6164 The management of babies born to women who are HIV positive at a district general hospital – a retrospective two year audit and quality improvement project

Objectives The British HIV Association (BHIVA) introduced guidance for the management of HIV in pregnancy and postpartum (2018, 2020 third interim update)¹ to facilitate standardised stratified management of babies born to women who are HIV positive. This audit evaluates how effectively the guideline is being adhered to in both the initial management and follow-up of these babies, born over a two year period. Methods The local paediatric infectious disease database was analysed to identify 14 patients who were born locally over a two year period (January 2020 – December 2021) to women who were HIV positive. Their case notes (electronic and/or paper-based) were retrospectively reviewed to determine if babies were: being treated accordingly to their infection risk group; receiving post-exposure prophylaxis (PEP) within the target time-frame; and were being followed-up correctly as per the guideline schedule. Results All neonates were correctly identified at birth within their 'risk' group based upon: neonatal gestational age, maternal anti-retroviral treatment and viral load; and subsequently timely commenced on the appropriate PEP regimen. Neonatal outpatient follow-up was arranged and conducted within the appropriate time-frames. For 21.4% (3/14) of cases, the incorrect (i.e. longer than necessary) duration of PEP was prescribed at discharge. For 21.4% (3/14) cases, there was no record of a discharge letter completed by the neonatal team. For 35.7% (5/14) cases, neonatal HIV viral load at birth was not chased by the neonatal team. Conclusion The audit highlighted that the initial management of babies born to HIV positive women was being correctly adhered to. However, it revealed there was definite room for improvement at discharge and the initial follow-up of results. We have therefore advised for the neonatal trainee handbook to include a prompt regarding completion of a discharge letter with parent discussion. A template electronic discharge letter has since been devised which can be uploaded to a patient's electronic record, enabling ease of completion (and record of PEP dose and duration) at the point of discharge. An information leaflet on PEP medication from the HIV Pharmacy Association² has also been identified as suitable for distribution to parents – to aid with their understanding and ensuring compliance. We have also advised for the creation of an electronic database for the neonatal team's regular review of babies currently/previously under their care whose infectious disease pathology results need chasing. We plan to re-audit after collecting an adequate number of cases over a one year period. References British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018 (2020 third interim update). HIV Pharmacy Association Patient Leaflet: 'Newborn post-exposure prophylaxis' Newborn-PEP.pdf (hivpa.org)