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Yee LM, Miller ES, Statton A, Ayala LD, Carter SD, Borders A, Wong AE, Olszewski Y, Cohen MH, Garcia PM. Sustainability of Statewide Rapid HIV Testing in Labor and Delivery. AIDS Behav 2018; 22:538-544. [PMID: 28986656 DOI: 10.1007/s10461-017-1920-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective was to assess sustainability of a statewide program of HIV rapid testing (RT) for pregnant women presenting for delivery with unknown HIV status. This is a population-based retrospective cohort study of women delivered in Illinois hospitals (2012-15). Deidentified data on RT metrics from state-mandated surveillance reports were compared using descriptive statistics and non-parametric tests of trend. Over 95% of the 608,408 women delivered had documented HIV status at presentation. The rate of undocumented HIV status rose from 4.19 to 4.75% (p < 0.001). However, overall 99.60% of women with undocumented status appropriately received RT and the proportion who did not receive RT declined (p = 0.003). The number of neonates discharged with unknown HIV status declined (p = 0.011). RT identified 23 new HIV diagnoses, representing 4.62% of maternal HIV diagnoses. In conclusion, statewide perinatal HIV RT resulted in nearly 100% of Illinois mother-infant dyads with known HIV status. Sustained RT completion represents an important prevention safety net.
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Affiliation(s)
- Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2191, Chicago, IL, 60611, USA.
- Perinatal HIV Hotline, Northwestern Memorial Hospital, Chicago, IL, USA.
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2191, Chicago, IL, 60611, USA
- Pediatric AIDS Chicago Prevention Initiative, Chicago, IL, USA
- Perinatal HIV Hotline, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Anne Statton
- Pediatric AIDS Chicago Prevention Initiative, Chicago, IL, USA
| | - Laurie D Ayala
- Perinatal HIV Hotline, Northwestern Memorial Hospital, Chicago, IL, USA
| | | | - Ann Borders
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Amy E Wong
- Department of Maternal-Fetal Medicine, Palo Alto Medical Foundation, Mountain View, CA, USA
| | | | - Mardge H Cohen
- Department of Medicine, John H. Stroger Jr Hospital of Cook County, Cook County Health & Hospital System, Chicago, IL, USA
| | - Patricia M Garcia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2191, Chicago, IL, 60611, USA
- Pediatric AIDS Chicago Prevention Initiative, Chicago, IL, USA
- Perinatal HIV Hotline, Northwestern Memorial Hospital, Chicago, IL, USA
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Affiliation(s)
- Jonathan Downie
- Department of General Paediatrics, Royal Hospital for Children, Glasgow, Lanarkshire, UK
| | - Helen Mactier
- Princess Royal Maternity Neonatal Unit, Glasgow, Lanarkshire, UK
| | - Ruth M Bland
- Department of General Paediatrics, Royal Hospital for Children, Glasgow, Lanarkshire, UK Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa Institute of Health and Wellbeing, University of Glasgow, Glasgow, Lanarkshire, UK
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Burgard SA, Chen PV. Challenges of health measurement in studies of health disparities. Soc Sci Med 2014; 106:143-50. [PMID: 24561776 DOI: 10.1016/j.socscimed.2014.01.045] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 12/29/2022]
Abstract
Health disparities are increasingly studied in and across a growing array of societies. While novel contexts and comparisons are a promising development, this commentary highlights four challenges to finding appropriate and adequate health measures when making comparisons across groups within a society or across distinctive societies. These challenges affect the accuracy with which we characterize the degree of inequality, limiting possibilities for effectively targeting resources to improve health and reduce disparities. First, comparisons may be challenged by different distributions of disease and second, by variation in the availability and quality of vital events and census data often used to measure health. Third, the comparability of self-reported information about specific health conditions may vary across social groups or societies because of diagnosis bias or diagnosis avoidance. Fourth, self-reported overall health measures or measures of specific symptoms may not be comparable across groups if they use different reference groups or interpret questions or concepts differently. We explain specific issues that make up each type of challenge and show how they may lead to underestimates or inflation of estimated health disparities. We also discuss approaches that have been used to address them in prior research, note where further innovation is needed to solve lingering problems, and make recommendations for improving future research. Many of our examples are drawn from South Africa or the United States, societies characterized by substantial socioeconomic inequality across ethnic groups and wide disparities in many health outcomes, but the issues explored throughout apply to a wide variety of contexts and inquiries.
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Affiliation(s)
- Sarah A Burgard
- University of Michigan, Department of Sociology, 500 South State Street, Ann Arbor, MI 48109-1382, USA.
| | - Patricia V Chen
- University of Michigan, Department of Sociology, 500 South State Street, Ann Arbor, MI 48109-1382, USA.
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Donovan M, Palumbo P. Diagnosis of HIV: challenges and strategies for HIV prevention and detection among pregnant women and their infants. Clin Perinatol 2010; 37:751-63, viii. [PMID: 21078448 DOI: 10.1016/j.clp.2010.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diagnosis and management of perinatally acquired human immunodeficiency virus infection poses many challenges in the areas of diagnosis, clinical and psychosocial intervention, and public health policy. Diagnostic tests have evolved over the years and many are currently used in the perinatal setting. Considerable progress has been realized in each of these areas through cooperative efforts of laboratory scientists, clinical teams, and stakeholders. However, there remain multiple challenges to address in the future.
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Affiliation(s)
- Margery Donovan
- Dartmouth-Hitchcock-Medical Center, Dartmouth Medical School, 1 Medical Center Drive, Lebanon, NH 03756, USA
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