Improving prenatal HIV screening with tailored educational interventions: an approach to guideline implementation

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Healthcare Quality Improvement

Background:

• Routine prenatal testing is crucial for a healthy pregnancy, with high compliance rates for established tests.
• Newer tests or those with complex ordering requirements may exhibit lower adherence.
• Updated guidelines for human immunodeficiency virus (HIV) screening emphasize the need to optimize prenatal testing performance.

Purpose of the Study:

• To evaluate and improve the rate of routine prenatal testing, specifically focusing on HIV screening.
• To assess the effectiveness of targeted educational interventions and audit feedback in enhancing testing compliance.

Main Methods:

• A single, rural, academic tertiary care center analyzed 12 months of data for four routine prenatal tests (HBsAg, 1-hour glucose tolerance test, Group B Streptococcus, HIV).
• Process mapping and provider discussions informed the development of targeted educational interventions.
• HIV testing rates were monitored monthly using process control charts following intervention implementation.

Main Results:

• Baseline HIV testing rate was 79.2%, significantly below the >90% compliance seen for other routine tests.
• Following interventions, the HIV testing rate increased to 94.2%.
• High compliance rates (>90%) for HIV testing were sustained for 10 out of 11 months post-intervention.

Conclusions:

• Targeted educational interventions coupled with audit and feedback are effective in increasing routine testing rates in outpatient settings.
• Understanding local context and processes is key to successful implementation of new guidelines.
• This strategy can improve compliance with prenatal testing guidelines, including HIV screening.