Carolyn Burr, EdD, RN, Francois Xavier Bagnoud Center, University of Medicine & Dentistry of New Jersey, 30 Bergen St, ADMC #4, Newark, NJ 07103, 973-972-0410, burrck@umdnj.edu and Elaine Gross, RN, MS, CNS-C, François Xavier Bagnoud Center, University of Medicine and Dentistry of New Jersey, 30 Bergen St., ADMC #4, Newark, NJ 07103.

ISSUE: Women who present in labor with unknown or undocumented HIV status (UUHS) pose a challenge and an opportunity to further reduce perinatal HIV transmission and to transition women into care for their own health. DESCRIPTION: NJ surveillance data for 1999 and 2000 indicated 7 of 8 infants infected with HIV were born to women with unknown HIV status. In response, the NJ Department of Health and Senior Services (NJDHSS), in collaboration with numerous stakeholders, including providers, professional organizations, hospitals and consumers, developed a Standard of Care (SOC) for counseling and rapid HIV testing (C&RT) for women in labor with UUHS. The SOC was widely disseminated. The François Xavier Bagnoud Center (FXB) developed a model curriculum on C&RT in labor. Half-day train-the-trainer (TOT) workshops targeting nurse educators/managers working in hospitals and 3-hour CME programs targeting OBs/midwives/APNs were offered statewide. The training focused on building skills for counseling women in labor, offering rapid testing, HIV pregnancy management, and reduction of perinatal transmission. Participants received the curriculum, a provider counseling “script,” and a model hospital policy along with clinical support materials and references. LESSONS LEARNED Four-month follow-up survey of participants found significant changes in hospitals’ policies and practice regarding identifying and intervening with women in labor with UUHS. 62% of hospitals offered C&RT in labor and 96% of those offered ARV prophylaxis. RECOMMENDATIONS: C&RT in labor provides an opportunity to reduce perinatal transmission and to identify women in need of care. Targeted strategies can support change in hospital and provider practice.

Learning Objectives: 1.To understand issues, obstacles and implementation of a statewide public health and health policy initiative.