Department of Pediatrics, Division of Allergy, Immunology and Infectious Disease, University of Medicine and Dentistry/Robert Wood Johnson Medical School, One Robert Wood Johnson Place, MEB 236, New Brunswick, NJ 08903-0019, USA.
Matern Child Health J. 2010 Mar;14(2):268-73. doi: 10.1007/s10995-009-0460-7. Epub 2009 Mar 4.
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.
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.
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.
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.
对未登记 HIV 状态的分娩妇女实施快速 HIV-1 检测，是预防围产期 HIV 传播的重要手段。然而，对于未知 HIV 状态的分娩妇女实施快速 HIV 检测的实践情况尚未得到研究。我们评估了在实施 CDC 建议前后快速 HIV 检测的应用情况，并分析了可能影响检测率的因素。
参与者是在医院实施快速 HIV 检测方案之前（n=422）和之后（n=403）各随机选择了六个月内所有分娩的妇女（n=2359）。我们查阅了产前和分娩/产程记录，以确定孕妇期间的 HIV 检测史和入院时的 HIV 状态；我们研究了在实施 CDC 建议的情况下快速 HIV 检测的应用情况；并分析了与快速 HIV 检测应用相关的产妇社会人口学和围产期因素。
在实施医院政策之前，22.0%的分娩妇女入院时 HIV 状态未知，而在实施医院政策之后，这一比例为 18.1%，原因是在怀孕期间既没有提供 HIV 检测，也没有接受 HIV 检测。在有资格接受快速 HIV 检测的妇女中，7.6%的人在实施新政策之前接受了检测，9.6%的人在实施新政策之后接受了检测。与接受检测的妇女相比，未接受检测的妇女更有可能是白人、已婚、并从私人医生那里接受了产前初级保健。
我们发现，未登记 HIV 状态的分娩妇女对快速 HIV-1 检测的低利用率主要与所服务妇女人群的社会经济不平等有关。为了成功实施当前的 CDC 建议，需要对卫生保健提供者进行持续教育，并对医院环境中快速 HIV 检测的应用情况进行系统审查。
