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Creating a Safety Net for Creating a Safety Net for HIV Exposed Infants HIV Exposed Infants
in Illinoisin Illinois
Perinatal HIV Elimination ProjectPerinatal HIV Elimination Project
National HIV Prevention Conference
December 3, 2007
Atlanta, GA
Anne Statton BA, Laurie Ayala MPH, Yolanda Olszewski MS MPH
The Safety NetThe Safety Net
�� Perinatal Rapid Perinatal Rapid Testing InitiativeTesting Initiative
�� Enhanced Case Enhanced Case ManagementManagement
�� 24/7 Perinatal HIV 24/7 Perinatal HIV HotlineHotline
HIV in IllinoisHIV in Illinois
�� SeroprevalenceSeroprevalence of HIV in Illinois is 0.1%of HIV in Illinois is 0.1%
�� Higher Higher seroprevalenceseroprevalence has been noted has been noted
in:in:
–– Chicago 0.3% Chicago 0.3%
–– Cook County 0.2% Cook County 0.2%
–– East St. Louis area 0.2%.East St. Louis area 0.2%.
�� In 2000 the Pediatric AIDS Chicago Prevention In 2000 the Pediatric AIDS Chicago Prevention Initiative (PACPI) was created to help eradicate the Initiative (PACPI) was created to help eradicate the transmission of HIV from mother to child in Chicago.transmission of HIV from mother to child in Chicago.
�� In 2003 the Perinatal Rapid HIV Testing In 2003 the Perinatal Rapid HIV Testing Implementation Initiative (PRTII) was created to find Implementation Initiative (PRTII) was created to find the women who presented late in pregnancy. the women who presented late in pregnancy.
�� In 2003 the 24/7 Perinatal HIV Hotline was created to In 2003 the 24/7 Perinatal HIV Hotline was created to help link hardhelp link hard--toto--reach women to care and to provide reach women to care and to provide realreal--time medical consultation on HIVtime medical consultation on HIV--related related obstetric and pediatric issues.obstetric and pediatric issues.
BackgroundBackground
PACPI PACPI has case managed 188 women (202 pregnancies) since 2002has case managed 188 women (202 pregnancies) since 2002
�� 4 cases of perinatal transmission have occurred (two cases prior4 cases of perinatal transmission have occurred (two cases prior to to
linkage with services) within the PACPI cohortlinkage with services) within the PACPI cohort
PRTIIPRTII has identified 69 HIV positive women since November 2004has identified 69 HIV positive women since November 2004
�� 5 cases of perinatal transmission have occurred among women 5 cases of perinatal transmission have occurred among women
identified through rapid testing on L&Didentified through rapid testing on L&D
24/7 Hotline24/7 Hotline has received 237 calls from 1/04has received 237 calls from 1/04--9/079/07
�� 105 unlinked pregnant HIV+ women were identified 105 unlinked pregnant HIV+ women were identified
-- 83 were linked to medical care83 were linked to medical care
-- 71 were linked to enhanced case management71 were linked to enhanced case management
AccomplishmentsAccomplishments
Case StudyCase Study
�� 23 23 y.oy.o. NHB female G4 P1 who presented with . NHB female G4 P1 who presented with symptoms of labor. symptoms of labor.
�� No prenatal record was available upon admission, so No prenatal record was available upon admission, so client was counseled, consented and a rapid test was client was counseled, consented and a rapid test was administered. administered.
�� Client had a history of injection drug use and was Client had a history of injection drug use and was receiving methadone in an outpatient program.receiving methadone in an outpatient program.
�� Client likely had been tested for HIV prior to the rapid Client likely had been tested for HIV prior to the rapid test, but was in deep denial about her status and not test, but was in deep denial about her status and not compliant with care. compliant with care.
�� Mother and baby were discharged home with seven Mother and baby were discharged home with seven days of AZT syrup for the baby.days of AZT syrup for the baby.
Hotline Involvement in Hotline Involvement in
the Casethe Case
�� The hospital called the 24/7 Perinatal HIV Hotline to The hospital called the 24/7 Perinatal HIV Hotline to report the preliminary positive result. report the preliminary positive result.
