Planning

To discuss the Florida Law related to HIV/STD testing in pregnancy, the importance of compliance with this mandate using rapid testing vs. Elisa, and to offer training and technical assistance to facilitate this process.

Key Players Meeting

Perinatal Educator, L&D Manager, Post-Partum Manager, Newborn/NICU Manager, Medical Director of the OB Department, Directors of Infection Control, Pharmacy, and Laboratory Services.

This meeting will determine if the hospital has rapid testing available for post-exposure prophylaxis, if there is a current policy in place and what test is being used.

The Lab will plan for turn-around time of less than one hour to report either negative or positive rapid test results. Key players are asked to establish a chain of command for positive results between determination and disclosure to the patient.

At this time the pharmacy is instructed on the need to maintain a supply of AZT for IV infusion, oral AZT for the infant after birth, and oral Nevirapine for both mother and infant in the event of this order by a consulting HIV specialist.

Pharmacy will plan to have IV AZT delivered stat upon receipt of positive RT or (preferably, if the facility allows) maintain vials and add mixtures available on the unit for the nursing staff to mix if pharmacy is not staffed 24/7.

Planning for an unscheduled C/S is discussed.

Key players are requested to establish a time-line for implementation beginning with staff training session(s). This training should be made mandatory for all Maternal/Child department nurses, medical assistants, and unit secretaries. All OB physicians should be invited and encouraged to attend. If the facility is authorized to offer CEU/CME, required packet for application is provided. This includes CV, program bibliography, and program outline/content and objectives.

Each participant is given a packet with the following resources:

  • Copy of the Florida law related to HIV/STD testing in pregnancy
  • Brochure
    • HIV & STD Testing,
    • It’s The Law
    • HIV & STD testing can save your baby’s life
  • Post Exposure Prophylaxis guidelines
  • Perinatal guidelines
  • Copy of policy and procedure, AZT drip rate and orders
  • Summary of MIRIAD study
  • List of web resources
  • Copy of map of HIV infected newborns in Florida 2005-2009
  • Business card with contact information
  • Sample copy of RT Flip Charts (these are samples only)
  • Posters on HIV testing in pregnancy
    • It is suggested that copies of these materials be put on a poster board for display in the Maternal/Child department to prepare the staff for the start of a new project.

Implementation

Training

One or more trainings are scheduled to meet the needs of the staff. The training incorporated an overview of HIV which includes:

  • World, national, state and local statistics
  • Risk factors with an additional focus on women’s risk
  • Exposure risks with a focus on vertical transmission and breastfeeding
  • Common HIV tests and laboratory markers
  • Opt-In vs. Opt-Out
  • Florida law related to HIV/STD testing in pregnancy
  • Best practices for notification of testing
  • Rapid testing in labor and delivery
  • Perinatal guidelines and the 076 Protocol
  • Breastfeeding
  • Care of mother and infant including long term follow up
  • Community support services
  • Pre and post-test education in L&D and post-partum
  • Case studies and role plays (as time allows)
  • Question and answer sessions

Each participant is given a packet with a copy of the slide presentation and the resources given to the participants in the key players meeting.

The manager of the OB department is given:

  • 250 copies of the patient education brochures in English, Spanish and Creole
  • 250 copies of the brochure HIV/STD Testing, It’s the Law

It is suggested that one of each of the above forms be laminated and attached to every fetal monitor on the unit to assist with patient education.

  • Posters in English, Spanish and Creole
  • Post exposure prophylaxis guidelines
  • Perinatal guidelines
  • Copies of sample policies, procedures and standing orders
  • Copy of DOH decline to test form
  • Flip charts to assist the staff and educate the patients on the rapid HIV test and why it is important. These are available in English, Spanish and Creole.
  • A comprehensive list of community providers and referral sources for mother and baby.

The manager is provided with a copy of a 3 month and 6 month data collection form to evaluate the progress of the project and a Rapid Testing Training evaluation form to evaluate the services and training offered.

GO LIVE

The management staff is encouraged to select a date to begin rapid testing.

They should plan for a practice run with a sample to determine if all objectives related to turn-around time for results and availability of medications are met.

The Perinatal HIV Prevention Program will provide on-going technical assistance as needed. Each participant is given information regarding the Perinatal Community website where forms can be downloaded and resources can be accessed.

Follow-up

The Perinatal HIV Prevention Program Coordinator will follow-up at 3 months and 6 months and request a copy of the appropriate completed follow-up surveys.