Improvement in Perinatal HIV Status Documentation in a Massachusetts Birth Hospital, 2009-2013

• Published in: Pediatrics (Evanston) 2015-07, Vol.136 (1), p.e234-e241
• Main Authors: Paydar-Darian, Niloufar, Pursley, DeWayne M, Haviland, Miriam J, Mao, Wenyang, Golen, Toni, Burris, Heather H
• Format: Article
• Language: English
• Subjects: Adult; Antiretroviral drugs; Care and treatment; Documentation; Female; HIV; HIV infection; HIV infections; HIV Infections - epidemiology; HIV Infections - transmission; Hospital Records - standards; Hospitals - statistics & numerical data; Human immunodeficiency virus; Humans; Incidence; Infant, Newborn; Infectious Disease Transmission, Vertical - statistics & numerical data; Intervention; Male; Massachusetts - epidemiology; Newborn babies; Pediatrics; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Prenatal care; Prenatal Care - statistics & numerical data; Prophylaxis; Quality Improvement; Quality management; Young Adult
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2014-3849

Despite recommendations for universal HIV testing during routine prenatal care, maternal HIV status is not always available at the time of delivery, which may lead to missed opportunities for antiretroviral prophylaxis. We completed a quality improvement project focused on increasing the availability of maternal HIV status documentation at our perinatal facility. Our primary aim was to improve documentation rates from 50% to 100% between 2009 and 2013. Our secondary aim was to identify predictors of documentation. After an initial needs assessment, we performed a multidisciplinary quality improvement effort to address lack of HIV documentation in perinatal charts. The interventions included a switch to a verbal-only consent process, a rapid HIV testing protocol, and a simplified newborn admission document. To assess the impact of our intervention, we audited 100 charts per month and formally analyzed a second random sample of 200 charts in the postimplementation phase. Rates of HIV status documentation improved between 2009 and 2013, from 55.5% to 96.5%. Multivariable models revealed that before our interventions, mothers receiving care at freestanding offices (versus community-based outreach clinics) and those privately insured (versus publicly) were less likely to have HIV status documented. In 2013, neither ambulatory site nor insurance type predicted documentation. We demonstrated improvement in maternal HIV status documentation on admission to labor and delivery after implementation of a 3-pronged intervention. Next steps include investigating persistent barriers to achieving universal screening and documentation.