�� Hotline staff verified the treatment of the mother Hotline staff verified the treatment of the mother (IV AZT) and baby (AZT syrup and Nevirapine).(IV AZT) and baby (AZT syrup and Nevirapine).
�� Hotline staff recommended the client be linked with Hotline staff recommended the client be linked with a PACPI enhanced case manager and faxed a a PACPI enhanced case manager and faxed a release of information form.release of information form.
�� Client signed the Hotline release of information, and Client signed the Hotline release of information, and the case manager visited the hospital later that the case manager visited the hospital later that same day.same day.
24/7 Perinatal HIV Hotline24/7 Perinatal HIV Hotline
�� Provide realProvide real--time medical time medical information on HIV related information on HIV related obstetric and pediatric obstetric and pediatric issues.issues.
�� Link HIVLink HIV--positive mothers positive mothers and infants to medical care and infants to medical care and case management and case management during and after pregnancy.during and after pregnancy.
�� Act as a reporting Act as a reporting mechanism for positive mechanism for positive rapid HIV tests and provide rapid HIV tests and provide postpost--test counseling and test counseling and linkage to care for mothers linkage to care for mothers and exposed infants with and exposed infants with positive rapid tests.positive rapid tests.
Case Study Case Study -- continuedcontinued
�� The case manager educated the client about HIV The case manager educated the client about HIV and what to expect. The client did not seem to be and what to expect. The client did not seem to be shocked by the news of her preliminary status.shocked by the news of her preliminary status.
�� Client did not attend her postpartum visit, missed Client did not attend her postpartum visit, missed the first pediatric visit for the baby and was initially the first pediatric visit for the baby and was initially resistant to case management and home visits.resistant to case management and home visits.
�� Baby developed a fever at 21 days and was Baby developed a fever at 21 days and was brought in by the client to the emergency room; at brought in by the client to the emergency room; at this time the mother disclosed the possible HIV this time the mother disclosed the possible HIV exposure to the staff.exposure to the staff.
�� The Department of Children and Family Services The Department of Children and Family Services conducted an investigation of the family and the conducted an investigation of the family and the mother was allowed to retain custody.mother was allowed to retain custody.
Enhanced Case Management Enhanced Case Management
Involvement in the CaseInvolvement in the Case
�� Permanent housing (client previously living Permanent housing (client previously living
with family)with family)
�� Starter cell phone with minutesStarter cell phone with minutes
�� Assistance with transportation to maternal Assistance with transportation to maternal
and pediatric appointmentsand pediatric appointments
�� Safety in the home with a new infantSafety in the home with a new infant
�� Parenting classesParenting classes
Enhanced Case ManagementEnhanced Case Management
Case management is a fieldCase management is a field--based service focusing on the based service focusing on the
hardesthardest--toto--reach, hardestreach, hardest--toto--link women experiencing the link women experiencing the
following:following:
�� homelessnesshomelessness
�� domestic and community violencedomestic and community violence
�� mental illnessmental illness
�� depressiondepression
�� chemical dependencychemical dependency
�� involvement with child welfare servicesinvolvement with child welfare services
�� arrest and incarcerationarrest and incarceration
�� legal status issueslegal status issues
�� povertypoverty
We also serve clients who are refugees/We also serve clients who are refugees/asyleesasylees, non, non--English English
speaking and multiply diagnosed.speaking and multiply diagnosed.
Rapid Testing Rapid Testing
Involvement in the CaseInvolvement in the Case
�� Labor and delivery staff performed a rapid Labor and delivery staff performed a rapid test on the woman who presented with no test on the woman who presented with no documented HIV status.documented HIV status.
�� Rapid results were available from the lab in Rapid results were available from the lab in 50 minutes and communicated to the 50 minutes and communicated to the patient by the physician handling the case.patient by the physician handling the case.
