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The California Perinatal HIV Transmission Prevention Project

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

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The California Perinatal HIV Transmission Prevention Project

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  1. 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: 916-449-5909 kbrockma@dhs.ca.gov

  2. Perinatal HIV Hotline 888-448-8765 National Perinatal HIV Consultation and Referral Service Advice on the HIV management in pregnant women and infants and HIV testing in pregnancy.

  3. Women in CA Living with HIV/AIDS Abstracted from next slide. See those footnotes for data and analysis limitations.

  4. CA Women Living with HIV by Mode of Exposure and Race/Ethnicity

  5. Comparison of Women with AIDS to Other States (2004) Data from The Kaiser Family Foundation Stat Health Facts at statehealthfacts.org.

  6. 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.

  7. 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.

  8. Prenatal HIV Testing The single most important factor in a woman choosing to take an HIV test is the provider’s enthusiasm in recommending the test. Andrew D. Hull, MD, FACOG

  9. 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.pdf

  10. Confidentiality and Reporting HIV Test Results • Health and Safety Code Section 121010 • Patient’s 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 patient’s health care provider who provides direct patient care

  11. Rapid Testing in Labor and Delivery:The 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.

  12. 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 L&D 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.

  13. 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

  14. 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.

  15. 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

  16. 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 women’s 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)

  17. 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 woman’s risk of becoming infected with HIV. Wingood, G. (2003). The influence of gendered factors as they influence African American’s women’s HIV risk. (T2-A1603) Presentation to the 2003 National HIV Prevention Conference, Atlanta, GA.

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

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