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Lessons Learned: Implementing HIV Rapid Testing in Labor and Delivery Hospitals in California. Kama Brockmann Carol Dawson Rose Asilomar Faculty Development Conference October 3, 2007. Perinatal HIV Hotline 888-448-8765 National Perinatal HIV Consultation and Referral Service

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lessons learned implementing hiv rapid testing in labor and delivery hospitals in california

Lessons Learned: Implementing HIV Rapid Testing in Labor and Delivery Hospitals in California

Kama Brockmann

Carol Dawson Rose

Asilomar Faculty Development Conference

October 3, 2007

slide2

Perinatal HIV Hotline

888-448-8765

National Perinatal HIV Consultation and Referral Service

Advice on the HIV management in pregnant women

and infants and HIV testing in pregnancy.

women in ca living with hiv aids
Women in CA Living with HIV/AIDS

Based on AIDS Case Registry data cumulative through March 2006.

comparison of women with aids to other states 2004
Comparison of Women with AIDS to Other States (2004)

Data from The Kaiser Family Foundation Stat Health Facts at statehealthfacts.org.

the california rapid testing in labor and delivery project rtld
The California Rapid Testing in Labor and Delivery Project (RTLD)

Goal: Eradicate perinatal (mom-to-baby) HIV transmission in California.

Objective: In California, to have every pregnant woman, and her obstetric health care provider, know her HIV status as early as possible during her pregnancy and no later than when she begins delivery.

timing of mother to child hiv transmission formula
Timing of Mother-to-Child HIV Transmission (Formula)

Early Antenatal

(<36 wks)

Labor and Delivery

Late Antenatal

(36 wks to labor)

0%

20%

40%

60%

80%

100%

Proportion of infections

current hiv testing law for pregnant women in california
Current HIV Testing Law for Pregnant Women in California
  • AB 1676 (Dutra) became Health and Safety Code Sec 125085 and 125090 in Jan 2004.
    • This law requires that pregnant women be informed that:
      • an HIV test will be preformed;
      • the test is a routine part of prenatal testing;
      • HIV can be transmitted during pregnancy, delivery, or breastfeeding;
      • without treatment the risk of HIV transmission is about 25%,
      • with treatment HIV transmission can be reduced to less than 2%, and
      • they can accept or refuse the test and must sign a document stating their choice.
    • This law also requires that women in labor and delivery be tested by a method that will ensure the earliest possible results.
    • AB 682 (pending in legislature) retains all of this language except requiring a signature for testing. If AB 682 passes, California will become an Opt-Out state in Jan 2008.

Link for DHS approved Perinatal HIV Testing Consent form: http://www.dhs.ca.gov/aids/resources/PDF/DHS8682_PerinatalInformationAndConsentForm.pdf

rapid hiv testing in labor and delivery rtld survey
Rapid HIV Testing in Labor and Delivery (RTLD) Survey
  • 18 page paper and electronic questionnaire to all 260 L&D hospitals with more than 50 births each year.
    • CA has 550,000 live births each year
      • 12% of all births in the US
  • Ultimately, 205 surveys were returned, for a 78.8% response rate.
    • It took about 6 months and as many as 5-8 contacts with some sites to secure responses.
results hiv
Results: HIV
  • HIV patients in population in 2005:
    • >60% reported that no HIV-infected women gave birth at their facility in 2005.
    • 32% reported 1-10 births to HIV-infected women.
    • Three reported >30 births to HIV-infected women.
  • 37% reported having a written protocol for managing women without a documented HIV test.
  • 25% reported that they offer rapid HIV testing to every woman lacking such documentation.
results prenatal care records
Results: Prenatal Care Records
  • 46% of the facilities reported >90% prenatal care record availability at the beginning of labor. (120/260 hospitals)
  • HIV test results were documented about 45% of the time. (54/120 hospitals)
  • So, as few as 21% of women may have an HIV test result available at the beginning of labor. (55 hospitals)
collaboration partners
Collaboration Partners

Pacific AIDS Education and

Training Center (PAETC)

Contracted with SOA to provide training and technical assistance to assist with implementation in 120 CA hospitals over 3 years.

slide12
Utilizing a regional model
    • Northern CA
      • SF, East Bay, San Jose
    • Central CA
      • San Joaquin
    • Southern CA
      • Drew, USC, UC Irvine, UC San Diego
needs assessment
Needs Assessment
  • Continuum
    • 1 to 5
    • 1 hospital has implemented and offering HIV test to women who present without documented HIV test
    • 5 rapid test is not currently available in hospital setting
slide14
Technical Assistance – Developing & adapting policy and procedures, assisting with cross-discipline integration (i.e. lab, pharmacy, nursing, obstetricians, administration)

Training – All care providers at your facility, at your convenience.

barriers to implementation
Barriers to Implementation
  • System
    • Lab
    • Record transfer
  • Stigma
    • Not in my hospital
  • Knowledge
    • What does it mean
challenges for paetc
Challenges for PAETC
  • Need for expertise in perinatal care
  • Resistance from hospitals
  • Regional approach
  • Essentially Prevention Project
case examples
Case Examples
  • Southern Region
  • Central Region
  • Northern Region