Implementation of universal rapid human immunodeficiency virus screening on labor and delivery

Therapeutic Advances in Infectious Disease
Stacia CrochetRachel K Scott

Abstract

A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resulted in the implementation of universal opt-out rapid testing of patients admitted for delivery. This article evaluates the policy's efficacy and implementation. We evaluated the implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. We could not evaluate decrease in MTCT rate secondary to low sample size (n = 3324) and no true-positive results. Patients not tested (n = 458) were predominately secondary to physician omission (93.7%) and were more likely to be White (p < 0.01) and older (p < 0.01). There was a negative relationship with physician omission over time. The policy was successfully implemented with decreasing proportions of patients not tested. Earlier inclusion of testing into standard admission orders and nurse-based approach may have expedited adoption. Given the low incidence of new HIV diagnosis in labor, we were unable to assess decrease in MTCT.

References

Apr 1, 1999·The New England Journal of Medicine·UNKNOWN International Perinatal HIV GroupR Tuomala
Sep 4, 1999·American Journal of Public Health·R E GlasgowS M Boles
Jul 1, 2005·Annals of Emergency Medicine·Michael S LyonsAlexander T Trott
Jan 17, 2007·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Sheryl B LyssRobert A Weinstein
Sep 2, 2008·Obstetrics and Gynecology·UNKNOWN American College of Obstetrics and Gynecology Committee on Obstetric Practice
Oct 16, 2009·The Journal of Emergency Medicine·Christian ArbelaezRochelle P Walensky
Jun 22, 2012·The New England Journal of Medicine·Karin Nielsen-SainesUNKNOWN NICHD HPTN 040/PACTG 1043 Protocol Team

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Methods Mentioned

BETA
Cesarean
enzyme-linked immunosorbent assay
cesarean section
ELISA

Software Mentioned

RE
Excel
SAS
AIM

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