Journal of Community Health

, Volume 36, Issue 4, pp 631–634

A Review of Missed Opportunities for Prenatal HIV Screening in a Nationwide Sample of Health Facilities in the Indian Health Service

  • Brigg Reilley
  • John T. Redd
  • James Cheek
  • Scott Giberson
Original Paper

Abstract

To better serve our patients, we sought to identify missed opportunities for prenatal HIV screening across Indian Health Service and potential ways to increase screening. Twenty-seven of 161 Federal or Tribal IHS health facilities were randomly selected. Each facility received a standardized set of commands to identify the charts of prenatal patients who were not screened for HIV according to the national Health Information Technology (HIT) platform. We reviewed 598 records at 27 sites of prenatal patients who were identified as not screened for HIV during their pregnancy. According to on-site chart review, nearly half (267/598, 45%) had been screened for HIV, and a slight majority (331/598, 55%) had not been screened. Among the 331 pregnant women not screened for HIV, about half had no HIV screening despite having had ≥2 prenatal care encounters and no screening exclusions (167/331, 50%). A majority of missed opportunities (118/167, 71%) had prenatal testing for other infectious diseases. Based on these results, the National HIV/AIDS program has encouraged increased bundling of HIV with infectious disease tests in prenatal laboratory panels. Improvements in documentation of HIV screening are expected with the IHS transition to electronic health records.

Keywords

Prenatal HIV Screening Prevention American Indian/Alaska Native 

References

  1. 1.
    Peters, V., Kai-Lih, L., Dominguez, K., et al. (2003). Missed Opportunities for Perinatal HIV Prevention Among HIV-Exposed Infants Born 1996–2000, Pediatric Spectrum of HIV Disease Cohort. Pediatrics, 111(5), 1186–1191.PubMedGoogle Scholar
  2. 2.
    Pregnancy and Childbirth, CDC website, http://www.cdc.gov/hiv/topics/perinatal. Accessed December 15 2010.
  3. 3.
    Pitt, J., Brambilla, D., Reichelderfer, P., et al. (1997). Maternal and immunologic and virologic risk factors for infant human immunodeficiency virus type 1 infection: Findings from the Women and Infants transmission study. Journal of Infectious Diseases, 175, 567–575.PubMedCrossRefGoogle Scholar
  4. 4.
    Public Health Service Task Force. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States, May 24, 2010. Accessed December 14, 2010. Available at http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf.
  5. 5.
    Cooper, E. R., Charurat, M., Mofenson, L., et al. (2002). Combination antiretroviral strategies for the treatment of pregnant HIV-1–infected women and prevention of perinatal HIV-1 transmission. Journal of Acquired Immune Deficiency Syndrome, 29, 484–494.Google Scholar
  6. 6.
    International Perinatal HIV Group. (1999). The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1: A meta-analysis of 15 prospective cohort studies. New England Journal of Medicine, 340, 977–987.CrossRefGoogle Scholar
  7. 7.
    American College of Obstetricians and Gynecologists. (2000). Scheduled cesarean delivery and the prevention of vertical transmission of HIV infection. International Journal of Gynecology and Obstetrics, 73, 279–281.Google Scholar
  8. 8.
    Tao, G., Patterson, E., Lee, L. M., et al. (2005). Estimating prenatal syphilis and HIV screening rates for commercially insured women. American Journal of Preventive Medicine, 28(2), 175–181.PubMedCrossRefGoogle Scholar
  9. 9.
    Anderson, J. E., & Koening, L. J. (2005). Lampe MA et. al. Achieving universal HIV screening in prenatal care in the United States: provider persistence pays off. AIDS Patient Care STDs, 19(4), 247–252.PubMedCrossRefGoogle Scholar
  10. 10.
    Schrag, S. J., Arnold, K. E., Mohle-Boetani, J. C., et al. (2003). Prenatal screening for infectious diseases and opportunities for prevention. Obstetrics and Gynecology, 102(4), 753–760.PubMedCrossRefGoogle Scholar
  11. 11.
    Anderson, J. E., & Sansom, S. (2006). HIV testing among U.S. women during prenatal care: findings from the 2002 National Survey of Family Growth. Maternal and Child Health Journal, 10, 413–417.PubMedCrossRefGoogle Scholar
  12. 12.
    US Congress, Ways and Means Committee, Health Information Technology and for Economic and Clinical Health (HITECH) Act, http://waysandmeans.house.gov/media/pdf/110/hit2.pdf, accessed December 15, 2010.
  13. 13.
    Blumenthal, D. Launching HITECH. New England Journal of Medicine. Published at www.nejm.org December 30, 2009 (10.1056/NEJMp0912825).

Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2011

Authors and Affiliations

  • Brigg Reilley
    • 1
  • John T. Redd
    • 1
  • James Cheek
    • 1
  • Scott Giberson
    • 2
  1. 1.Division of Epidemiology and Disease PreventionIndian Health ServiceAlbuquerqueUSA
  2. 2.Indian Health Service HeadquartersRockvilleUSA

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