The California Perinatal HIV Transmission Prevention Project

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The California Perinatal HIV Transmission
Prevention Project
Eradicating Perinatal HIV Transmission in
California Implementing Rapid HIV Testing in
Labor and Delivery (RTLD) Presentation to the
2006 Southern California Forum on Rapid Testing
Challenges and Solutions March 23, 2006 Kama
Brockmann, PhD, LCSW Perinatal Project
Coordinator, DHS/Office of AIDS Phone
916-449-5964 Fax [phone] kbrockma_at_dhs.ca.gov

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Perinatal HIV Hotline [phone] National
Perinatal HIV Consultation and Referral Service
Advice on the HIV management in pregnant women
and infants and HIV testing in pregnancy.
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Women in CA Living with HIV/AIDS
Abstracted from next slide. See those footnotes
for data and analysis limitations.
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CA Women Living with HIV by Mode of Exposure and
Race/Ethnicity
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Comparison of Women with AIDS to Other States
(2004)
Data from The Kaiser Family Foundation Stat
Health Facts at statehealthfacts.org.
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Rapid Testing in Labor and Delivery (RTLD)

• Goal Eradicate perinatal (mom-to-baby) HIV
  transmission in California.
• Objective In California, to have every pregnant
  woman, and her obstetric health care provider,
  know her HIV status as early as possible during
  her pregnancy and no later than when she begins
  delivery.

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DHS Maternal, Child and Adolescent Health (MCAH)
Collaborators

• Comprehensive Perinatal Services Program (CPSP)
  Enhanced Medi-Cal services for pregnant women.
• Regional Perinatal Project Coordinators (RPPC)
  Coordinates labor and delivery Nurse Managers.
• California Perinatal Quality Care Collaborative
  (CPQCC) Gathers data and provides technical
  assistance to perinatal health providers.

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Prenatal HIV Testing

• The single most important factor in a woman
  choosing to take an HIV test is the providers
  enthusiasm in recommending the test.
• 
  
• 
  Andrew D. Hull, MD,
  FACOG

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HIV Testing is best done in Prenatal Care
Settings

• Assist prenatal care providers with
  implementation of AB 1676 (Dutra) aka Health and
  Safety Code Sec 125085 and 125090.
• This law requires that pregnant women be informed
  that
• an HIV test will be preformed
• the test is a routine part of prenatal testing
• HIV can be transmitted during pregnancy,
  delivery, or breastfeeding
• without treatment the risk of HIV transmission is
  about 25,
• with treatment HIV transmission can be reduced to
  less than 2, and
• they can accept or refuse the test and must sign
  a document stating their choice.
• Link for DHS approved Perinatal HIV Testing
  Consent form http//www.dhs.ca.gov/aids/resources
  /PDF/DHS8682_PerinatalInformationAndConsentForm.pd
  f

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Confidentiality and Reporting HIV Test Results

• Health and Safety Code Section 121010
• Patients health care provider can disclose HIV
  results via medical record or in other ways to
  licensed health care professionals or any agent
  or employee of the patients health care provider
  who provides direct patient care

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Rapid Testing in Labor and DeliveryThe
Technology

• Four rapid HIV tests available
• All can use whole blood or plasma/serum.
• One test can also use oral fluid. (Orasure
  ADVANCE)
• All tests provide an HIV negative OR a
  PRELIMINARY HIV positive result that requires a
  confirmatory HIV test.
• In general, HIV treatment does not begin until
  confirmation.
• In Labor and Delivery, treatment to inhibit HIV
  transmission begins immediately.
• Mom receives oral or IV ART. Baby receives ART 6
  weeks post-partum or until confirmatory test is
  HIV negative.

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Rapid Testing in Labor and Delivery

• Build capacity to provide rapid HIV testing in
  every California Labor and Delivery Hospital
• Provide rapid HIV test to pregnant women who
  present to LD with an undocumented HIV status.
• Hospital must be able to turn around HIV test in
  1 hour (either by lab or at point-of-care).
• Hospital must have oral and IV AZT available for
  women who have a preliminary positive result.

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California Labor and Delivery Statistics

• Approx. 500,000 live births each year
• 45 of pregnancies are unintended
• 280 Delivery Hospitals in CA
• 30 hospitals reported to offer RTLD
• CDC requests implementation in 120 hospitals over
  3 years
• 1st year 30 2nd 40 3rd 50

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Barriers to RTLD

• Cost who will pay? Medi-Cal?
• Who will do the test? Midwives, doctors, nurses,
  techs?
• Where will the test be processed? Lab or
  point-of-care (Labor and Delivery)
• Who will give the results? Many are hesitant to
  give positive results.
• Who will provide future care to mother and baby?
• CDHS Lab Field Services requirement of Letter of
  Approval for all new testing technologies.

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RTLD Activities

• Survey all California Delivery Hospitals
• Determine current capacity for testing and
  medication delivery
• Case studies of hospitals that have implemented
  RTLD
• Provide technical assistance and training to
  Delivery Hospitals who need to implement RTLD
• Pacific AIDS Education and Training Center
  (PAETC) to provide training on RTLD using model
  of CDC and other states
• Implementation evaluation conducted by Stanford
  University

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Upcoming Issues for Women and HIV

• Statewide
• AB 2203 (Garcia)
• Mandates that women receive an HIV information
  handout at each annual gynecological exam.
• SB 699 (Soto) HIV reporting
• Provides better data
• How will this influence womens HIV testing
  decisions?
• National
• Reauthorization of Ryan White Care Act
• Due by September 30, 2005 funding to begin April
  2006
• HHS Reauthorization Principles published July
  2005
• 75 of RW funds to Core Medical Services (these
  are left undefined)

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Women and HIV Infection

• Research suggests that 35-40 of women with HIV
  in the southern US have an unidentifiable risk
  for HIV and that 80 of those women are infected
  by a primary partner. This must challenge any
  notion that monogamy and long-term relationships
  eliminate or even diminish a womans risk of
  becoming infected with HIV.
• Wingood, G. (2003). The influence of gendered
  factors as they influence African Americans
  womens HIV risk. (T2-A1603) Presentation to the
  2003 National HIV Prevention Conference, Atlanta,
  GA.

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• Internationally, marriage is the number 1
  behavioral risk factor of women becoming
  infected with HIV.