Creating a Safety Net for Creating a Safety Net for HIV Exposed Infants HIV Exposed Infants

in Illinoisin Illinois

Perinatal HIV Elimination ProjectPerinatal HIV Elimination Project

National HIV Prevention Conference

December 3, 2007

Atlanta, GA

Anne Statton BA, Laurie Ayala MPH, Yolanda Olszewski MS MPH

The Safety NetThe Safety Net

�� Perinatal Rapid Perinatal Rapid Testing InitiativeTesting Initiative

�� Enhanced Case Enhanced Case ManagementManagement

�� 24/7 Perinatal HIV 24/7 Perinatal HIV HotlineHotline

HIV in IllinoisHIV in Illinois

�� SeroprevalenceSeroprevalence of HIV in Illinois is 0.1%of HIV in Illinois is 0.1%

�� Higher Higher seroprevalenceseroprevalence has been noted has been noted

in:in:

–– Chicago 0.3% Chicago 0.3%

–– Cook County 0.2% Cook County 0.2%

–– East St. Louis area 0.2%.East St. Louis area 0.2%.

�� In 2000 the Pediatric AIDS Chicago Prevention In 2000 the Pediatric AIDS Chicago Prevention Initiative (PACPI) was created to help eradicate the Initiative (PACPI) was created to help eradicate the transmission of HIV from mother to child in Chicago.transmission of HIV from mother to child in Chicago.

�� In 2003 the Perinatal Rapid HIV Testing In 2003 the Perinatal Rapid HIV Testing Implementation Initiative (PRTII) was created to find Implementation Initiative (PRTII) was created to find the women who presented late in pregnancy. the women who presented late in pregnancy.

�� In 2003 the 24/7 Perinatal HIV Hotline was created to In 2003 the 24/7 Perinatal HIV Hotline was created to help link hardhelp link hard--toto--reach women to care and to provide reach women to care and to provide realreal--time medical consultation on HIVtime medical consultation on HIV--related related obstetric and pediatric issues.obstetric and pediatric issues.

BackgroundBackground

PACPI PACPI has case managed 188 women (202 pregnancies) since 2002has case managed 188 women (202 pregnancies) since 2002

�� 4 cases of perinatal transmission have occurred (two cases prior4 cases of perinatal transmission have occurred (two cases prior to to

linkage with services) within the PACPI cohortlinkage with services) within the PACPI cohort

PRTIIPRTII has identified 69 HIV positive women since November 2004has identified 69 HIV positive women since November 2004

�� 5 cases of perinatal transmission have occurred among women 5 cases of perinatal transmission have occurred among women

identified through rapid testing on L&Didentified through rapid testing on L&D

24/7 Hotline24/7 Hotline has received 237 calls from 1/04has received 237 calls from 1/04--9/079/07

�� 105 unlinked pregnant HIV+ women were identified 105 unlinked pregnant HIV+ women were identified

-- 83 were linked to medical care83 were linked to medical care

-- 71 were linked to enhanced case management71 were linked to enhanced case management

AccomplishmentsAccomplishments

Case StudyCase Study

�� 23 23 y.oy.o. NHB female G4 P1 who presented with . NHB female G4 P1 who presented with symptoms of labor. symptoms of labor.

�� No prenatal record was available upon admission, so No prenatal record was available upon admission, so client was counseled, consented and a rapid test was client was counseled, consented and a rapid test was administered. administered.

�� Client had a history of injection drug use and was Client had a history of injection drug use and was receiving methadone in an outpatient program.receiving methadone in an outpatient program.

�� Client likely had been tested for HIV prior to the rapid Client likely had been tested for HIV prior to the rapid test, but was in deep denial about her status and not test, but was in deep denial about her status and not compliant with care. compliant with care.

�� Mother and baby were discharged home with seven Mother and baby were discharged home with seven days of AZT syrup for the baby.days of AZT syrup for the baby.

Hotline Involvement in Hotline Involvement in

the Casethe Case

�� The hospital called the 24/7 Perinatal HIV Hotline to The hospital called the 24/7 Perinatal HIV Hotline to report the preliminary positive result. report the preliminary positive result.

