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Published on: October 12, 2018
Implementation of universal rapid human immunodeficiency virus screening on labor and delivery
Stacia Crochet1, Chun-Chih Huang2, Melissa Fries3
1MedStar Washington Hospital Center, Washington, DC, USA; Emory University School of Medicine, Atlanta, GA, USA.
Background:
A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resulted in the implementation of universal opt-out rapid testing of patients admitted for delivery. This article evaluates the policy's efficacy and implementation.
Methods:
We evaluated the implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Results:
We could not evaluate decrease in MTCT rate secondary to low sample size (n = 3324) and no true-positive results. Patients not tested (n = 458) were predominately secondary to physician omission (93.7%) and were more likely to be White (p < 0.01) and older (p < 0.01). There was a negative relationship with physician omission over time.
Conclusion:
The policy was successfully implemented with decreasing proportions of patients not tested. Earlier inclusion of testing into standard admission orders and nurse-based approach may have expedited adoption. Given the low incidence of new HIV diagnosis in labor, we were unable to assess decrease in MTCT.
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