1. The Perinatal Nurse’s Role in the Prevention of HIV vertical Transmission Ana Rua Dobles, RN,ACRN HUG Me Program Arnold Palmer Hospital Orlando, Florida adobles@orhs.org

2. Goal: Zero Transmission A study conducted in four states (Michigan, New Jersey, Louisiana, and South Carolina) found that the proportion of pregnant women voluntarily tested for HIV increased from 68% in 1993 to 79% in 1996. The percentage of women offered AZT increased from 27% in 1993 to 85% in 1996. A study conducted in four states (Michigan, New Jersey, Louisiana, and South Carolina) found that the proportion of pregnant women voluntarily tested for HIV increased from 68% in 1993 to 79% in 1996. The percentage of women offered AZT increased from 27% in 1993 to 85% in 1996. However, the study also found that 15% of HIV-infected pregnant women in these states did not receive prenatal care and therefore could not be offered this intervention. However, the study also found that 15% of HIV-infected pregnant women in these states did not receive prenatal care and therefore could not be offered this intervention.

3. Community resources Dedicated Personnel Healthy Start Programs WIC Programs Private Practice Clinicians, Clinics, Hospitals, Ob Centers Health Insurance AIDS Service Organizations ADAP

4. Points of intervention Preconception Care Protocol 076 PrenatalIntrapartum Post Partum- Baby Any entity, agent, service, institution, or system that touches my patient I need to interact with

5. Zero Transmission Strategies Prenatal Zero Transmission Strategies Prenatal Track referrals Track referrals Establish contact prior to visit Establish contact prior to visit Discuss first visit Discuss first visit Meet at prenatal visit Meet at prenatal visit Orient to protocol and prenatal care process Orient to protocol and prenatal care process Address concerns Address concerns Collaborate with MD for care plan Collaborate with MD for care plan Adherence Adherence Establish open access – pager Establish open access – pager Be present at each visit Be present at each visit Track missed visits Track missed visits Engage in care plan Engage in care plan Education!! Education!!

6. Prenatal Staff Support Recommendations/Updates Policies and procedures Care Standards Report to Registry Case Management Psychosocial services Ryan White Title Funds

7. Intrapartum Notify admission to Nurse ERTriage Labor Room Urgent care Newborn Nurseries- NICU, ECN Transition Nursery Transition Nursery Mother/Baby Units Vaginal DeliveryC-Section Rapid testing needed ? Provide Staff support for Protocol implementation Discharge Plan

8. Post partum-Baby Ensure Pediatric Team is notified Pediatric Team is notified AZT started for infant AZT started for infant Review f.u. per protocol with mother Review f.u. per protocol with mother Counsel for infant HIV test Counsel for infant HIV test Obtain consent for HIV PCR RNA Obtain consent for HIV PCR RNA Discharge Plan Discharge Plan AZT administration do’s/don’t’s AZT administration do’s/don’t’s Provide 6 week supply AZT Provide 6 week supply AZT Provide dose marked syringes, spill proof cap Provide dose marked syringes, spill proof cap Arrange f.u. appointment Arrange f.u. appointment Post discharge call Post discharge call

9. Post partum- Mother Discharge Plan P/P self care P/P self care Arrange for P/P f.u. Arrange for P/P f.u. Primary/HIV care for mother Primary/HIV care for mother