�� Hotline staff verified the treatment of the mother Hotline staff verified the treatment of the mother (IV AZT) and baby (AZT syrup and Nevirapine).(IV AZT) and baby (AZT syrup and Nevirapine).

�� Hotline staff recommended the client be linked with Hotline staff recommended the client be linked with a PACPI enhanced case manager and faxed a a PACPI enhanced case manager and faxed a release of information form.release of information form.

�� Client signed the Hotline release of information, and Client signed the Hotline release of information, and the case manager visited the hospital later that the case manager visited the hospital later that same day.same day.

24/7 Perinatal HIV Hotline24/7 Perinatal HIV Hotline

�� Provide realProvide real--time medical time medical information on HIV related information on HIV related obstetric and pediatric obstetric and pediatric issues.issues.

�� Link HIVLink HIV--positive mothers positive mothers and infants to medical care and infants to medical care and case management and case management during and after pregnancy.during and after pregnancy.

�� Act as a reporting Act as a reporting mechanism for positive mechanism for positive rapid HIV tests and provide rapid HIV tests and provide postpost--test counseling and test counseling and linkage to care for mothers linkage to care for mothers and exposed infants with and exposed infants with positive rapid tests.positive rapid tests.

Case Study Case Study -- continuedcontinued

�� The case manager educated the client about HIV The case manager educated the client about HIV and what to expect. The client did not seem to be and what to expect. The client did not seem to be shocked by the news of her preliminary status.shocked by the news of her preliminary status.

�� Client did not attend her postpartum visit, missed Client did not attend her postpartum visit, missed the first pediatric visit for the baby and was initially the first pediatric visit for the baby and was initially resistant to case management and home visits.resistant to case management and home visits.

�� Baby developed a fever at 21 days and was Baby developed a fever at 21 days and was brought in by the client to the emergency room; at brought in by the client to the emergency room; at this time the mother disclosed the possible HIV this time the mother disclosed the possible HIV exposure to the staff.exposure to the staff.

�� The Department of Children and Family Services The Department of Children and Family Services conducted an investigation of the family and the conducted an investigation of the family and the mother was allowed to retain custody.mother was allowed to retain custody.

Enhanced Case Management Enhanced Case Management

Involvement in the CaseInvolvement in the Case

�� Permanent housing (client previously living Permanent housing (client previously living

with family)with family)

�� Starter cell phone with minutesStarter cell phone with minutes

�� Assistance with transportation to maternal Assistance with transportation to maternal

and pediatric appointmentsand pediatric appointments

�� Safety in the home with a new infantSafety in the home with a new infant

�� Parenting classesParenting classes

Enhanced Case ManagementEnhanced Case Management

Case management is a fieldCase management is a field--based service focusing on the based service focusing on the

hardesthardest--toto--reach, hardestreach, hardest--toto--link women experiencing the link women experiencing the

following:following:

�� homelessnesshomelessness

�� domestic and community violencedomestic and community violence

�� mental illnessmental illness

�� depressiondepression

�� chemical dependencychemical dependency

�� involvement with child welfare servicesinvolvement with child welfare services

�� arrest and incarcerationarrest and incarceration

�� legal status issueslegal status issues

�� povertypoverty

We also serve clients who are refugees/We also serve clients who are refugees/asyleesasylees, non, non--English English

speaking and multiply diagnosed.speaking and multiply diagnosed.

Rapid Testing Rapid Testing

Involvement in the CaseInvolvement in the Case

�� Labor and delivery staff performed a rapid Labor and delivery staff performed a rapid test on the woman who presented with no test on the woman who presented with no documented HIV status.documented HIV status.

�� Rapid results were available from the lab in Rapid results were available from the lab in 50 minutes and communicated to the 50 minutes and communicated to the patient by the physician handling the case.patient by the physician handling the case.

�� The 24/7 Perinatal HIV Hotline was called The 24/7 Perinatal HIV Hotline was called per protocol and the preliminary positive per protocol and the preliminary positive data form was completed and faxed to data form was completed and faxed to PRTII.PRTII.

