140. An Analysis of Perinatal HIV Testing and Screening Practices Documented for Women Delivering at an Urban Academic Medical Center
Session: Poster Abstract Session: Big Viruses in Little People (Pediatric Viral Diseases)
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDWEEK2016-Perinatal HIV Testing & Screening-Duthely-Oldak.pdf (292.5 kB)
  • Background: Mother-to-child HIV transmission (MTCT) is greatly reduced with initial testing, re-test 3rd trimester and at delivery. Some metropolitan areas like Miami account for disproportionate MTCT in the United States (US). Per CDC guidelines, HIV testing in pregnancy follows “Opt-out testing": include with standard antenatal screening, unless patient “opts out”. Specifically, the CDC recommends: (a) HIV screening early as possible; and, (b) repeat testing in 3rd trimester in high HIV prevalence areas and for women at risk of acquiring HIV; (c) women not tested in pregnancy or with undocumented HIV status are offered rapid screening on labor/delivery. We sought to quantify documented prenatal (PN) HIV screening in Miami for women delivered at a tertiary care academic medical center.

    Methods: A sub-analysis was conducted on 753 delivered women with at least one documented PN visit in 1st or 2nd trimester, and one documented 3rd trimester visit. Records with undocumented PN HIV testing were excluded. The cohort was derived from a retrospective review of 1003 deliveries from January and June, 2015. Race, ethnicity, education, and third trimester testing were analyzed, then stratified by PN clinic. Race and ethnicity were recoded hierarchically; race/ethnicity, education and clinic were collapsed into 3-level variables.

    Results: We analyzed 753 cases. Majority were minorities (51% Hispanic, 27% Black, non-Hispanic), mean age of 30 years, high school attained (65%). Over half (56%) received care at or within the hospital's academically-affiliated clinic system, 27% elsewhere, and 16% transferred into the hospital's clinic system. Whereas an equal proportion receiving PN with the hospital’s clinic system had no documentation of 3rd trimester screening (14.9% vs 14.6%), a significantly higher proportion (49.4%; p=0.000) receiving PN outside of the hospital clinic system were not re-tested 3rd trimester.

    Conclusion: The data indicate that 3rd trimester HIV re-test, as recommended by the CDC, was not consistently offered prenatally in this cohort delivering in an HIV high risk region. A significantly higher proportion of women receiving PN outside of the hospital's clinic system were not retested 3rd trimester. Additional education for PN providers of women in care in HIV high risk metropolitan regions could yield higher 3rd trimester HIV re-test.

    Lunthita M Duthely, Ed.D, MS, BS, Obstetrics & Gynecology, University of Miami Miller School of Medicine, Miami, FL, Alec Szlachta-Mcginn, BS, University of Miami Miller School of Medicine, Miami, FL, Ruchi Babriwala, BS, University of Miami, Miami, FL, Karla E Maguire, MD, MPH, Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL and Jonell E Potter, ARNP, Ph.D, Department of Obstetrics & Gynecology, University of Miami Miller School of Medicine, Miami, FL

    Disclosures:

    L. M. Duthely, None

    A. Szlachta-Mcginn, None

    R. Babriwala, None

    K. E. Maguire, None

    J. E. Potter, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.