Increasing Use of Rapid HIV Testing in Labor and Delivery Among Women with No Prenatal Care: A Local Initiative Judy Levison • Lena T. Williams • Anna Moore • Jenny McFarlane • Jessica A. Davila Published online: 3 July 2010 Ó Springer Science+Business Media, LLC 2010 Abstract Pregnant women who do not receive prenatal care and may not be aware of their HIV status are at greatest risk of transmitting HIV to their newborn. A multi- component intervention was designed and implemented to increase the use of rapid HIV testing among pregnant women with no prenatal care at labor and delivery in two county hospitals in Houston/Harris County, Texas. The intervention involved establishing a local task force including representatives from each hospital, assessing each hospital’s readiness to implement rapid testing, pro- viding educational presentations and materials, and offer- ing individualized follow-up. Outcomes data were obtained and included the number of patients presenting with no prenatal care who received rapid HIV testing on admission. Before the intervention, both hospitals had rapid test kits available but were not using them consistently. Following the intervention, we observed a significant increase in the use of rapid HIV testing at both institutions (P \ 0.001). In the 3 months immediately following the intervention, use of rapid testing at Hospital 1 increased from 7.4 to 35.3% and at Hospital 2 from 27.4 to 41.5%. At 1 year, almost 100% of women with no prenatal care at both hospitals received rapid testing. Educating staff and clinicians and implementing system-wide changes may facilitate behavior change regarding prenatal HIV testing. Keywords Rapid HIV testing Á Prenatal testing Á Prevention of perinatal HIV transmission Á Hospital staff education Introduction Pregnant women infected with HIV who lack prenatal care and may not be aware of their HIV status miss opportu- nities to reduce risk of HIV transmission to their infants and receive life-saving treatment for themselves. In 2007, the number of perinatally infected infants in the United States was estimated at 100–200 [1]. Perinatal HIV infec- tion is preventable. Cost of an HIV test is low compared to the lifetime cost of care for HIV. For example, the local cost of the standard ELISA is *$3.49 per test and of a brand name rapid test is *$10.50, while the lifetime cost of care for each child born with HIV is over one million dollars (at the rate of $1,000 per month for antiretroviral medication, the cost of 70 years of treatment is in the range of $840,000 to which can be added the cost of physician visits, laboratory studies, and hospitalizations). Further, each child born with HIV can infect others, contributing to perpetuation of the epidemic. Forty percent of mothers of babies born with HIV in the United States do not know their HIV status before labor [2]. The US Centers for Disease Control and American College of Obstetricians and Gynecologists recommend rapid HIV testing for J. Levison (&) Departments of Obstetrics/Gynecology and Family/Community Medicine, Northwest Health Center, Baylor College of Medicine, 1100 W. 34th St., Houston, TX 77018, USA e-mail: jlevison@bcm.edu L. T. Williams Á J. A. Davila Department of Medicine Health Services Research, Baylor College of Medicine, Houston, TX, USA A. Moore The Harris County Hospital District, Houston, TX, USA J. McFarlane The Texas Department of State Health Services, Austin, TX, USA 123 Matern Child Health J (2011) 15:822–826 DOI 10.1007/s10995-010-0636-1