Case Study Hospital: Rapid Case Study Hospital: Rapid

Testing PerformanceTesting Performance

�� This particular hospital has a 7.2% undocumented This particular hospital has a 7.2% undocumented HIV test rate at presentation (Q3 2007)HIV test rate at presentation (Q3 2007)

�� Initial rapid testing rate: 97.1% in 2005 (Q4)Initial rapid testing rate: 97.1% in 2005 (Q4)

�� Current rapid testing rate: 100% in 2007 (all Current rapid testing rate: 100% in 2007 (all quarters)quarters)

�� Perinatal Network Stats: Perinatal Network Stats:

–– 11.4% undocumented HIV status at presentation11.4% undocumented HIV status at presentation

–– 99.1% of women accept RT at L&D99.1% of women accept RT at L&D

–– 100% of mother/baby pairs discharged with HIV 100% of mother/baby pairs discharged with HIV status (Q3 2007)status (Q3 2007)

University of Illinois

Cook County

Northwestern University

University of Chicago

Rush UniversityLoyola University

Springfield

Peoria

Rockford

Southern Illinois

To implement Rapid To implement Rapid

HIV Testing in every HIV Testing in every

L&D unit in Illinois by L&D unit in Illinois by

June 2005 to reduce June 2005 to reduce

perinatal HIV perinatal HIV

transmission and transmission and

prevent pediatric HIV prevent pediatric HIV

in Illinoisin Illinois

PRTII Mission StatementPRTII Mission Statement

PRTII RationalePRTII Rationale

�� Opportunity Opportunity

–– New Illinois law New Illinois law

–– FDA approved Rapid HIV TestFDA approved Rapid HIV Test

�� NeedNeed–– Incomplete prenatal testingIncomplete prenatal testing

–– Unknown maternal HIV status = preventable Unknown maternal HIV status = preventable pediatric HIVpediatric HIV

�� Intervention Intervention –– If maternal HIV status known = effective If maternal HIV status known = effective treatment on labor & delivery to prevent perinatal treatment on labor & delivery to prevent perinatal transmissiontransmission

�� Goal Goal –– Eliminate Pediatric HIV in IllinoisEliminate Pediatric HIV in Illinois

An Opportunity: An Opportunity: Illinois Illinois

Perinatal HIV Prevention ActPerinatal HIV Prevention Act

� All pregnant women in Illinois will be counseled and offered an HIV test.

� HIV test results will be documented in prenatal, L&D and newborn pediatric chart.

� If there is no documented maternal HIV status on arrival to L&D, the patient will be offered a Rapid HIV test. (Opt-In)

� If maternal status not known at delivery, newborn will be given rapid HIV test. (Opt-Out 6/05, Mandatory as of 6/06)

�� Client agreed to case management services and home Client agreed to case management services and home visits by the case managervisits by the case manager

�� Mother and baby remain linked to care at six months Mother and baby remain linked to care at six months postpartumpostpartum

�� Client has retained custody of the infantClient has retained custody of the infant

�� Client continues to receive outpatient methadoneClient continues to receive outpatient methadone

�� Infant has a Infant has a negative PCRnegative PCR at 4 months of ageat 4 months of age

Case Study - Outcome

24/7 Perinatal HIV 24/7 Perinatal HIV

Hotline DataHotline Data

Reason for Call Reason for Call (1/2004(1/2004--9/2007)*9/2007)*

48.9%

41.4%42.6%

48.9%

17.3%

En

ha

nc

ed

Ca

se

Mg

mt.

43

.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Preliminary

Positive Report

Medical Consult Social Service

Consult

Linkage to Medical

Care

HIV Info Request

*Data are not mutually exclusive

Referral Sources (N=237 calls)Referral Sources (N=237 calls)

54.9%

13.5%11.4%

3.0%1.3% 0.8% 0.8%

14.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Hospital

L&D

OB Clinic Hospital

Other

Dept.

