Abstract
Objectives The implementation of rapid HIV-1 testing for women in labor with undocumented HIV status is an essential tool for the prevention of perinatal HIV transmission. Unfortunately, practices of rapid HIV testing for women with unknown HIV status in labor have not been studied. We evaluated the utilization of rapid HIV testing prior to and after implementation of CDC recommendations as well as factors that may affect the utilization rate. Design Study participants were randomly selected from all deliveries (n = 2,359) six months prior to (n = 422) and after (n = 403) hospital implementation of the rapid HIV testing protocol. We reviewed prenatal and labor/delivery records to identify HIV testing history during pregnancy and HIV status at admission; we studied Rapid HIV testing utilization in respect to the implementation of the CDC recommendation; and we analyzed maternal sociodemographic and perinatal factors in association with rapid HIV testing utilization. Results Unknown HIV status at admission was recorded for 22.0% of women who gave birth prior to, and 18.1% after, implementation of the hospital policy due to either no offering or no acceptance of HIV testing during the pregnancy. Among those eligible for rapid HIV testing, 7.6% were tested prior to, and 9.6% were tested after, implementation of the new policy. As compared with tested women, women not tested were more likely to be white, married, and to have received prenatal primary care from a private physician. Conclusions We found that low utilization of rapid HIV-1 testing for women in labor with undocumented HIV status is mostly associated with the sociodemographic inequality of the population of women served. Continuous education of health care providers and a systematic review of rapid HIV testing utilization in the hospital setting are needed in order to achieve successful implementation of the current CDC recommendations.
Similar content being viewed by others
References
CDC. (2006). Achievements in public health: Reduction in perinatal transmission of HIV infection–United States, 1985–2005. Morbidity and Mortality Weekly Report, 55, 592–597.
Sia, J., Paul, S., Martin, R. M., & Cross, H. (2004). HIV infection and zidovudine use in childbearing women. Pediatrics, 114, e707–e712. doi:10.1542/peds.2004-0414.
Fowler, M. G., Simonds, R. J., & Roongpisuthipong, A. (2000). Update on perinatal HIV transmission. Pediatric Clinics of North America, 47, 21–38. doi:10.1016/S0031-3955(05)70193-0.
Lindegren, M. L., Steinberg, S., & Byers, R. H. (2000). Epidemiology of HIV/AIDS in children. Pediatric Clinics of North America, 47, 1–20. doi:10.1016/S0031-3955(05)70192-9.
Centers for Disease Controls, Prevention. (2003). Advancing HIV prevention: New strategies for a changing epidemic-United States. Morbidity and Mortality Weekly Report, 52, 329–332.
Centers for Disease Control and Prevention. (2004). Rapid HIV antibody testing during labor and delivery for women of unknown HIV status: A practical guide and model protocol. Posted February 2, 2004. Retrieved June 15, 2004, from http://www.cdc.gov/hiv/rapid_testing/index.htm#women.
CDC. (1994). Recommendations of the U.S. public health service task force on the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus. Morbidity and Mortality Weekly Report, 43(No. RR-11).
Connor, E. M., Sperling, R. S., Gelber, R., et al. (1994). Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS clinical trials group protocol 076 study group. The New England Journal of Medicine, 331, 1173–1180. doi:10.1056/NEJM199411033311801.
Kourtis, A. P., Bulterys, M., Nesheim, S. R., & Lee, F. K. (2001). Understanding the timing of HIV transmission from mother to infant. Journal of the American Medical Association, 279, 1743–1744.
CDC. (2004). Enhanced perinatal surveillance––United States, 1999–2001. Atlanta, GA: US Department of Health and Human Services, CDC. http://www.cdc.gov/hiv/stats/hasrsupp.htm.
Bulterys, M., Jamieson, D. J., O’Sullivan, M. J., Cohen, M. H., Maupin, R., Nesheim, S., et al. (2004). Rapid HIV-1 testing during labor: A multicenter study. Journal of the American Medical Association, 292, 219–223. doi:10.1001/jama.292.2.219.
Webber, M. P., Chazotte, C., Fox, A. S., Moskaleva, G., Arnold, J., & Schoenbaum, E. E. (2003). Implementation of expedited human immunodeficiency virus testing of women delivering infants in a large New York City hospital. Obstetrics and Gynecology, 101, 982–986. doi:10.1016/S0029-7844(03)00043-7.
Delaney, K. P., Branson, B. M., Uniyal, A., Kerndt, P. R., Keenan, P. A., Jafa, K., et al. (2006). Performance of a fluid rapid HIV-1/2 test; experience from four CDC studies. AIDS (London, England), 20, 1655–1660. doi:10.1097/01.aids.0000238412.75324.82.
Cabana, M. D., Rand, C. S., Rowe, N. R., Wu, A. W., Wilson, M. H., Abboud, P. A., et al. (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement. Journal of the American Medical Association, 282, 1458–1465. doi:10.1001/jama.282.15.1458.
Duggan, J., Khuser, S., Sibha, N., & Chakraborty, J. (2003). Survey of physician attitudes toward HIV testing in pregnant women in Ohio. AIDS Patient Care and STDs, 17, 121–127. doi:10.1089/108729103763807945.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gaur, S., Whitley-Williams, P., Flash, C. et al. Disparity in Hospital Utilization of Rapid HIV-1 Testing for Women in Labor with Undocumented HIV Status. Matern Child Health J 14, 268–273 (2010). https://doi.org/10.1007/s10995-009-0460-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-009-0460-7