Implementing a Perinatal HIV Testing and Treatment Program

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 HIV infected women 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.

Proposed change:

Our MCH department experienced a missed opportunity regarding an HIV positive woman,  an all too frequent event nationwide. The patient presented with incomplete labs; subsequent high risk labs were drawn after the infant showed signs of illness resulting in a preliminary maternal positive HIV test.  Despite these results, notes indicate the infant breastfed during the postpartum period.  This event exposed gaps in the department’s management of high risk OB 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 addressing 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 addressing 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 were inserviced. Following implementation of the policy, audits were conducted to evaluate compliance with the protocol. Initial review indicated 100% compliance with HIV documentation on the L & D summary sheets.  Other areas of documentation were at 75-90% 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 CDC report 100-200 infants in the US are infected with HIV annually. Given the most common route of transmission in children is through the mother, it is imperative 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.

Keywords: `Perinatal, HIV, Neonatal, Transmission