Dept of

Health

Hospital

ED

Private

Provider

Social

Service

Agency

Self

Referral

Pregnancy Status at Time of Call Pregnancy Status at Time of Call

(N=237 calls)(N=237 calls)

14.8%

9.7%

13.9%

21.9%

39.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

Antepartum Intrapartum Postpartum (in

hospital)

Postpartum

(remote)

Non-pregnant

Care Status of Pregnant Women Care Status of Pregnant Women -- Positive and Positive and

Preliminary Positive Preliminary Positive -- at Time of Identificationat Time of Identification

(N=158 cases)(N=158 cases)

81

42

28

7

0

10

20

30

40

50

60

70

80

90

No Care Some Prenatal

Care - No HIV

Care

Linked to Care Unknown

Linkage to Medical Care for Unlinked Linkage to Medical Care for Unlinked

Pregnant HIV+ Women (N=105)Pregnant HIV+ Women (N=105)

51

4

32

18

0

10

20

30

40

50

60

70

80

90

Linked to Care Not linked to care

PostpartumHIV Care

PrenatalHIV/OB Care

Timing of Calls and Referral to Enhanced Case Timing of Calls and Referral to Enhanced Case

Management for Linkage to Care (N=105)Management for Linkage to Care (N=105)

68

3

21

13

0

10

20

30

40

50

60

70

80

Real-time Retrospective

Timing of Call

Referred toEnhancedCase Mgmt.

Not Referredto EnhancedCase Mgmt.

HIV Status of Perinatally Exposed HIV Status of Perinatally Exposed

Infants Identified to Hotline (N=100)Infants Identified to Hotline (N=100)

915

6

70

0

10

20

30

40

50

60

70

80

Positive Negative Negative

Testing to Date

No Info

Available

Enhanced Case Enhanced Case

Management DataManagement Data

Enhanced Case Management:Enhanced Case Management:

ModelModel

�� Intensive model targeted to hardIntensive model targeted to hard--toto--reach, reach, hardhard--toto--link womenlink women

�� FieldField--based model including home visitsbased model including home visits

�� Targeted around the pregnancy and Targeted around the pregnancy and postpartum periodpostpartum period

�� Small caseloadsSmall caseloads

�� Connected to the Hotline and Rapid Testing Connected to the Hotline and Rapid Testing follow upfollow up

Enhanced Case Management: Enhanced Case Management:

Direct ReferralsDirect Referrals

�� Northeastern Illinois Case Management Northeastern Illinois Case Management

CooperativeCooperative

�� Specialty HIV/OB programsSpecialty HIV/OB programs

�� Social service programs (chemical Social service programs (chemical

dependency treatment, child welfare, dependency treatment, child welfare,

shelters, housing agencies, health dept)shelters, housing agencies, health dept)

�� Previous clientsPrevious clients

�� Escort to appointmentsEscort to appointments

�� Family counseling/educationFamily counseling/education

�� Assistance with benefits, referralsAssistance with benefits, referrals

�� Emergency assistance (housing, utilities)Emergency assistance (housing, utilities)

�� Transportation (rides, public transit, taxi)Transportation (rides, public transit, taxi)

�� Social and emotional supportSocial and emotional support

�� Coordination with other case managers (child welfare, Coordination with other case managers (child welfare, mental health, housing)mental health, housing)

�� Observation of AZT administration in homeObservation of AZT administration in home

Enhanced Case Management:Enhanced Case Management:

MethodsMethods

Who are the case Who are the case

managers?managers?

�� Experienced case managersExperienced case managers

�� Specialty experience in at least one field Specialty experience in at least one field

(adolescents, housing, substance abuse, (adolescents, housing, substance abuse,

domestic violence)domestic violence)

�� Younger, approachable women who are also Younger, approachable women who are also

mothersmothers

�� Specialty training in perinatal HIV treatment Specialty training in perinatal HIV treatment

and issuesand issues

Enhanced Case Management: Enhanced Case Management:

DemographicsDemographics

�� Average age of clients: 27 years Average age of clients: 27 years

�� Average age at first pregnancy: 16.5Average age at first pregnancy: 16.5

�� Race:Race:

