Collaborating to Support Hospitals in Implementing Rapid Testing in Labor and Delivery in Florida

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Collaborating to Support Hospitals in
Implementing Rapid Testing in Labor and Delivery
in Florida

• Shalewa Noel-Thomas, M.P.H.
• Florida/Caribbean AETC

Funded by Florida Department of Health, Bureau
of HIV/AIDS
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Optimal Factors for Rapid Testing Implementation
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Optimal Factors for Rapid Testing Implementation

• Florida Legislation
• Perinatal HIV Prevention Funding
• Epidemiology
• Existing perinatal HIV prevention project
• Contract from the Florida Department of Health
• Initial stages of developing a Rapid Testing
  Initiative
• Florida Department of Health, Bureau of HIV/AIDS
• Florida/Caribbean AETC

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Florida Legislation

• Any pregnant women who appears at delivery with
  no record of a blood test for HIV must be
  counseled and offered an HIV test.

Florida Administrative Code Ch.64D-3.019
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Epidemiology

• High incidence of perinatal HIV disease
• Ranked second in number of pediatric AIDS cases
  reported in 2004
• 95 were perinatally acquired
• Only 60 of mothers of perinatal HIV/AIDS cases
  knew their status prior to birth

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Role of the Florida/Caribbean AETC

• Florida/Caribbean AIDS Education and Training
  Centers pre-workshop involvement
• Identified hospitals
• Highly affected areas
• Established training relationships
• Readiness for implementation
• Provided contact information for key players

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Role of the Florida/Caribbean AETC

• During the workshop
• Provided information on Florida/Caribbean AIDS
  Education and Training Centers training,
  technical assistance, and resources.

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Role of the Florida/Caribbean AETC

• Post-workshop activities
• Consistently followed-up with each hospital to
  determine their progress with implementation
• Developed and provided resources
• Rapid Testing binder samples of Florida specific
  policies and procedures, counseling flip charts,
  HIV consent templates, information on rapid
  tests, DOH letter supporting implementation, ACOG
  opinion, MIRIAD findings, referrals for mother
  and babies.
• Educational brochures for providers and patients
• Pocket treatment guidelines

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What we did after the workshop.

• Workshop provided framework for the roll-out of a
  statewide rapid testing implementation
  initiative.
• Developed framework for training
• Statewide Rapid Testing coordinator
• Three regional perinatal trainers
• Program coordinator
• Divided the state into 3 distinct training
  regions
• Regional trainers assigned to different areas

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Objectives

• Implement rapid testing in all birthing hospitals
  and centers in Florida.
• Provide hospital specific training, technical
  assistance and resources to insure complete and
  effective implementation of rapid testing.
• Evaluate compliance with and adherence to a
  hospital policy for rapid HIV testing in the
  context of a continuing quality improvement
  program.

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Methods

• A list of obstetrical hospitals and birthing
  centers in the state of Florida was generated (N
  146).
• Hospitals contacted by telephone, e-mails, and
  on-site visits.
• Labor and Delivery
• Pharmacy
• Laboratory
• Key players meeting

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Methods

• Provide ongoing training, technical assistance
  and support
• On-site training
• Trained all labor and delivery/nursery staff (day
  and evening shifts).
• Policy and procedure development
• Problem solving (laboratory vs. point-of-care
  testing)
• Counseling and testing (role plays)
• Referrals for infected mothers and exposed babies

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Results

• Since December 2004, all OB hospitals and
  birthing centers have been contacted about rapid
  testing.

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Quality Assurance
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Evaluation
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Challenges

• Lack of response from labor and delivery staff
  and/or administration.
• Lack of consensus on what department is
  responsible LD or laboratory.
• Conflicting reports of rapid testing
  implementation
• LD staff unaware
• Staff turnover
• No perception of risk.

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Conclusion

• Continued collaboration between the
  Florida/Caribbean AETC and the Florida Department
  of Health.
• Goal Continue to facilitate rapid testing
  implementation in all OB units statewide.

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• Our website
• www.usfcenter.org/perinatal

Funded by Florida Department of Health, Bureau
of HIV/AIDS