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.