–– 73.4% NHB73.4% NHB

–– 17% H17% H

–– 5.3% NHW5.3% NHW

–– 4.3% Other/Unknown4.3% Other/Unknown

Enhanced Case Management:Enhanced Case Management:

HIV StatusHIV Status

�� 47% of women diagnosed with HIV in 47% of women diagnosed with HIV in

current pregnancy current pregnancy

�� 11% of women have an AIDS 11% of women have an AIDS

diagnosisdiagnosis

�� Insurance Status:Insurance Status:

–– 63.3% Medicaid63.3% Medicaid

–– 15.4% Uninsured15.4% Uninsured

–– 11.7% Medicare11.7% Medicare

–– 5.3% Unreported5.3% Unreported

–– 2.7% Private2.7% Private

–– 1.6% Other/other public1.6% Other/other public

Enhanced Case Management:Enhanced Case Management:

Insurance StatusInsurance Status

�� One caseOne case of transmission from 2001of transmission from 2001--2006 2006

(City of Chicago recorded 19 other cases of (City of Chicago recorded 19 other cases of

transmission in the same period)transmission in the same period)

�� All clients connected with prenatal care, ID All clients connected with prenatal care, ID

care and pediatric ID for exposed newbornscare and pediatric ID for exposed newborns

�� CDC cost effectiveness and outcomes CDC cost effectiveness and outcomes

evaluation of perinatal enhanced case evaluation of perinatal enhanced case

management (8/06 management (8/06 –– 8/08)8/08)

Enhanced Case Management:Enhanced Case Management:

OutcomesOutcomes

Enhanced Case Management:Enhanced Case Management:

Future PlansFuture Plans

�� Standardization of perinatal case Standardization of perinatal case

management protocol for the statemanagement protocol for the state

�� Perinatal case management training (Ryan Perinatal case management training (Ryan

White Part A, B and C) and certificationWhite Part A, B and C) and certification

�� Publicize results of the case management Publicize results of the case management

evaluationevaluation

�� Expansion across the state to other metro Expansion across the state to other metro

areasareas

Rapid HIV Testing DataRapid HIV Testing Data

Delivering pts

Documented UndocumentedWomen

Missed Declined Tested

UndocumentedBabies

No refusalUntested

RefusedUntested

Tested

PrelimPos

PrelimPos

Neg

Neg

Neg Pos

141,773

439 (2.6%)

659 (15.9%)

1314,470 (26.9%) 11,625 (70.1%)

27

11,595

TruePos

TruePos

FalsePos

FalsePos

4,135

3,227 (78.0%) 242 (5.9%)

1

241

20

7

1

0

Illinois Birthing Hospitals

January - December 2005

as of 5/30/06

125,198 (88.3%)

125,067

16,575 (11.7%)

Babies dischargedwithout HIV statusBabies dischargedwithout HIV status

3,886

Documentation at discharge: 97.3%

An additional three true positives

(and one false positive)

identified in outpatients on L&D

Delivering pts

Documented UndocumentedWomen

Missed Declined Tested

UndocumentedBabies

No refusalUntested

RefusedUntested

Tested

PrelimPos

PrelimPos

Neg

Neg

Neg Pos

175,248

92 (0.7%)

119 (6.2%)

1361849 (14.3%)

12,909 (7.4%)

10,979 (85.0%)

24

10,952

TruePos

TruePos

FalsePos

FalsePos

1,927

1616 (83.9%) 175 (9.1%)

0

175

14

10

0

0

Illinois Hospitals

January – December 06

as of 02/01/07

162,329 (92.6%)

162,192

An additional nine true positives

(and four false positives)

identified in outpatients on L&D

Fetal demise/IUFD33

Babies dischargedw/o HIV status

1,735

Maternal docPostpartum

17 (0.8%)

Documentation at discharge: 99.0%

Delivering pts

Documented UndocumentedWomen

Missed Declined Tested

UndocumentedBabies

No refusalUntested

RefusedUntested

Tested

PrelimPos

PrelimPos

Neg

Neg

Neg Pos

132,185

52 (0.6%)

