XIX International AIDS Conference


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WEPE194 - Poster Exhibition

Improving rapid HIV testing at labor and delivery in southern California

M. Caffery1, S. Jed2, F. Huang2, L. Espinoza2, A. Stek2, S. Fitzgibbons3, C. Sarnquist4

1University of California at San Diego, Pediatrics, San Diego, United States, 2University of Southern California, Los Angeles, United States, 3University of California at Irvine, Irvine, United States, 4Stanford University, Palo Alto, United States

Background: The Centers for Disease Control and Prevention (CDC) recommends opt-out rapid HIV testing (RT) at labor and delivery (RTLD) for all women presenting to labor and delivery (L&D) with undocumented HIV serostatus. RTLD is essential in the U.S. to maximally prevent mother-to-child transmission of HIV (PMTCT) and ensure that women learn their HIV statuses. In 2007, a training and technical assistance intervention was implemented to improve RTLD offer in California hospitals. A substudy was conducted to assess changes in RTLD in Southern California delivery hospitals.
Methods: The 70 largest delivery hospitals (78.1% of births) reported the number of RTs performed at L&D in 2007-2009. We compared (1) annual changes in median RT, and (2) number of RTs performed in 2008 to the number of women with no prenatal care (PNC), a proxy for the minimum needed number of RTs. A stratified analysis by median annual births was conducted to compare RTLD by hospital size.
Results: Compared to 2007 (5.75 tests), the median number of tests was significantly higher in 2008 (29.0 tests, p< .001) and 2009 (57.0 tests, p< .0001). In 2008, 48% of hospitals conducted equal or more RTs than the number of women with no PNC, leaving 51% that did not meet this minimum expected testing benchmark. Stratified by size, 52% of the 21 hospitals with >3,499 annual births conducted RTLD equal to or more often than the no PNC number, while only 43% of the 14 hospitals with < 3,500 annual births did so.
Conclusions: RTLD significantly increased from 2007 to 2009. However, over 50% of hospitals reported insufficient testing in 2008, with smaller hospitals less likely to report conducting at least the minimum expected number of RTs. Thus, missed opportunities for HIV testing and PMTCT persist in this region, highlighting the need for additional interventions with L&D facilities.

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