Mayris P. Webber, DrPH, Epidemiology & Population Health & Montefiore School Health Program, Montefiore Medical Center/AECOM, 111 E. 210th St, Bronx, NY 10467, 718-655-0037, mwebber@montefiore.org and Penelope Demas, PhD, AIDS Reserach Program Department of Epidemiology and Social Medicine, Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467.

ISSUES: Beginning in 1997, New York (NY) state required all babies to be screened for HIV. In 1999, NY was first to institute voluntary testing of women who presented at labor and delivery (L&D) without documentation of their HIV status, backed up by mandatory testing of newborns if mothers refused testing. Between 1999-2002, mandatory HIV testing required HIV results for delivering women or their newborns to be available as soon as possible, and no later than 48 hours after the blood draw. In November 2003, NY reduced its required turn-around time to 12-hours based on FDA approval of the Oraquick rapid HIV-1 test. DESCRIPTION: The perspective of several NYC hospitals in meeting these successive challenges will be discussed. LESSONS LEARNED: 1) NY mandatory testing regulations produced an increase in the number of women offered and accepting prenatal HIV testing. 2) Gaps in access to or use of documentation of prenatal HIV test results caused unnecessary HIV tests to be done during L&D; 3) Hospitals, without additional counseling staff and other resources, were financially pressed to comply with these regulations. 4) FDA-approved rapid HIV tests requiring little or no laboratory processing were not available until November 2002, three years after the mandatory regulations went into effect. RECOMMENDATIONS: Regulations for testing during L&D, with timely neonatal prophylaxis, can be effective in virtually eliminating perinatal HIV transmission if the testing requirements are conceived and implemented effectively. In addition, once identified, it is imperative to provide follow-up care for the mothers including assistance with neonatal prophylaxis.

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