Implementing a Perinatal HIV Testing and Treatment Program
Article first published online: 11 JUN 2013
© 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2013 Convention Proceedings
Volume 42, Issue s1, pages S19–S20, June 2013
How to Cite
Webber, E. and Cecil, J. (2013), Implementing a Perinatal HIV Testing and Treatment Program. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42: S19–S20. doi: 10.1111/1552-6909.12074
- Issue published online: 11 JUN 2013
- Article first published online: 11 JUN 2013
Purpose for the Program
Perinatal transmission of HIV is the most common route of HIV transmission in children. Infection can occur late in the pregnancy, during delivery, or through breastfeeding. Nearly one in four women who are infected with HIV are unaware of their HIV status. Many cases of perinatal HIV infection involve women who were not tested early enough in pregnancy or who did not receive prevention services. This presentation describes the development of a comprehensive HIV testing and treatment program for pregnant women in a community hospital.
Our maternal and child health department experienced a missed opportunity regarding an HIV-positive woman, an all too frequent event nationwide. The patient came to the hospital with incomplete laboratory test results. Subsequent tests for a high-risk patient were conducted after the infant showed signs of illness, which indicated a preliminary maternal positive-HIV test result. Despite the test result, notes indicate the infant breastfed during the postpartum period. This event exposed gaps in the department's management of high-risk obstetric patients. A task force was convened to develop a comprehensive HIV management plan. Working with the Department of Community Health to ensure the plan incorporated state recommendations and statutory requirements, a new interdisciplinary plan was developed, which addressed areas of inadequate maternal assessment, poor data gathering and documentation, and delayed treatment options.
Implementation, Outcomes, and Evaluation
A new policy, HIV Testing and Treatment, was written to address the revision of documentation and legal consent issues regarding HIV testing. To reduce procedural errors, an algorithm, Hospital Responsibilities for HIV Testing and Treatment, was developed and all department personnel attended in-services on the algorithm. After the implementation of the policy, audits were conducted to evaluate compliance with the protocol. Initial review indicated 100% compliance with HIV documentation on the labor and delivery summary sheets. Other areas of documentation were between 75% and 90% compliance. To address areas of lower compliance, ongoing education regarding HIV testing, treatment, and documentation is currently included in the department's mandatory education program for all staff and continued audits are ongoing.
Implications for Nursing Practice
The Centers for Disease Control and Prevention (CDC) reports that 100 to 200 infants in the United States are infected with HIV annually. Given that the most common route of transmission in infants is through the mother, it is imperative that hospitals comply with state guidelines for testing and treatment of all pregnant women. Maternity nurses must be aware of the importance of early HIV status identification for all pregnant women and follow-up with appropriate care for mother and infant.