20 (14.3%)

11396 (1.2%)

8,119 (6.1%)

7,972 (98.2%)

16

7,956

TruePos

TruePos

FalsePos

FalsePos

140

13 (9.3%) 92 (65.7%)

1

91

14

2

1

0

Illinois Birthing Hospitals

January – September 07

as of 11/15/07

124,066 (93.9%)

123,953

Fetal demise/IUFD15

Babies dischargedw/o HIV status

33

Maternal RT post-partum

15 (10.7%)

An additional six true positives

(and two false positives)

identified as outpatients

Documentation at discharge: 99.96%

IDPH Performance Standards IDPH Performance Standards

and September 07 resultsand September 07 results

Documentation at presentationDocumentation at presentation

�� Minimal acceptable rate of documentation 80% Minimal acceptable rate of documentation 80% -- Target documentation Target documentation rate 95%rate 95% (Sept = 93.9%)(Sept = 93.9%)

Acceptance of rapid testing at deliveryAcceptance of rapid testing at delivery

�� Minimum acceptable testing acceptance 89% Minimum acceptable testing acceptance 89% -- Target rate 95%Target rate 95%(Sept = 98.8%)(Sept = 98.8%)

Decline rate for testingDecline rate for testing

�� Minimum acceptable decline rate 10% Minimum acceptable decline rate 10% -- Target decline rate 5%Target decline rate 5%(Sept = 0.3%)(Sept = 0.3%)

Women missed for rapid testing at labor and deliveryWomen missed for rapid testing at labor and delivery

�� Minimum acceptable rate of women missed for rapid testing 1% Minimum acceptable rate of women missed for rapid testing 1% -- Target Target rate 0% rate 0% (Sept = 1.0%)(Sept = 1.0%)

Newborns with no refusal and not testedNewborns with no refusal and not tested

�� Target rate of newborns with no maternal refusal, not rapid testTarget rate of newborns with no maternal refusal, not rapid tested 0ed 0

(Sept = 5)(Sept = 5)

Documentation at dischargeDocumentation at discharge

�� Minimum acceptable discharge documentation standard 95.5% Minimum acceptable discharge documentation standard 95.5% -- Target Target rate 100% rate 100% (Sept = 99.98%)(Sept = 99.98%)

Undocumented Babies Undocumented Babies ––

Percentage of Total DeliveriesPercentage of Total Deliveries

3.25%

2.90%

3.05%

1.65%

0.60%

0.20%

0.04% 0.02% 0.02%

2.81%

1.70%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07

Documentation at DischargeDocumentation at Discharge

97.1%

98.3%

99.4%99.9% 99.9% 99.9% 99.9%

92.0%

94.8%95.1%

97.9% 98.4%

86%

88%

90%

92%

94%

96%

98%

100%

Q4

2004

Q1

2005

Q2

2005

Q3

2005

Q4

2005

Q1

2006

Q2

2006

Q3

2006

Q4

2006

Q1

2007

Q2

2007

Q3

2007

Preliminary Positive Rapid Preliminary Positive Rapid

Tests Tests –– 10/04 to 11/0710/04 to 11/07

50.0% False 50.0% False

positive ratepositive rate29.4% False positive 29.4% False positive

raterate21.8% False 21.8% False

positive ratepositive rate27.6% False 27.6% False

positive ratepositive rate

12 False positives12 False positives5 False positives5 False positives12 False positives12 False positives27 False positives27 False positives

12 True positives12 True positives12 True positives12 True positives43 True positives43 True positives71 True positives71 True positives

24 Preliminary 24 Preliminary

positivespositives17 Preliminary 17 Preliminary

positivespositives55 Preliminary 55 Preliminary

positivespositives98 Total Preliminary 98 Total Preliminary

positivespositives

Outside Outside

CookCookCook Cook --

SuburbanSuburbanCookCook--

Chicago Chicago

(only)(only)

Statewide Statewide

(Illinois)(Illinois)

