Good prenatal package includes HIV, TB testing
In Florida, practice leads to completed prophylaxis
In Dade County, FL, women are offered both HIV and TB tests as routine parts of prenatal care, says Joan Otten, RN, director of the office of TB control at Jackson Memorial Hospital in Miami. "We probably test the majority of prenatal women for PPD, because it obviously has such an influence on the child," Otten says. "We’ve been offering HIV testing for at least two years, and PPD skin-testing much longer, probably as far back as four or five years."
The reason is found in Dade County’s demographics, she adds. There, about half of the population is Hispanic or otherwise foreign-born with a substantial percentage arriving TB-infected, she says.
If a woman has a positive reaction to her skin test, and if active disease is ruled out, then preventive therapy is generally delayed until after the end of the first trimester "just to be safe," Otten says. If disease is present, treatment begins right away. In most cases, TB prophylaxis and treatment care are coordinated with prenatal care so women don’t have to go to more than one place to get the care they need, she says.
A retrospective study of women offered HIV testing and TB skin testing at Jackson Memorial found that more than half of patients who were infected latently with TB completed preventive therapy.
In the study, researchers at the Miami School of Medicine and the Centers for Disease Control and Prevention looked at 218 women in prenatal care that had tested positive for HIV. Of the 208, 59 (28%) had a prior AIDS-defining condition; HIV status was unknown at the time of the first prenatal visit in 112 (54%) of the women.
A TB skin test was performed on 180 (87%) of the women. Of the 208, 135 (65%) had anergy testing performed as well. Of the 208, 81 women either tested positive to the TB skin test or were anergic. Of those 81, 48 (56%) started isoniazid prophylaxis. One patient developed hepatitis and stopped treatment; two others were found to have active disease, and they were treated accordingly.
By the time of delivery, "the majority of our OB patients have on record both an HIV and a PPD test," says Otten. "It just makes sense for us. It’s such a convenient point of care."
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