV
Providers should test all patients between 13 and 64 years old, regardless of risk profile, at least once in their lifetime, and preferably on an annual basis as part of routine health screening
There kit?is an urgent need to increase the proportion of persons who are aware of their HIV-infection status
Expanded, routine, voluntary, opt-out screening in reproductive health care settings is needed
Such screening is cost-effective and feasible
Getting the Word Out kit?
Rebeca L. Ramos MA, MPH, et. alPublic Health Rep. 2010 Jul-Aug; 125(4): 528–533
Test Everyday! kit?
Perinatal HIV/AIDS kit?
Rapid perinatal HIV consultation from practicing providers
HIV testing in pregnancy
Treating HIV-infected pregnant women
Preventing transmission during labor and delivery and the post-partum period
HIV-exposed infant care
Call for a Phone Consultation
(888) 448-876524 hours, Seven days a week
(888) 448-876524 hours, Seven days a week
Advice from national experts in perinatal HIV care
rovideconsultation on all levels of perinatal HIV management, including on complex and unique treatment dilemmas, to provide you the best possible information on up-to-date, high-quality care
Consultation on complex perinatal HIV treatment issues
Addressing adherence issues
Managing HIV-positive pregnancies with late presentation to care
Safer conception options for HIV-affected couples
Referral to perinatal providers and reproductive health services
Connecting HIV-infected women and exposed infants to HIV-experienced clinicians
Connecting HIV-affected couples considering conception with supportive providers
A Guide to the Clinical Care of Women with HIV, 2013 Edited by Jean R Anderson, M.D.
Distributed by HRSA, available online at www.ask.hrsa.gov
Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings, MMWR September 22, 2006 / 55(RR14); 1-17.
Public Health Service Task Force. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1-Transmission in the United States, 2014. Updated yearly.
Rapid Human Immunodeficiency Virus Testing on Labor and Delivery
Lisa Rahangdale, MD, MPH, and Deborah Cohan, MD, MPH
OBSTETRICS & GYNECOLOGY VOL. 112, NO. 1, JULY 2008, 159-163
Women’s Opinions about Routine HIV Testing During Pregnancy:
Implications for the Opt-Out Approach Linda S. Podhurst, Ph.D.,
Deborah S. Storm, Ph.D., and Sarah Dolgonos, M.P.H.
AIDS PATIENT CARE and STDs Volume 23, Number 5, 2009