True Positives Identified by True Positives Identified by

Quarter, Oct 04 to presentQuarter, Oct 04 to present

0 1 2 3 4 5 6 7 8 9

Oct-Dec 04

Jan-Mar 05

Apr-Jun 05

Jul-Sep 05

Oct-Dec 05

Jan-Mar 06

Apr-Jun 06

Jul-Sep 06

Oct-Dec 06

Jan-Mar 07

Apr-Jun 07

Jul-Sep 07

Infant HIV Status, Oct 04 to Infant HIV Status, Oct 04 to

presentpresent

0 1 2 3 4 5 6 7 8 9

Oct-Dec 04

Jan-M ar 05

Apr-Jun 05

Jul-Sep 05

Oct-Dec 05

Jan-M ar 06

Apr-Jun 06

Jul-Sep 06

Oct-Dec 06

Jan-M ar 07

Apr-Jun 07

Jul-Sep 07

Mothers Negative infants Positive infants Fetal deaths

Holes in the Safety NetHoles in the Safety Net

�� Illinois law still allows for religious refusal of Illinois law still allows for religious refusal of

mandatory newborn testing mandatory newborn testing –– originally originally

developed for Amish populationdeveloped for Amish population

�� HIV testing of pregnant women in nonHIV testing of pregnant women in non--

birthing hospitals is not universalbirthing hospitals is not universal

�� Not all hospitals report preliminary positive Not all hospitals report preliminary positive

rapid tests in a timely manner to allow realrapid tests in a timely manner to allow real--

time linkage with case managementtime linkage with case management

AcknowledgmentsAcknowledgments

The safety net of prevention would not be The safety net of prevention would not be possible without the participation and possible without the participation and support of the Illinois Department of Public support of the Illinois Department of Public Health, the PRTII regional coordinators, Health, the PRTII regional coordinators, PACPI enhanced case managers, Illinois PACPI enhanced case managers, Illinois perinatal network administrators, perinatal network administrators, Northwestern Memorial Hospital Hotline Northwestern Memorial Hospital Hotline staff, Dr. Pat Garcia, Dr. staff, Dr. Pat Garcia, Dr. MardgeMardge Cohen, Cohen, Sinai Urban Health Institute, AIDS Sinai Urban Health Institute, AIDS Foundation of Chicago and all the nurse Foundation of Chicago and all the nurse managers and staff on labor & delivery at managers and staff on labor & delivery at the 133 birthing hospitals in Illinois.the 133 birthing hospitals in Illinois.

Illinois Perinatal LegislationIllinois Perinatal Legislation

�� New law effective July 1, 2007: New law effective July 1, 2007: www.ilga.gov/legislation/95/HB/PDF/09500HB1759rwww.ilga.gov/legislation/95/HB/PDF/09500HB1759ren.pdfen.pdf

�� Current Illinois law, June 2006: Current Illinois law, June 2006: www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2483www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2483&ChapAct=410%26nbsp%3BILCS%26nbsp%3B335&ChapAct=410%26nbsp%3BILCS%26nbsp%3B335%2F&ChapterID=35&ChapterName=PUBLIC+HEAL%2F&ChapterID=35&ChapterName=PUBLIC+HEALTH&ActName=Perinatal+HIV+Prevention+Act%2ETH&ActName=Perinatal+HIV+Prevention+Act%2E

�� Original legislation, 2003: Original legislation, 2003: www.ilga.gov/legislation/publicacts/93/PDF/093www.ilga.gov/legislation/publicacts/93/PDF/093--0566.pdf0566.pdf

Questions?Questions?

HotlineHotline: Laurie Ayala: Laurie Ayala

layala@nmh.orglayala@nmh.org

Tel: 312Tel: 312--472472--35623562

Rapid testingRapid testing: Yolanda Olszewski : Yolanda Olszewski yonodey@ameritech.netyonodey@ameritech.net

Tel: 312Tel: 312--560560--14511451

Case ManagementCase Management: Anne Statton : Anne Statton pacpi2000@aol.compacpi2000@aol.com

Tel: 312Tel: 312--334334--09740974