Rapid human immunodeficiency virus testing in labor and delivery: a comparison of implementation models between 2 hospitals.

Despite the use of antiretroviral medications during the antenatal/perinatal period, 280 to 370 human immunodeficiency virus (HIV)-infected infants are born each year in the United States. Women who might transmit the virus to their infants are (1) those not offered antenatal testing due to perceived low risk; (2) those who are noncompliant with their antiretroviral regimen; (3) those with prophylaxis failures despite good compliance; and (4) those who present late to delivery without prenatal care. The Centers for Disease Control and prevention sponsored MIRIAD (mother-infant rapid intervention at delivery) to study rapid testing of women who present late in pregnancy and/or to labor and delivery with unknown HIV status. MIRIAD was implemented in 18 hospitals in 6 American cities. In Atlanta, GA, the 2 participating hospitals had institutional differences that created different models of implementation. Hospital 1 is large and publicly funded, practicing team nursing and utilizing laboratory-based testing. Hospital 2 is a medium-sized nonprofit, whose primary nursing model allowed for specially trained staff to do point-of-care (POC) testing. Regardless of hospital type, nursing care paradigms, or testing model, facilities interested in successfully implementing a similar protocol must formulate policies for testing, notification, and treatment as well as consider dedicating a staff member to the program.

Nurses' experiences of delivering voluntary counseling and testing services for people with HIV/AIDS in the Vhembe District, Limpopo Province, South Africa.

Voluntary counseling services are seen as a cost-effective strategy for HIV prevention and management because they help people to cope with their illness and reduce infection rates in others. This study explored and described the experiences of 20 nurses who rendered voluntary counseling in the Vhembe district, Limpopo Province, South Africa. A qualitative and contextual research design was used, with data gathered from in-depth individual interviews and analyzed using an open-coding method. The main experiences of the nurses rendering voluntary counseling and testing arose in the following themes: challenges related to inadequate resources; the emotional drain associated with stress and burnout; and frustration related to certain behaviors and practices of clients and community members. The main conclusions drawn from the findings were that nurses are continuously exposed to emotionally draining activities with very little support from their supervisors, which makes them prone to experiencing burnout.

Understanding why women decline HIV testing.

BACKGROUND: The Department of Health (DH) set a target for HIV testing--uptake should be at least 90% by 31 December 2002 (Department of midwife Health, 2000), i the number of 80% decrease in n order to see a babies born with HIV (Tookey et al, 2002). As an exercise to measure Newham Healthcare Trust against this standard and review the antenatal care HIV-positive women received, the maternity unit undertook an audit. One in 160 pregnant women receiving antenatal care in the London Borough of Newham are HIV positive (Communicable Disease Screening Centre, 2003), according to the HIV anonymous screening programme, however the rate of transmission to the baby is virtually zero, when babies were followed up at birth, six months and one year Healthcare NH S Trust, 2003). Newham's HIV testing uptake ranges from 80% to 90% (with an average of 88%). A strategy for improving the uptake has been to explore why the 10% to 20% of women decline testing; hence the Trust underwent an audit to explore the reasons women gave when they declined testing. Audit findings Some 2138 forms were returned over a seven-month period, of which 328 (15%) were from women who declined HIV testing. Uptake within that period ranged from 74% to 90%. Ten new positive women were identified. The HIV-specialist midwife carries a caseload and is aware of all positive women, therefore was able to identify the new cases. The reasons given for decline ranged from cultural and religious beliefs to those who said they were not at risk. Practice implications Where women are aware of their HIV status, services can be put in place to support them through their pregnancy and life as a positive parent, equally important is the ability to minimise the risk of transmission to babies, therefore it is vital that women understand the purpose of early diagnosis through testing and its consequences. Midwives have a vital role to play in ensuring pregnant women receive adequate information to form their decision. If a woman chooses not to have the test, midwives should explore her reasons without prejudice. It is also recommended that women who decline testing are reoffered the HIV test at their subsequent antenatal visit, allowing them the opportunity to digest the information and discuss it with a partner. The purpose of the audit was to assess how the Trust would meet the DH target (90% uptake), as part of a review of the maternity HIV service.

HIV screening in pregnancy: what women think.

OBJECTIVE: To describe the experience of screening for human immunodeficiency virus (HIV) in pregnancy from the perspective of pregnant women. DESIGN: A descriptive study using a sample of pregnant women who had been offered prenatal HIV screening. Women participated in semistructured interviews. Transcripts of the interviews were analyzed using a combination of grounded theory and content analysis to describe their experience of this screening practice. SETTING: Women were recruited from tertiary care hospitals, a family practice unit, and a community health center in a western Canadian city. PARTICIPANTS: Thirty-two pregnant women who ranged in age from 16 to 40 years. Of those interviewed, 21 consented to screening and 11 declined. RESULTS: The thirty-two women who shared their thoughts and feelings all differed in their recollections and opinions. Some were not offended by the idea of mandatory screening, whereas others were more vocal in their support of women's choices. Most recognized that women want healthy infants but were divided in how that responsibility was acted upon. The analysis of the interviews yielded six themes. The women described being offered the screening test, how they made the decision whether to be tested or not, and how they felt while waiting for the test results. They described how the results were communicated to them and how they felt on learning the results of the test. Finally, the women clarified their thoughts on the way screening is offered. CONCLUSIONS: Nurses must continue to inform women of the many and varied choices available to them. Nurses also must be respectful of women's decisions and recognize the problems inherent in making any kind of screening mandatory.

HIV counseling, testing, and prevention in primary care.

Human immunodeficiency virus (HIV) continues to be the second leading cause of death for persons ages 25 to 44 years in the United States, whereas new HIV infection rates remain steady. Coupled with the advent of new antiviral therapies that have significantly decreased mortality and morbidity rates, the importance of the primary care clinician in HIV prevention, early detection, and treatment is paramount. This article presents HIV risk analysis and prevention strategies for the primary care clinician practice. New HIV testing methods are reviewed as well as the Centers for Disease Control (CDC) pretest and posttest counseling guidelines.

Application of laboratory diagnostics in HIV nursing.

The HIV epidemic has challenged nursing to rethink the tools it uses and to consider how traditional medical tools may be used in the assessment of nursing problems. This article presents information for the direct care nurse on laboratory tests and how they may be used to meet the traditional needs of physiologic assessment and evaluation and to develop specific nursing interventions. This articles discusses tests used for HIV infection, HIV disease progression, presence of microbiologic agents of opportunistic infections commonly associated with advanced HIV disease, and common laboratory tests and their special relevance to HIV. Nursing implications and interventions are discussed throughout the text.

The integration of HIV testing and counseling into nursing practice.

Historically, registered professional nurses have responded to the health care needs of the community in a variety of roles. Practitioner, educator, administrator, consultant, or researcher--health promotion and prevention have served as an integral part of nursing practice. With the emergence this decade of HIV infection, nurses are responding with much needed education, skill, expertise, and care.