Since 1994, perinatal transmission of HIV has been greatly reduced among HIV-positive women through therapies given to birthing mothers before and during delivery, and to infants after birth. The U.S. Public Health Service, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics all recommend HIV testing for pregnant women. Although great strides have been made in identifying and testing HIV-infected women, those who have not received prenatal care and were not offered HIV counseling and testing are one of the groups still at high risk for transmitting HIV to their infants. Women in California continue to present to L&D units with undocumented HIV status, putting the health of the laboring woman and her child at unnecessary risk.

As part of current HIV prevention efforts, the Centers for Disease Control and Prevention (CDC) has requested that the California Department of Health Services (CDHS), State Office of AIDS (SOA) begin to assist hospitals with implementation of HIV rapid testing in California Labor and Delivery facilities ("RTLD"). As part of this project, SOA has contracted with the Pacific AIDS Education and Training Center (PAETC) to provide training and technical assistance to hospitals in support of the goal of implementing HIV rapid testing in L&D units.

The PAETC is a network of clinicians and HIV program experts who provide clinical consultation, HIV education and clinical training, and capacity-building technical assistance to clinicians and institutions in their efforts to increase the quality of care provided to HIV-infected patients and families. Four northern California PAETC sites are collaborating to provide training and technical assistance on HIV rapid testing in labor and delivery.

Technical assistance support and training efforts are tailored to each site, and may include any of the following:

• Resources and background materials that support the need for and efforts to identify HIV status in laboring women.
  
• Technical advice on applying to CDHS Lab Field Services for approval to offer HIV rapid testing.
  
• Information on currently available rapid testing technologies (i.e., cost, methods, sensitivity, etc.).
  
• Sample policies, procedures, protocols, and forms used for conducting rapid testing in labor and delivery.
  
• Training and consultation for staff on issues related to:
  
  • Implementation: e.g., initiating the HIV testing discussion with laboring women; gaining consent; laboratory procedures; how and when results are given; medication protocols for HIV medications to administer in L&D and postpartum.
    
• Staff concerns related to systems changes, additional and new tasks, and identifying and working with HIV-infected women.
  
• Information on and linkage to the National Perinatal HIV Consultation and Referral Service (Perinatal Hotline, offering 24-hour expert advice).

RTLD Resource & Reference Manual