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1
Rapid HIV test utilization The impact of the
administration a hospital clinical protocol
Sunanda Gaur, MD, Patricia Whitley-Williams,MD,
Roseann Marone,RN, BSN, MPH, Anna Petrova, MD,
Charlene Flash, MD, Tanushree Dutta, BS, Emanuel
Jimenez, MD, Amisha Malhotra, MD, Kathy Mahoney,
APN UMDNJ/Robert Wood Johnson Medical School
Robert Wood Johnson University Hospital, New
Brunswick, NJ

• ABSTRACT
• Background
• Unknown maternal HIV status is the major risk
  factor of mother-to-child HIV transmission.
• Objectives
• To evaluate the impact of the implementation of
  the Rapid HIV test utilization protocol and to
  identify factors that may
• affect physician compliance with hospital
  policy.
• Methods
• A retrospective analysis of randomly selected
  medical records of deliveries occurring six
  months before and six months after implementation
  of the new Rapid HIV test policy at the Robert
  Wood Johnson University Hospital was utilized.
• Results
• Analysis of medical records of the 732 women
  showed that 150 women (20.5) presented in labor
  with unknown HIV status
• (21.9, 92/422 before and 18.8
  58/307after). Overall, the women in labor with
  unknown HIV status were more likely to have
  private medical insurance (71.5 vs. 47.6), to
  be older (30.7/-6.0 yrs vs. 28.2 /-6.4 yrs), to
  be married (77.5 vs. 59.7), white, non Hispanic
  (61.6 vs. 23.1), and college educated (62.9
  vs. 44.5). The Rapid HIV test was utilized in
  7.6 of eligible women before and 12.1 after the
  implementation of the new hospital policy
  (OR1.67 95CI 0.55, 5.03). The HIV tested
  women were more likely to have had no prenatal
  care, no insurance, be unmarried, black or
  Hispanic and drug using as compared with eligible
  but not tested women.
• Conclusion
• Low compliance and disparity in the utilization
  of Rapid HIV testing dictates the need for
  education of OB providers in order
• to achieve successful implementation of the
  current CDC recommendations regarding HIV testing
  for women presenting in labor with unknown HIV
  status.
• Rational of this Study
• The CDC facilitated the development and the
  states implementation of protocols for HIV
  testing during labor and delivery for women with
  unknown HIV status (results not documented in the
  prenatal medical record)

Comparison of the HIV testing activities among
eligible (with unknown HIV status) women during
delivery before and after intervention

• Results
• 422 medical records before and 309 after
  implementation of
• the HIV testing policy at RWJUH were reviewed.
• No differences in demographic and pregnancy
  characteristics,
• type of insurance, PCP type of practice were
  found.

OR1.67 95CI 0.55, 5.03
Offering of HIV testing during pregnancy ()
Eligible (with unknown HIV status) n150
Tested n14 (9.3)
Not tested n136 (90.7)
1. Offered 2. Not offered 3. Unknown status
HIV testing accepted during pregnancy ()
Characteristics of women eligible for the Rapid
HIV testing during delivery who were tested and
not tested
HIV 1.2 (n4)
HIV 0
Plt 0.0001 (52.5)
Plt 0.0007 (31.2)
Plt 0.002 (25.4)
1. Accepted 2. Not accepted 3. Unknown status
A total number of 150 women (20.5) with unknown
HIV status during pregnancy were eligible for HIV
testing during delivery 92 (21.9) among women
admitted before implementation of HIV testing
protocol 58 (18.8) among women admitted after
implementation of HIV testing protocol

• Women eligible for Rapid HIV testing who were
  tested prior to delivery were more likely to
• have no prenatal care during pregnancy
• have no insurance
• be married
• be black or Hispanic
• have a history of drug use

• Women with HIV unknown
• status during pregnancy
• because
• HIV test not offered
• HIV test offered but not accepted
• HIV test performed but result not recorded in the
  medical record

CONCLUSION The post-intervention outcome
evaluation is important for identification of the
educational needs and development of new
strategies to improve the compliance of rapid HIV
testing for women with unknown HIV status prior
to delivery

• Reference
• A Practical Guide and Model Protocol for the
  Rapid HIV-1 Antibody Testing during Labor and
  Delivery for Women of Unknown HIV Status (CDC,
  2004

Anna Petrova MD, PhD MPH Associate Professor of
Pediatrics Phone[phone] E-mail
petroran_at_umdnj.edu Roseann Marone, RN, BSN,
MPH Instructor of Pediatrics Phone
732-235-7383 Email maronero_at_umdnj.edu

• Women with unknown HIV status during pregnancy
  are more likely to
• have received prenatal care from OB in private
  practices
• have coverage from private insurances
• be older
• be married
• be white and English speaking