588 - Implementation of Updated Perinatal Maternal Fetal HIV Transmission Guidelines

Publication Number: 588.5534

Rebecca McCullough, Dwaine and Cynthia Willett Children’s Hospital of Savannah, Savannah, GA, United States; Ricardo Zegarra-Linares, Dwaine and Cynthia Willett Children’s Hospital of Savannah, Savannah, GA, United States; Erin Smith, Mercer University School of Medicine, Savannah, GA, United States; Kaitlyn Vu, Mercer University School of Medicine, Savannah, GA, United States

Background: In January 2023, the NIH Office of AIDS Research Advisory Council (OARAC) published recommendations for the use of antiretroviral therapy (ART) drugs during pregnancy and interventions to reduce perinatal human immunodeficiency virus (HIV) transmission. The current order sets in the Memorial Health University Medical Center electronic medical record (EMR) required updating to match the new standard of care specific to newborn transmission of HIV. Changes to the current ART delivery process using standardized order sets for all newborns who were exposed perinatally to HIV will reduce the risk of vertical HIV transmission.

Objective: Implement the updated OARAC perinatal maternal-fetal HIV transmission recommendations by revising EMR order sets to align with the 2023 OARAC guidelines to provide standardized, timely and accurate care in preventing vertical transmission of HIV in newborns.

Design/Methods: Collaboration with Pediatric and OB/GYN physicians, pharmacists, quality, and IT leadership to implement the new OARAC recommendations. Changes to the EMR order sets were made, including proper approvals. Education on the new recommendations were conducted with the Pediatric and OB/GYN physicians to ensure use of the updated OARAC recommendations for standardized care and better patient outcomes. Pharmacy leadership provided education to their staff to make certain everyone knew of the EMR order set changes.

Results: Baseline data prior to the initiation of updated order sets in Neonatal Intensive Care Unit (NICU) and newborn nursery (NBN) identified 32.25% of patients born to HIV-positive mothers were prescribed (including orders cancelled before medication was administered) the wrong ART medications. Based on the new guidelines, nevirapine dosage was the most common medication error. Preliminary results show a significant increase in guideline compliance and improved documentation of care processes, suggesting that the updated EMR order sets will effectively support healthcare providers in delivering standardized, high-quality care for pregnant individuals living with HIV and neonates born to mothers with HIV.

Conclusion(s): Implementing the 2023 updated recommendations from NIH OARAC will highlight the critical role of EMR systems in facilitating adherence to clinical guidelines and improving health outcomes in perinatal HIV. By addressing the complex factors associated with HIV vertical transmission, especially when related to health disparities and syndemics, risks for newborns can be significantly reduced by reducing incidence of HIV and ensuring optimal health outcomes for their future.

Implementation of Updated Perinatal Maternal Fetal HIV Transmission Guidelines
McCullough Training Record.pdf