�� The 24/7 Perinatal HIV Hotline was called The 24/7 Perinatal HIV Hotline was called per protocol and the preliminary positive per protocol and the preliminary positive data form was completed and faxed to data form was completed and faxed to PRTII.PRTII.
Case Study Hospital: Rapid Case Study Hospital: Rapid
Testing PerformanceTesting Performance
�� This particular hospital has a 7.2% undocumented This particular hospital has a 7.2% undocumented HIV test rate at presentation (Q3 2007)HIV test rate at presentation (Q3 2007)
�� Initial rapid testing rate: 97.1% in 2005 (Q4)Initial rapid testing rate: 97.1% in 2005 (Q4)
�� Current rapid testing rate: 100% in 2007 (all Current rapid testing rate: 100% in 2007 (all quarters)quarters)
�� Perinatal Network Stats: Perinatal Network Stats:
–– 11.4% undocumented HIV status at presentation11.4% undocumented HIV status at presentation
–– 99.1% of women accept RT at L&D99.1% of women accept RT at L&D
–– 100% of mother/baby pairs discharged with HIV 100% of mother/baby pairs discharged with HIV status (Q3 2007)status (Q3 2007)
University of Illinois
Cook County
Northwestern University
University of Chicago
Rush UniversityLoyola University
Springfield
Peoria
Rockford
Southern Illinois
To implement Rapid To implement Rapid
HIV Testing in every HIV Testing in every
L&D unit in Illinois by L&D unit in Illinois by
June 2005 to reduce June 2005 to reduce
perinatal HIV perinatal HIV
transmission and transmission and
prevent pediatric HIV prevent pediatric HIV
in Illinoisin Illinois
PRTII Mission StatementPRTII Mission Statement
PRTII RationalePRTII Rationale
�� Opportunity Opportunity
–– New Illinois law New Illinois law
–– FDA approved Rapid HIV TestFDA approved Rapid HIV Test
�� NeedNeed–– Incomplete prenatal testingIncomplete prenatal testing
–– Unknown maternal HIV status = preventable Unknown maternal HIV status = preventable pediatric HIVpediatric HIV
�� Intervention Intervention –– If maternal HIV status known = effective If maternal HIV status known = effective treatment on labor & delivery to prevent perinatal treatment on labor & delivery to prevent perinatal transmissiontransmission
�� Goal Goal –– Eliminate Pediatric HIV in IllinoisEliminate Pediatric HIV in Illinois
An Opportunity: An Opportunity: Illinois Illinois
Perinatal HIV Prevention ActPerinatal HIV Prevention Act
� All pregnant women in Illinois will be counseled and offered an HIV test.
� HIV test results will be documented in prenatal, L&D and newborn pediatric chart.
� If there is no documented maternal HIV status on arrival to L&D, the patient will be offered a Rapid HIV test. (Opt-In)
� If maternal status not known at delivery, newborn will be given rapid HIV test. (Opt-Out 6/05, Mandatory as of 6/06)
�� Client agreed to case management services and home Client agreed to case management services and home visits by the case managervisits by the case manager
�� Mother and baby remain linked to care at six months Mother and baby remain linked to care at six months postpartumpostpartum
�� Client has retained custody of the infantClient has retained custody of the infant
�� Client continues to receive outpatient methadoneClient continues to receive outpatient methadone
�� Infant has a Infant has a negative PCRnegative PCR at 4 months of ageat 4 months of age
Case Study - Outcome
Reason for Call Reason for Call (1/2004(1/2004--9/2007)*9/2007)*
48.9%
41.4%42.6%
48.9%
17.3%
En
ha
nc
ed
Ca
se
Mg
mt.
43
.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Preliminary
Positive Report
Medical Consult Social Service
Consult
Linkage to Medical
Care
HIV Info Request
*Data are not mutually exclusive
Referral Sources (N=237 calls)Referral Sources (N=237 calls)
54.9%
13.5%11.4%
3.0%1.3% 0.8% 0.8%
14.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Hospital
L&D
OB Clinic Hospital
Other
Dept.
