National HIV Prevention Conference Atlanta, Georgia, USA — July 27 - 30, 2003

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-D1603
Burr CK, Gross E, Paul S, Di Fendinando G
Univ of Medicine & Dentistry of NJ, Newark, NJ

ISSUE: Women who present in labor with unknown or undocumented HIV status (UUHS) pose a challenge and an opportunity to further reduce perinatal HIV transmission and to transition women into care for their own health. NJ surveillance data for 1999 and 2000 indicated 7 of 8 infants infected with HIV were born to women with unknown HIV status. In response, the NJ Department of Health and Senior Services (NJDHSS), in collaboration with numerous stakeholders, developed a Standard of Care (SOC) for counseling and rapid HIV testing (C&RT;) for women in labor with UUHS.

SETTING: Physicians and nurses practicing in NJ hospitals providing labor and delivery services.

PROJECT: The National Pediatric & Family HIV Resource Center at FXB Center (NPHRC/FXB) provided support for implemetation of the NJDHSS SOC. Provider training was a central strategy. NPHRC/FXB developed a model curriculum on C&RT; in labor. The curriculum was used for half-day train-the-trainer (TOT) workshops targeting nurse educators/managers working in hospitals and 3-hour CME programs targeting OBs/midwives/APNs. The training focused on building skills for counseling women in labor, offering rapid testing, HIV pregnancy management, and reduction of perinatal transmission. Training participants received the curriculum, a provider counseling "script," and a model hospital policy along with clinical support materials and references.

RESULTS: Five TOT workshops held across the state reached 138 nurses representing 72 hospitals. Ninety additional providers attended 4 CME programs (26 MD's; 21 nurse midwives/APNs; 26 OB/perinatal nurses, and 18 others). Of the 104 participants who completed the pre-training survey, 57 consented to be followed up after 4 months. Pretraining practice: 91% of participants currently provide care to pregnant women; 78% of participants' hospitals have a policy on HIV C&RT; for women in prenatal care; 79% reported that their hospitals almost always/always routinely inquire about and document a woman's HIV status when she presents in labor; 51% almost always/always offer HIV C&T; during labor. In hospitals with rapid testing (N=53), 79% of respondents almost always/always offer ARVs to reduce perinatal transmission. Follow-up change in practice at 4 months: (response rate 37/57 = 65%) 97% (+19%) of hospitals have a policy for HIV C&T; in prenatal care; 97% (+19%) almost always/always offer ARVs to women known to have HIV; 94% (+15%) almost always/always inquire about/ document a woman's HIV status when she presents in labor; 62% (+11%) almost always/always offer HIV C&RT; during labor; and where counseling and rapid testing are available, 96% (+17%) almost always/always offer ARVs to reduce HIV transmission. Surveillance data documenting the impact of the training on perinatal transmission is pending.

LESSONS LEARNED: Targeted provider education including a counseling "script" for C&RT; and a model hospital policy for women in labor with UUHS can increase hospitals' ability to respond. While universal HIV C&T; remains the best option for reducing perinatal HIV transmission and getting women into care, C&RT; in labor provides an additional opportunity to reduce perinatal transmission and to identify women in need of care. Multiple strategies are needed to support HIV C&RT; of women in labor with UUHS.

030727
M1-D1603

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