The Perinatal Nurse’s Role in the The Perinatal Nurse’s Role in the Prevention of HIV vertical Prevention of HIV vertical

TransmissionTransmission

Ana Rua Dobles, RN,ACRNAna Rua Dobles, RN,ACRNHUG Me ProgramHUG Me Program

Arnold Palmer HospitalArnold Palmer HospitalOrlando, FloridaOrlando, Florida

adobles@orhs.orgadobles@orhs.org

Goal: Zero TransmissionGoal: Zero Transmission

A study conducted in four states A study conducted in four states (Michigan, New Jersey, Louisiana, (Michigan, New Jersey, Louisiana, and South Carolina) found that and South Carolina) found that the proportion of pregnant women the proportion of pregnant women voluntarily tested for HIV voluntarily tested for HIV increased from 68% in 1993 to increased from 68% in 1993 to 79% in 1996. The percentage of 79% in 1996. The percentage of women offered AZT increased women offered AZT increased from 27% in 1993 to 85% in 1996.from 27% in 1993 to 85% in 1996.

However, the study also However, the study also found that 15% of HIV-found that 15% of HIV-infected pregnant women in infected pregnant women in these states did not receive these states did not receive prenatal care and therefore prenatal care and therefore could not be offered this could not be offered this intervention.intervention.

Community resourcesCommunity resources

Dedicated Personnel

Healthy Start Programs

WIC Programs

Private Practice Clinicians, Clinics, Hospitals, Ob Centers

Health Insurance

AIDS Service Organizations

ADAP

Points of interventionPoints of intervention

Preconception CarePreconception Care

Protocol 076

Prenatal IntrapartumPost Partum- Baby

Any entity, agent, service, institution, or system that touches my patient I need to interact with

Zero Transmission StrategiesZero Transmission Strategies

PrenatalPrenatal

Track referralsTrack referrals Establish contact prior to visit Establish contact prior to visit Discuss first visit Discuss first visit Meet at prenatal visitMeet at prenatal visit Orient to protocol and prenatal Orient to protocol and prenatal

care processcare process Address concernsAddress concerns Collaborate with MD for care Collaborate with MD for care

planplan AdherenceAdherence Establish open access – pagerEstablish open access – pager Be present at each visitBe present at each visit Track missed visitsTrack missed visits Engage in care planEngage in care plan Education!!Education!!

PrenatalPrenatal

Staff SupportStaff SupportRecommendations/Recommendations/UpdatesUpdates

Policies and proceduresPolicies and procedures

Care StandardsCare Standards

Report to RegistryReport to Registry

Case ManagementCase Management

Psychosocial servicesPsychosocial services

Ryan White Title FundsRyan White Title Funds

Intrapartum Intrapartum

Notify admission to NurseNotify admission to NurseERERTriageTriageLabor RoomLabor RoomUrgent careUrgent careNewborn Nurseries- NICU, Newborn Nurseries- NICU,

ECNECN Transition NurseryTransition NurseryMother/Baby UnitsMother/Baby Units

Vaginal Delivery

C-Section

Rapid testing needed ?

Provide Staff support for Protocol implementation

Discharge Plan

Post partum-BabyPost partum-Baby

Ensure Ensure Pediatric Team is notifiedPediatric Team is notified AZT started for infantAZT started for infant Review f.u. per protocol with Review f.u. per protocol with

mothermother Counsel for infant HIV testCounsel for infant HIV test Obtain consent for HIV PCR Obtain consent for HIV PCR

RNA RNA Discharge PlanDischarge Plan

AZT administration AZT administration do’s/don’t’sdo’s/don’t’s

Provide 6 week supply AZTProvide 6 week supply AZT Provide dose marked Provide dose marked

syringes, spill proof capsyringes, spill proof cap Arrange f.u. appointmentArrange f.u. appointment Post discharge callPost discharge call

Post partum- MotherPost partum- Mother

Discharge PlanDischarge Plan P/P self careP/P self care Arrange for P/P f.u.Arrange for P/P f.u. Primary/HIV care for Primary/HIV care for

mothermother