Poor Hospital Conditions Can Increase Mother-to-Child HIV Transmission

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Choose your hospitals wisely. Your health may depend on it. Poor infrastructure in a hospital setting is frustrating, but it affects much lot more than your mental health.

Published on July 6 in the Journal of the Pediatric Infectious Diseases Society, a new study examined the impact of gaps in hospital infrastructure and how they contribute to mother-to-child (vertical) HIV transmission. The new data suggests that poor organizational framework in hospitals could exacerbate vertical HIV transmissions.

From March 2015 to March 2016, 71 healthcare providers at 11 hospitals and the workers involved were observed. The hospitals — which deliver upwards of 4,000 babies annually — were all based in metropolitan Atlanta, Georgia.

The results aren’t acceptable, researchers say.

Investigators learned that eight of the 11 hospitals had limitations on vertical transmission care. Worse, four of the 11 hospitals admitted to having no standardized procedures prepared for HIV-positive expecting mothers. They also found that at three labor and delivery units, HIV testing for expecting mothers was optional.

“There is an urgent need to close the healthcare gaps identified in Georgia and in the United States, assuming the situation is similar nationally, if we are to eliminate [mother-to-child transmission] of HIV in the United States,” researchers wrote. “Strong state and national leadership, particularly in public health departments, is necessary to disseminate evidence-based guidelines and to implement infrastructure changes in the many delivery units across the United States.”

In addition to the findings, only three of the 11 hospitals conduct nucleic acid testing of HIV-exposed babies. Seven of the 11 hospitals said that their crew did not stock nevirapine, however all hospitals reported that they stock oral zidovudine for infant prophylaxis.

Investigators also looked at individual knowledge. In total, 44 obstetricians were surveyed. Twenty-three of the 44 obstetricians did not routinely offer rapid testing at delivery time for patients who did not have a third-trimester HIV test available. Forty-one of the 44 obstetricians did not test for HIV at delivery if the expecting mother declined antenatal testing.

Even the hospital “with the most annual births in Georgia” did not offer rapid HIV testing at the time of delivery for women with an unknown HIV status.

Sixteen neonatologists were also surveyed. Only eight of the 16 neonatologists and neonatal nurses said they perform routine virologic diagnostic testing at birth for babies that have been exposed to HIV who were at high risk transmission. Among a handful of the neonatologists, two of six were unable to identify correct dosing for zidovudine and three  of six were unable to identify the correct dosage of nevirapine.

So what’s the solution?

Investing in better hospital infrastructure can help save lives. With a little risk assessment, the dangers of losing out on hospital services because of a poor groundwork can be abated.

The seemingly minor discrepancies in hospital infrastructure could directly contribute to differences in preventable vertical HIV transmissions. One can assume that the shortcomings go well beyond Atlanta and Georgia and extend to hospitals in other states.

 

 

 

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