Implementation of universal rapid human immunodeficiency virus screening on labor and delivery

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.