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Implementation of a Statewide Standard of Care for Rapid Testing of Women in Labor with Unknown HIV Serostatus. The Role of Provider Education Elaine Gross, RN, MS, CNSC and Carolyn Burr, EdD, RN National Pediatric & Family HIV Resource Center/FXB, UMDNJ
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The Role of Provider Education
Elaine Gross, RN, MS, CNSC and Carolyn Burr, EdD, RNNational Pediatric & Family HIV Resource Center/FXB, UMDNJ
Sindy Paul, MD, MPHNew Jersey Department of Health and Senior Services
8:00 am Registration and Breakfast
8:45 am Welcome and Overview
9:00 am What We Know About Perinatal HIV Transmission
9:30 am HIV Counseling and Rapid Testing in Labor
10:15 am Break
10:30 am Issues and Experiences: Panel Discussion
11:30 am Educational Strategies
11:50 am Evaluations
12:00 noon Adjourn
AIDS in women has risen from 7% early in the epidemic to 27% of adult cases
Epidemic in the US Among Women and Children, 2003
Without antiretroviral (ARV) drugs during pregnancy, perinatal transmission ranged from 16%–25% in North America and Europe
Perinatal HIV Transmission
Breastfeeding and HIV Infection
A phase III randomized placebo-controlled trial of ZDV for preventing maternal-fetal HIV transmission
Maria J. (former IVDU) is 32 weeks gestation, tested HIV negative at her 1st prenatal visit during the second trimester. This is her 3rd pregnancy, she has a history of STDs and genital herpes. She reports that her partner sometimes refuses to wear a condom and he “gets very angry about it, especially when he’s had a few drinks.” This visit she complains about a yellowish vaginal discharge that itches.
Ms. R is admitted from the ER fully dilated and pushing. According to her chart, she had 2 prenatal visits for care and this is her 4th baby. Her history leads you to believe she is at risk for HIV.
Ms. M was not offered an HIV test during her prenatal care. She consented to have a rapid test during labor. The result of the test is negative.
Ms M: asks for reassurance that the negative test is truly negative
Mrs. Q’s prenatal record does not indicate an HIV test during this pregnancy. She’s a private patient of the acting Chief of OB.
When the nurse offers Mrs Q. rapid HIV testing she says: “What kind of woman do you think I am?”
Ms. G. has just been admitted to L&D. No HIV test results are on her chart. Her husband and her mother are with her. The family speaks little English.
Husband: concerned about wife; keeps asking for “DOCTOR”
Mother: refuses to leave her daughter
Follow-up Survey of Change in Practice
4-Months Post Training (n – 38)
( p < . 01)
Change in practice (cont.)
4-Months Post Training
( p < .01)