With routine antenatal screening and antiretroviral therapy, mother to child transmission (MTCT) of human immunodeficiency virus (HIV) is largely preventable. A case of MTCT secondary to late undiagnosed HIV seroconversion at MedStar Washington Hospital Center (MWHC) in the District of Columbia (DC) challenged the standard antenatal screening protocol and prompted a universal screening pilot of all patients in labor. This study evaluates the implementation and efficacy of universal rapid HIV screening on labor and delivery (L&D).METHODS:
This study is a pilot retrospective chart review of all viable deliveries at MWHC from July 1, 2013 to July 1, 2014. We used the RE-AIM (Efficacy, Adoption, Implementation, and Maintenance) framework for evaluation. To assess efficacy, we evaluated positive and unknown rapid HIV results on L&D. We evaluated the logistics of implementation by analyzing the trend of physician omissions and surveying physicians.RESULTS:
Effectiveness on MTCT could not be evaluated secondary to low sample size of the pilot study (n=3374), and no cases of true positive screening. Those that were not tested (n=469) were predominately secondary to physician omission (93.8%). There was a negative relationship with physician omissions over time as the protocol became the new standard. Weekly variability correlated with rotations of new residents onto L&D.CONCLUSION:
As this successfully implemented program continues, and the proportion not tested approaches zero, efficacy will inevitably become evident. More prompt adoption could have been achieved with continued provider awareness, and earlier addition of the screening test to the admission order profile.