Implementation of expedited human immunodeficiency virus testing of women delivering infants in a large New York city hospital.
OBJECTIVE
Since August 1999, New York has required expedited human immunodeficiency virus (HIV) testing of pregnant women in labor or their newborns, with results available within 48 hours if no intrapregnancy test result was available. We documented the frequency and circumstances of expedited HIV testing, the time required for a result to be available, and hospital factors associated with different intervals.


METHODS
We conducted chart reviews for women listed in the expedited HIV testing logbook between October 1, 2000 and December 31, 2000, abstracting prenatal care history and the dates and times of hospital admission, blood specimen collection, expedited HIV testing result availability, and the infant's birth.


RESULTS
Of 1115 women admitted for labor and delivery during this period, 13.6% were tested under the expedited HIV testing procedure, and none were found to be HIV positive. Twenty-seven percent of women having expedited HIV testing had documentation of testing during prenatal care that was unavailable or overlooked during admission. Expedited HIV testing results were available at 48 hours or less time for 96% of the women, although results for women admitted Friday to Sunday took longer than weekday results (mean +/- standard deviation, 30.4 +/- 11.7 hours versus 21.3 +/- 9.3 hours, P <.001). Expedited HIV testing results were available before delivery for 3.3% of women and less than 12 hours after birth for 31.7% of infants.


CONCLUSIONS
We found excellent compliance with the 48-hour time limit for expedited HIV testing but report lapses in access to prenatal HIV testing documentation, resulting in frequent duplicative testing. Further, the potential for optimal neonatal prophylaxis within 12 hours of birth was limited, as the turnaround time for HIV results exceeded 12 hours for two thirds of the infants in our sample.
AIDS Research Program, Montefiore Medical Center, Bronx, New York 10457, USA. mwebber@montefiore.org
Mayris P
MP
Webber
Cynthia
C
Chazotte
Amy S
AS
Fox
Galina
G
Moskaleva
Jessica
J
Arnold
Ellie E
EE
Schoenbaum
D015492:AIDS Serodiagnosis; D001800:Blood Specimen Collection; D036861:Delivery, Obstetric; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D018580:Mandatory Testing; D008499:Medical Records; D009518:New York; D009519:New York City; D011247:Pregnancy; D013997:Time Factors