Dept of
Health
Hospital
ED
Private
Provider
Social
Service
Agency
Self
Referral
Pregnancy Status at Time of Call Pregnancy Status at Time of Call
(N=237 calls)(N=237 calls)
14.8%
9.7%
13.9%
21.9%
39.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Antepartum Intrapartum Postpartum (in
hospital)
Postpartum
(remote)
Non-pregnant
Care Status of Pregnant Women Care Status of Pregnant Women -- Positive and Positive and
Preliminary Positive Preliminary Positive -- at Time of Identificationat Time of Identification
(N=158 cases)(N=158 cases)
81
42
28
7
0
10
20
30
40
50
60
70
80
90
No Care Some Prenatal
Care - No HIV
Care
Linked to Care Unknown
Linkage to Medical Care for Unlinked Linkage to Medical Care for Unlinked
Pregnant HIV+ Women (N=105)Pregnant HIV+ Women (N=105)
51
4
32
18
0
10
20
30
40
50
60
70
80
90
Linked to Care Not linked to care
PostpartumHIV Care
PrenatalHIV/OB Care
Timing of Calls and Referral to Enhanced Case Timing of Calls and Referral to Enhanced Case
Management for Linkage to Care (N=105)Management for Linkage to Care (N=105)
68
3
21
13
0
10
20
30
40
50
60
70
80
Real-time Retrospective
Timing of Call
Referred toEnhancedCase Mgmt.
Not Referredto EnhancedCase Mgmt.
HIV Status of Perinatally Exposed HIV Status of Perinatally Exposed
Infants Identified to Hotline (N=100)Infants Identified to Hotline (N=100)
915
6
70
0
10
20
30
40
50
60
70
80
Positive Negative Negative
Testing to Date
No Info
Available
Enhanced Case Management:Enhanced Case Management:
ModelModel
�� Intensive model targeted to hardIntensive model targeted to hard--toto--reach, reach, hardhard--toto--link womenlink women
�� FieldField--based model including home visitsbased model including home visits
�� Targeted around the pregnancy and Targeted around the pregnancy and postpartum periodpostpartum period
�� Small caseloadsSmall caseloads
�� Connected to the Hotline and Rapid Testing Connected to the Hotline and Rapid Testing follow upfollow up
Enhanced Case Management: Enhanced Case Management:
Direct ReferralsDirect Referrals
�� Northeastern Illinois Case Management Northeastern Illinois Case Management
CooperativeCooperative
�� Specialty HIV/OB programsSpecialty HIV/OB programs
�� Social service programs (chemical Social service programs (chemical
dependency treatment, child welfare, dependency treatment, child welfare,
shelters, housing agencies, health dept)shelters, housing agencies, health dept)
�� Previous clientsPrevious clients
�� Escort to appointmentsEscort to appointments
�� Family counseling/educationFamily counseling/education
�� Assistance with benefits, referralsAssistance with benefits, referrals
�� Emergency assistance (housing, utilities)Emergency assistance (housing, utilities)
�� Transportation (rides, public transit, taxi)Transportation (rides, public transit, taxi)
�� Social and emotional supportSocial and emotional support
�� Coordination with other case managers (child welfare, Coordination with other case managers (child welfare, mental health, housing)mental health, housing)
�� Observation of AZT administration in homeObservation of AZT administration in home
Enhanced Case Management:Enhanced Case Management:
MethodsMethods
Who are the case Who are the case
managers?managers?
