Sustainability of Statewide Rapid HIV Testing in Labor and Delivery

Abstract

The objective was to assess sustainability of a statewide program of HIV rapid testing (RT) for pregnant women presenting for delivery with unknown HIV status. This is a population-based retrospective cohort study of women delivered in Illinois hospitals (2012-15). Deidentified data on RT metrics from state-mandated surveillance reports were compared using descriptive statistics and non-parametric tests of trend. Over 95% of the 608,408 women delivered had documented HIV status at presentation. The rate of undocumented HIV status rose from 4.19 to 4.75% (p < 0.001). However, overall 99.60% of women with undocumented status appropriately received RT and the proportion who did not receive RT declined (p = 0.003). The number of neonates discharged with unknown HIV status declined (p = 0.011). RT identified 23 new HIV diagnoses, representing 4.62% of maternal HIV diagnoses. In conclusion, statewide perinatal HIV RT resulted in nearly 100% of Illinois mother-infant dyads with known HIV status. Sustained RT completion represents an important prevention safety net.

Evaluation of State-Mandated Third Trimester Repeat HIV Testing in a Large Tertiary Care Center

“…12 Although PRTII ended in 2012, the lasting public health infrastructure, including the creation of the Perinatal HIV Hotline, has been sustained and effective. 11,12,18 We hypothesize that our results show the benefits of over a decade of nurse and physician education, normalization of universal opt-out HIV testing pregnancy, and infrastructure building. Leveraging nursing experience and equipping them with autonomy to make clinical decisions (e.g.…”

“…Analysis of the earlier interventions demonstrated excellent uptake and revealed the feasibility of a statewide approach to HIV prevention that includes the participation of a diverse cadre of providers and patients from rural, suburban, and urban centers across Illinois. 11,12 This new law went into effect January 2018 and…”

Home Birth in the Era of COVID-19: Counseling and Preparation for Pregnant Persons Living with HIV

“…Finally, local and national resources are available for clinical questions pertaining to management of HIV. 22,64 Regarding intrapartum management for virally suppressed pregnant PLHIV (e.g., viral load less than 1,000 copies/mL), ACOG and the U.S. DHHS state that intravenous zidovudine does not need to be administered to reduce the risk for vertical transmission. 57,65 An important consideration is that data informing this practice note no difference in frequency of transmission among pregnant PLHIV with viral loads <400 copies/mL who did and did not receive intrapartum zidovudine (0 vs. 0.6%, p ¼ 0.17).…”

“…Finally, local and national resources are available for clinical questions pertaining to management of HIV. 22 64…”

“… 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Existing data regarding perinatal COVID-19 infection have reported requirements for mechanical ventilation, with need for extracorporeal membranous oxygenation support, as well as maternal death. 6 9 12 18 19 Furthermore, although case series postulate the potential for perinatal transmission of COVID-19, 10 20 21 22 this has not yet clearly been demonstrated. Nonetheless, maternal COVID-19 acquisition has been associated with a high incidence of preterm birth, fetal distress, delivery via cesarean, and perinatal loss.…”