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Documentation of prenatal HIV strategy may decrease risk of vertical transmission
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More than 50% of hospitals have a written policy to review records for prenatal HIV tests, and approximately 36% of hospitals have a written policy to test all women in labor and delivery, according to findings presented at the 2009 National HIV Prevention Conference, in Atlanta.
The data were drawn from the National Hepatitis B Hospital Survey, which was conducted by CDC in March 2006. The results are from a random sample of 190 hospitals with more than 100 deliveries per year. The hospitals were surveyed on policies regarding review of medical records for prenatal HIV tests and HIV screening at labor and delivery.
Lauren Fitz Harris, MPH, of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and the Division of HIV/AIDS Prevention at CDC, presented the results. “The data demonstrated a lot of missed opportunities,” she said. “Hepatitis B virus testing is a long-standing strategy that meets little resistance from providers, but we are still seeing a lot of risk-based testing among pregnant women.”
Compared with white women, black women and Hispanic women were more likely to receive an HIV test upon admission.
Black women and Hispanic women also were more likely than white women to have documented prenatal HIV test results.
“We need to help providers understand the rationale behind universal screening,” Harris said. “We need to create more testing policies in hospitals and promote routine testing during pregnancy and on admission to labor and delivery.”
Other findings
Harris said that, overall, 16.6% of women with no prior documented HIV test were tested at labor and delivery.
Women with a documented prenatal HIV test were more likely to deliver in hospitals with written policies to review records than in hospitals that had no such policies (OR=3.26; 95% CI, 1.86–5.73). Women with documented HIV tests who delivered in hospitals with a testing policy were more likely to get tested than women who delivered in hospitals with no such written policy (OR=3.76; 95% CI, 2.11–6.72).
Women with an undocumented HIV status were more likely to have an HIV test on admission if they delivered in hospitals with written policies to review records (OR=5.63; 95% CI, 1.85–17.17). Women with an undocumented HIV status were more likely to be tested if they delivered in hospitals with written policies for testing in labor and delivery (OR=8.19; 95% CI, 3.12–21.47).
Harris said that hospitals in urban areas were twice as likely to have written policies for dealing with HIV testing and pregnant women as rural hospitals.
“Written policies in labor and delivery is integral to achieving better documentation of prenatal test results and higher labor and delivery HIV testing rates, which in turn will reduce transmission of the virus,” Harris said. “More efficient mechanisms to transfer information between providers, mother records and infant records will help achieve these goals.”
For more information:
- Harris LF. G09-3. Presented at: 2009 National HIV Prevention Conference; Aug. 23-26, 2009; Atlanta.