�� Experienced case managersExperienced case managers
�� Specialty experience in at least one field Specialty experience in at least one field
(adolescents, housing, substance abuse, (adolescents, housing, substance abuse,
domestic violence)domestic violence)
�� Younger, approachable women who are also Younger, approachable women who are also
mothersmothers
�� Specialty training in perinatal HIV treatment Specialty training in perinatal HIV treatment
and issuesand issues
Enhanced Case Management: Enhanced Case Management:
DemographicsDemographics
�� Average age of clients: 27 years Average age of clients: 27 years
�� Average age at first pregnancy: 16.5Average age at first pregnancy: 16.5
�� Race:Race:
–– 73.4% NHB73.4% NHB
–– 17% H17% H
–– 5.3% NHW5.3% NHW
–– 4.3% Other/Unknown4.3% Other/Unknown
Enhanced Case Management:Enhanced Case Management:
HIV StatusHIV Status
�� 47% of women diagnosed with HIV in 47% of women diagnosed with HIV in
current pregnancy current pregnancy
�� 11% of women have an AIDS 11% of women have an AIDS
diagnosisdiagnosis
�� Insurance Status:Insurance Status:
–– 63.3% Medicaid63.3% Medicaid
–– 15.4% Uninsured15.4% Uninsured
–– 11.7% Medicare11.7% Medicare
–– 5.3% Unreported5.3% Unreported
–– 2.7% Private2.7% Private
–– 1.6% Other/other public1.6% Other/other public
Enhanced Case Management:Enhanced Case Management:
Insurance StatusInsurance Status
�� One caseOne case of transmission from 2001of transmission from 2001--2006 2006
(City of Chicago recorded 19 other cases of (City of Chicago recorded 19 other cases of
transmission in the same period)transmission in the same period)
�� All clients connected with prenatal care, ID All clients connected with prenatal care, ID
care and pediatric ID for exposed newbornscare and pediatric ID for exposed newborns
�� CDC cost effectiveness and outcomes CDC cost effectiveness and outcomes
evaluation of perinatal enhanced case evaluation of perinatal enhanced case
management (8/06 management (8/06 –– 8/08)8/08)
Enhanced Case Management:Enhanced Case Management:
OutcomesOutcomes
Enhanced Case Management:Enhanced Case Management:
Future PlansFuture Plans
�� Standardization of perinatal case Standardization of perinatal case
management protocol for the statemanagement protocol for the state
�� Perinatal case management training (Ryan Perinatal case management training (Ryan
White Part A, B and C) and certificationWhite Part A, B and C) and certification
�� Publicize results of the case management Publicize results of the case management
evaluationevaluation
�� Expansion across the state to other metro Expansion across the state to other metro
areasareas
Delivering pts
Documented UndocumentedWomen
Missed Declined Tested
UndocumentedBabies
No refusalUntested
RefusedUntested
Tested
PrelimPos
PrelimPos
Neg
Neg
Neg Pos
141,773
439 (2.6%)
659 (15.9%)
1314,470 (26.9%) 11,625 (70.1%)
27
11,595
TruePos
TruePos
FalsePos
FalsePos
4,135
3,227 (78.0%) 242 (5.9%)
1
241
20
7
1
0
Illinois Birthing Hospitals
January - December 2005
as of 5/30/06
125,198 (88.3%)
125,067
16,575 (11.7%)
Babies dischargedwithout HIV statusBabies dischargedwithout HIV status
3,886
Documentation at discharge: 97.3%
An additional three true positives
(and one false positive)
identified in outpatients on L&D
Delivering pts
Documented UndocumentedWomen
Missed Declined Tested
UndocumentedBabies
No refusalUntested
RefusedUntested
Tested
PrelimPos
PrelimPos
Neg
Neg
Neg Pos
175,248
92 (0.7%)
119 (6.2%)
1361849 (14.3%)
12,909 (7.4%)
10,979 (85.0%)
24
10,952
TruePos
TruePos
FalsePos
FalsePos
1,927
1616 (83.9%) 175 (9.1%)
0
175
14
10
0
0
Illinois Hospitals
January – December 06
