A state program for postpartum HIV counseling and testing.

The New York State Department of Health began its Obstetrical HIV Counseling/Testing/Care Initiative in 1989. The objective of the initiative was to expand the availability of and access to human immunodeficiency virus (HIV) infection counseling and voluntary testing in the postpartum setting. Programs have been initiated in 24 hospitals statewide. The initiative emphasizes cooperative arrangements within participating hospitals for referring patients to medical and social services. Participation by hospitals in the initiative is voluntary. Initial grants to hospitals for the initiative ranged from $50,000 to $80,000. The main obstacle in implementing the initiative has been a lack of such resources as administrative or clinical support, phlebotomy services, and office or clinical space. During the period from August 1, 1990, through March 31, 1992, 16,436 women at risk for HIV infection were counseled in the postpartum setting at 24 hospitals participating in the initiative. Of them, 6,754 (41.1 percent) consented to HIV testing. Of the 6,754 tested, 3,000 women (44.5 percent) returned to receive test results and posttest counseling. Counseling and testing activities supported through the initiative identified 196 of 1,227 (16 percent) of the HIV-positive women who gave birth at participating hospitals and 196 of 892 (22 percent) seropositive women not previously identified. Combining testing data from the initiative with other data on seropositivity, the authors estimated that 43.3 percent of HIV-positive women delivering infants at participating hospitals were identified by voluntary testing. Hospital performance in the program varied markedly. Further study is needed to determine how to improve the effectiveness of the effort to identify HIV-positive childbearing women at the less successful hospitals and to enhance the rates of patients returning for posttest counseling and community followup.