Stacia Crochet1, Chun-Chih Huang2, Melissa Fries3, Rachel K Scott4. 1. MedStar Washington Hospital Center, Washington, DC, USA; Emory University School of Medicine, Atlanta, GA, USA. 2. MedStar Health Research Institute, Washington, DC, USA. 3. MedStar Washington Hospital Center, Washington, DC, USA. 4. MedStar Washington Hospital Center, Washington, DC, USA; MedStar Health Research Institute, Washington, DC, USA.
Abstract
BACKGROUND: A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resulted in the implementation of universal opt-out rapid testing of patients admitted for delivery. This article evaluates the policy's efficacy and implementation. METHODS: We evaluated the implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS: We could not evaluate decrease in MTCT rate secondary to low sample size (n = 3324) and no true-positive results. Patients not tested (n = 458) were predominately secondary to physician omission (93.7%) and were more likely to be White (p < 0.01) and older (p < 0.01). There was a negative relationship with physician omission over time. CONCLUSION: The policy was successfully implemented with decreasing proportions of patients not tested. Earlier inclusion of testing into standard admission orders and nurse-based approach may have expedited adoption. Given the low incidence of new HIV diagnosis in labor, we were unable to assess decrease in MTCT.
BACKGROUND: A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resulted in the implementation of universal opt-out rapid testing of patients admitted for delivery. This article evaluates the policy's efficacy and implementation. METHODS: We evaluated the implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS: We could not evaluate decrease in MTCT rate secondary to low sample size (n = 3324) and no true-positive results. Patients not tested (n = 458) were predominately secondary to physician omission (93.7%) and were more likely to be White (p < 0.01) and older (p < 0.01). There was a negative relationship with physician omission over time. CONCLUSION: The policy was successfully implemented with decreasing proportions of patients not tested. Earlier inclusion of testing into standard admission orders and nurse-based approach may have expedited adoption. Given the low incidence of new HIV diagnosis in labor, we were unable to assess decrease in MTCT.
Entities:
Keywords:
HIV; implementation analysis; mother to child transmission (MTCT); pregnancy
Authors: Sheryl B Lyss; Bernard M Branson; Karen A Kroc; Eileen F Couture; Daniel R Newman; Robert A Weinstein Journal: J Acquir Immune Defic Syndr Date: 2007-04-01 Impact factor: 3.731
Authors: Karin Nielsen-Saines; D Heather Watts; Valdilea G Veloso; Yvonne J Bryson; Esau C Joao; Jose Henrique Pilotto; Glenda Gray; Gerhard Theron; Breno Santos; Rosana Fonseca; Regis Kreitchmann; Jorge Pinto; Marisa M Mussi-Pinhata; Mariana Ceriotto; Daisy Machado; James Bethel; Marisa G Morgado; Ruth Dickover; Margaret Camarca; Mark Mirochnick; George Siberry; Beatriz Grinsztejn; Ronaldo I Moreira; Francisco I Bastos; Jiahong Xu; Jack Moye; Lynne M Mofenson Journal: N Engl J Med Date: 2012-06-21 Impact factor: 91.245
Authors: Michael S Lyons; Christopher J Lindsell; Holly K Ledyard; Peter T Frame; Alexander T Trott Journal: Ann Emerg Med Date: 2005-07 Impact factor: 5.721
Authors: E M Connor; R S Sperling; R Gelber; P Kiselev; G Scott; M J O'Sullivan; R VanDyke; M Bey; W Shearer; R L Jacobson Journal: N Engl J Med Date: 1994-11-03 Impact factor: 91.245
Authors: Christian Arbelaez; Elizabeth A Wright; Elena Losina; Jennifer C Millen; Simeon Kimmel; Matthew Dooley; William M Reichmann; Regina Mikulinsky; Rochelle P Walensky Journal: J Emerg Med Date: 2009-10-14 Impact factor: 1.484