as of 02/01/07
162,329 (92.6%)
162,192
An additional nine true positives
(and four false positives)
identified in outpatients on L&D
Fetal demise/IUFD33
Babies dischargedw/o HIV status
1,735
Maternal docPostpartum
17 (0.8%)
Documentation at discharge: 99.0%
Delivering pts
Documented UndocumentedWomen
Missed Declined Tested
UndocumentedBabies
No refusalUntested
RefusedUntested
Tested
PrelimPos
PrelimPos
Neg
Neg
Neg Pos
132,185
52 (0.6%)
20 (14.3%)
11396 (1.2%)
8,119 (6.1%)
7,972 (98.2%)
16
7,956
TruePos
TruePos
FalsePos
FalsePos
140
13 (9.3%) 92 (65.7%)
1
91
14
2
1
0
Illinois Birthing Hospitals
January – September 07
as of 11/15/07
124,066 (93.9%)
123,953
Fetal demise/IUFD15
Babies dischargedw/o HIV status
33
Maternal RT post-partum
15 (10.7%)
An additional six true positives
(and two false positives)
identified as outpatients
Documentation at discharge: 99.96%
IDPH Performance Standards IDPH Performance Standards
and September 07 resultsand September 07 results
Documentation at presentationDocumentation at presentation
�� Minimal acceptable rate of documentation 80% Minimal acceptable rate of documentation 80% -- Target documentation Target documentation rate 95%rate 95% (Sept = 93.9%)(Sept = 93.9%)
Acceptance of rapid testing at deliveryAcceptance of rapid testing at delivery
�� Minimum acceptable testing acceptance 89% Minimum acceptable testing acceptance 89% -- Target rate 95%Target rate 95%(Sept = 98.8%)(Sept = 98.8%)
Decline rate for testingDecline rate for testing
�� Minimum acceptable decline rate 10% Minimum acceptable decline rate 10% -- Target decline rate 5%Target decline rate 5%(Sept = 0.3%)(Sept = 0.3%)
Women missed for rapid testing at labor and deliveryWomen missed for rapid testing at labor and delivery
�� Minimum acceptable rate of women missed for rapid testing 1% Minimum acceptable rate of women missed for rapid testing 1% -- Target Target rate 0% rate 0% (Sept = 1.0%)(Sept = 1.0%)
Newborns with no refusal and not testedNewborns with no refusal and not tested
�� Target rate of newborns with no maternal refusal, not rapid testTarget rate of newborns with no maternal refusal, not rapid tested 0ed 0
(Sept = 5)(Sept = 5)
Documentation at dischargeDocumentation at discharge
�� Minimum acceptable discharge documentation standard 95.5% Minimum acceptable discharge documentation standard 95.5% -- Target Target rate 100% rate 100% (Sept = 99.98%)(Sept = 99.98%)
Undocumented Babies Undocumented Babies ––
Percentage of Total DeliveriesPercentage of Total Deliveries
3.25%
2.90%
3.05%
1.65%
0.60%
0.20%
0.04% 0.02% 0.02%
2.81%
1.70%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07
Documentation at DischargeDocumentation at Discharge
97.1%
98.3%
99.4%99.9% 99.9% 99.9% 99.9%
92.0%
94.8%95.1%
97.9% 98.4%
86%
88%
90%
92%
94%
96%
98%
100%
Q4
2004
Q1
2005
Q2
2005
Q3
2005
Q4
2005
Q1
2006
Q2
2006
Q3
2006
Q4
2006
Q1
2007
Q2
2007
Q3
2007
Preliminary Positive Rapid Preliminary Positive Rapid
Tests Tests –– 10/04 to 11/0710/04 to 11/07
50.0% False 50.0% False
positive ratepositive rate29.4% False positive 29.4% False positive
raterate21.8% False 21.8% False
positive ratepositive rate27.6% False 27.6% False
positive ratepositive rate
12 False positives12 False positives5 False positives5 False positives12 False positives12 False positives27 False positives27 False positives
12 True positives12 True positives12 True positives12 True positives43 True positives43 True positives71 True positives71 True positives
24 Preliminary 24 Preliminary
positivespositives17 Preliminary 17 Preliminary
positivespositives55 Preliminary 55 Preliminary
positivespositives98 Total Preliminary 98 Total Preliminary
