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Labor and delivery staff at
Columbus Regional Healthcare System.
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Throughout each day, expectant mothers are admitted to the hospital in
anticipation of the birth of a healthy baby. Unfortunately, some of these
women fear they may have passed their HIV infection to the unborn child.
With the great progress made in medicine and infectious disease prevention,
a mother's HIV status does not mean her baby will have HIV as well. By
testing mothers, initiating treatment prior to delivery and educating
families, lives are changed forever.
On December 8, 2010, Columbus Regional Medical Center presented a grant
proposal to the physician executive committee to assist Georgia families in
HIV prevention and education. The committee approved the request and the
medical center was fortunate to receive the approval of the Georgia
Department of Public Health (DPH) to participate in the Third Trimester HIV
Testing Grant. The driving force behind the Medical Center and the
hospital's participation in the DPH, Third Trimester HIV Testing Grant is
clear: "Your Health, Our Mission." The mission was to utilize this grant
opportunity and offer women, who had not previously been tested during the
third trimester of pregnancy or who had no prenatal care, access to the
OraQuick Advance Rapid Test and provide the test results prior to the
delivery of their child. Of course, the optimum course of treatment is to
implement Highly Active Antiretroviral Therapy (HAART) early in pregnancy,
which provides protection to the growing fetus and works to lower the
mother's viral load. Even though the majority of testing expected would be
in mothers facing eminent delivery, benefits are present if a maternal test
is seropositive or indeterminate and immediate Ziduvodine (ZDV) Therapy is
initiated during labor. This limited treatment can protect the fetus and
potentiate prevention of in-utero transmission to the fetus prior to
delivery.
Testing
Between April 5, 2011 and June 30, 2012, the medical center conducted 613
rapid screen tests. Prior to each test, the admitting nurse reviewed all of
the woman's prenatal records, conducted a full physical assessment,
discussed HIV testing and provided essential pre-test counseling. To prepare
for the counseling aspect of the program, the nursing staff took advantage
of the generosity offered by various agencies in the state of Georgia. "HIV
Testing and Counseling for Pregnant Women," written and presented by William
Hight, Ph.D., assistant clinical professor, Department of Psychiatry and
Health Behaviors, Medical College of Georgia at Georgia Health Sciences
University and Southeast AIDS Training and Education Center (Emory
University), provided key counseling points essential to the quality of care
every person deserves. Education for the staff did not end when testing
began. Throughout the course of the program, periodic in-service training
continued, from test form completion to postpartum care of mother and
neonate. This was offered to the nursing and management staff by Tonia
Russell, RN, maternal outreach/transport coordinator, Columbus Regional
Medical Center and HIV Contract Monitor. Educational material was given to
mothers and quality time was dedicated to answering all of the questions
asked.
Not only did educational opportunities evolve, procedural changes took place
to enhance the program and allow for hospital and state auditing. Testing
forms were placed on each chart with the expectation of testing each
patient. If the mother chose not to be tested, a signed decline or opt-out
form was obtained and scanned into the computerized charting system as a
permanent part of the medical record. If testing was requested, the
completed HIV test form provided by DPH was removed from the chart and
placed in a box designated for HIV testing. These forms were collected at
the end of each calendar month, audited, verified for accuracy and submitted
to DPH with the monthly audit report.
The Results
At the conclusion of the Third Trimester HIV Testing Grant, 613
mothers-to-be were tested while in the hospital. All 613 test results were
provided to the physician and documented in the medical record within one
hour of collection and the physician notified the woman of her status. Of
those tested, no indeterminate or seropositive test results were identified.
Conclusion
The medical center may have completed the DPH initiated grant, but that is
not where it ends. As an active participant to improve the health of the
local community, Columbus Regional Medical Center will continue providing
third trimester HIV testing to expectant mothers, simply because it is the
right thing to do. Test results will continue to be provided within one
hour. If seropositive results are returned, Ziduvodine (ZDV) and linkage to
care protocols will be initiated, as early detection provides greater
opportunities for positive outcomes for both mother and child. It has been a
privilege for Columbus Regional Medical Center to work with the Georgia
Department of Public Health and HIV Prevention Services and be an integral
part of the programs benefiting Georgia families.
-Story by Tonia Russell, R.N., Maternal Outreach and Transport
Coordinator, Columbus Regional Medical Center; Chris Dews Cannon, R.N.,
M.S.N., Director, High Risk Nursery and Special Care Nursery, Columbus
Regional Medical Center
-Reprinted with permission of the Emory University School of Medicine