positivespositives
Outside Outside
CookCookCook Cook --
SuburbanSuburbanCookCook--
Chicago Chicago
(only)(only)
Statewide Statewide
(Illinois)(Illinois)
True Positives Identified by True Positives Identified by
Quarter, Oct 04 to presentQuarter, Oct 04 to present
0 1 2 3 4 5 6 7 8 9
Oct-Dec 04
Jan-Mar 05
Apr-Jun 05
Jul-Sep 05
Oct-Dec 05
Jan-Mar 06
Apr-Jun 06
Jul-Sep 06
Oct-Dec 06
Jan-Mar 07
Apr-Jun 07
Jul-Sep 07
Infant HIV Status, Oct 04 to Infant HIV Status, Oct 04 to
presentpresent
0 1 2 3 4 5 6 7 8 9
Oct-Dec 04
Jan-M ar 05
Apr-Jun 05
Jul-Sep 05
Oct-Dec 05
Jan-M ar 06
Apr-Jun 06
Jul-Sep 06
Oct-Dec 06
Jan-M ar 07
Apr-Jun 07
Jul-Sep 07
Mothers Negative infants Positive infants Fetal deaths
Holes in the Safety NetHoles in the Safety Net
�� Illinois law still allows for religious refusal of Illinois law still allows for religious refusal of
mandatory newborn testing mandatory newborn testing –– originally originally
developed for Amish populationdeveloped for Amish population
�� HIV testing of pregnant women in nonHIV testing of pregnant women in non--
birthing hospitals is not universalbirthing hospitals is not universal
�� Not all hospitals report preliminary positive Not all hospitals report preliminary positive
rapid tests in a timely manner to allow realrapid tests in a timely manner to allow real--
time linkage with case managementtime linkage with case management
AcknowledgmentsAcknowledgments
The safety net of prevention would not be The safety net of prevention would not be possible without the participation and possible without the participation and support of the Illinois Department of Public support of the Illinois Department of Public Health, the PRTII regional coordinators, Health, the PRTII regional coordinators, PACPI enhanced case managers, Illinois PACPI enhanced case managers, Illinois perinatal network administrators, perinatal network administrators, Northwestern Memorial Hospital Hotline Northwestern Memorial Hospital Hotline staff, Dr. Pat Garcia, Dr. staff, Dr. Pat Garcia, Dr. MardgeMardge Cohen, Cohen, Sinai Urban Health Institute, AIDS Sinai Urban Health Institute, AIDS Foundation of Chicago and all the nurse Foundation of Chicago and all the nurse managers and staff on labor & delivery at managers and staff on labor & delivery at the 133 birthing hospitals in Illinois.the 133 birthing hospitals in Illinois.
Illinois Perinatal LegislationIllinois Perinatal Legislation
�� New law effective July 1, 2007: New law effective July 1, 2007: www.ilga.gov/legislation/95/HB/PDF/09500HB1759rwww.ilga.gov/legislation/95/HB/PDF/09500HB1759ren.pdfen.pdf
�� Current Illinois law, June 2006: Current Illinois law, June 2006: www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2483www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2483&ChapAct=410%26nbsp%3BILCS%26nbsp%3B335&ChapAct=410%26nbsp%3BILCS%26nbsp%3B335%2F&ChapterID=35&ChapterName=PUBLIC+HEAL%2F&ChapterID=35&ChapterName=PUBLIC+HEALTH&ActName=Perinatal+HIV+Prevention+Act%2ETH&ActName=Perinatal+HIV+Prevention+Act%2E
�� Original legislation, 2003: Original legislation, 2003: www.ilga.gov/legislation/publicacts/93/PDF/093www.ilga.gov/legislation/publicacts/93/PDF/093--0566.pdf0566.pdf
Questions?Questions?
HotlineHotline: Laurie Ayala: Laurie Ayala
layala@nmh.orglayala@nmh.org
Tel: 312Tel: 312--472472--35623562
Rapid testingRapid testing: Yolanda Olszewski : Yolanda Olszewski yonodey@ameritech.netyonodey@ameritech.net
Tel: 312Tel: 312--560560--14511451
Case ManagementCase Management: Anne Statton : Anne Statton pacpi2000@aol.compacpi2000@aol.com
Tel: 312Tel: 312--334334--09740974
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